No matter how rabid any of us are about politics, the length and intensity of the American election cycle must have all of us praying for a little break after an election. The current mid-terms are over, and while there was a significant shift in Congress and a potentially even larger shift in the states, it may not make much difference in health policy. Starting with the health reform law, while Republicans have pledged to repeal it, and may actually do so in the House, there is almost zero chance that repeal would pass the Senate and less than zero chance that it would be signed by the President.
Certain parts might be successfully rolled back by the House, such as the CLASS program or the Medicaid expansion, and maybe the Senate would go along, but it is unclear that the President will sign any significant change to the law as enacted and a veto in not likely to be overridden. A few minor provisions, like the IRS payment-filing limit, could get changed and signed by the President. The idea of de-funding sounds appealing, but is trickier to implement than it sounds, since it must be accomplished in an appropriation bill that ultimately has to be signed by the President. What we most likely may see is a lot of loud debate and posturing and little actual change. The Republicans may also try to pass their own reform ideas, such as malpractice protections, and some might get through Congress, but the President’s willingness to do anything like that is just unclear. So we suspect we will have two years with much discussion and little change. And some important areas like the EHR and other health information initiatives seem to be broadly supported by both parties, and will therefore face little threat of change.
The state level is actually more interesting. Many governorships changed hands as did a number of state legislatures. State spending on Medicaid and on employee health benefits are a substantial contributor to state deficits. There probably will be increased resistance to federally encouraged Medicaid expansions and to other burdens placed on the states from the reform law. The states have an ability to limit their participation in program expansion and a number may do so, although this could itself have a negative impact on their budget situations. There may also be continued experimentation at the state level around alternate ways to solve issues of health care costs and access.