Divided Congress likely to result in incremental changes on health care policy

Although the final votes are still being counted, Democrats will continue to control the U.S. Senate, and it is likely that Republicans will have a narrow majority in the House. As a result, dramatic changes in health care policy are unlikely during the next Congress.

“Inflation was a big topic for many voters, as was abortion, but there is a big difference between what motivated voters and what Congress actually can get done,” says Larry Levitt, executive vice president for health policy at KFF. “With a divided Congress, policy gridlock is what immediately comes to mind.”

Levitt moderated “The Health Wonk Shop: What’s Next for Health Policy After the Election?” an online discussion on Nov 15. Two policy experts shared what might happen in a divided Congress. One thing that likely won’t happen is a renewed effort to replace the Affordable Care Act.

“For once, repeal and replace will not be the defining backbone of Republican health policy in Congress,” says Jennifer Young, a partner in the consulting firm Tarplin, Downs & Young, “It took us years, but I think we have learned that it is not a winning issue. There has been acknowledgement that a Democratic president is not terribly likely to sign repeal and replace.”

Democrats will focus on defending the ground they won while controlling both houses of Congress and the White House.

“One reason Democrats are still in the majority is fear of losing protections people care about, whether it is electoral, abortion or health care in general,” says Chris Jennings, founder and president of Jennings Policy Strategies. ”It strengthened their resolve to protect the rights and benefits they have provided over a period of time.”

In baseball terms, both parties will be playing small ball instead of swinging for the fences. The Republican House is likely to focus on such things as security related to pandemic preparedness, supply chains, affordability, competition and promoting U.S.-manufactured pharmaceuticals while lowering drug costs.

“One thing that continues to be of interest to Republicans is concern about the negotiation provision of the Inflation Reduction Act that was passed in the current Congress,” Young says. “Republicans understand that a Democratic Senate won’t take that up and even if they did, the president wouldn’t sign it. But discussions will continue around whether negations can impede the robust research-and-development pipeline.”

Also expect heightened House oversight of health care policy, especially in regard to the pandemic response. In the Senate, the Republican minority will seek ways to reinforce work being done by their counterparts in the House.

Jennings expects Democrats to pause their pursuit of major changes to the health care system.

“Some Democrats will continue to advocate for expansion of the Medicare program in areas such as vision, hearing and dental,” he says. “But when Congress is so closely divided, most members care about pursuing policies that they can see at least getting passed by the Senate and hopefully, maybe even being seriously considered in the House and signed into law.”

This could include such things as mental health, telehealth, technology, transparency, data collection, purchaser empowerment and marketplace consolidation. “These are areas where you could see bipartisan cooperation in the House and Senate,” he says.

Read more: Proposed policy changes to address unaffordability of health care

Although the next Congress is unlikely to pass bold legislation, incremental changes to improve the health care system are possible.

“No matter what, for good or for bad, health care is a high priority on the agenda,” Jennings says. “Sometimes we have to lower our expectations about how big and broad it is. Leftovers from Build Back Better still have big sponsors in the Senate, and they will continue to promote those policies. But in a Senate that is split and in a House that is owned by Republicans, the appetite for and successful movement on them will be limited.”