What Could the Upcoming Midterm Elections Mean for Physicians and Healthcare?

Leigh Page


October 09, 2018

In This Article

Gridlock Is Nothing New

Even if the new Congress gets caught up in gridlock, however, it wouldn't be that much different from now. The current Senate is already immersed in it.

Republicans in the Senate have had a one- or two-vote majority. This is far short of the 60-vote majority that most bills need to pass, and it's often not enough even to pass bills that just require a simple majority.

In this session, the low point for the Republican majority in the Senate was its failure to pass an ACA repeal in July 2017. Just three GOP senators jumped ship. But in December, the Senate did squeeze through a tax-cut bill. It included removing the ACA's penalty payment for not buying insurance, further weakening the health law.

In the next Congress, if Republicans were to increase their slim Senate majority and still retain control of the House, they would have a better shot at repealing the ACA. But on many other issues, they would probably still not have enough Senate seats to reach the crucial 60-vote majority, and some of the gridlock would continue.

Deep partisanship has become the norm in American politics, says Daniel Derksen, MD, a family physician and professor of public health policy at the University of Arizona. As such, it's become impossible to build a comprehensive and lasting national health policy, he says.

"In the past two administrations," he recalls, "the party in control of the federal government took unilateral action to legislate health policy. Only Democrats backed the ACA, and only Republicans voted for repeal. As a result, health policy lurches back and forth, with no continuity."

Pearl adds that this discontinuity means that "the underlying failures of the system cannot be addressed," such as rising healthcare costs and the structure, reimbursement, and technology of healthcare delivery. "All of these things are broken," Pearl says.


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