Summary
The upcoming elections on Tuesday, November 8, are the first midterms under President Joe Biden’s tenure. The political stakes are particularly high for the Biden Administration, as Democrats are at risk of losing control of Congress. At the moment, Democrats are slightly favored to win the Senate, while Republicans are slightly favored to with the House. A split Congress could significantly impede the Administration’s legislative agenda, therefore limiting policymaking through regulations.
Top voter priorities include economic issues, access to abortion and reproductive rights, and immigration issues. On the campaign trail, Democrats are discussing a slate of health-related issues, including access to abortion, COVID-19, workforce shortage, telehealth waiver extension, Affordable Care Act, drug pricing reforms, mental health, and health equity. Republicans are mostly focused on inflation and the economy, though there may be some discussion on telehealth waiver extensions, workforce shortage, vaccination mandates, and mental health.
House
Democrats currently have a 9-vote majority in the House (221-212 with two vacancies). All House seats are up for re-election. Prior to the Supreme Court’s decision to overturn Roe v. Wade, Republicans were widely expected to take the House. Republicans are still expected to win the majority, but many races have narrowed. Pollsters are taking a much more cautious approach to forecasting these races. The majority will likely be decided by roughly 12 “toss up” races (VA-2, AZ-2, AK, NY-19, PA-7, CA-27, TX-15, IA-3, OR-5, CA-22, KS-3, and NM-2). Republicans will need to gain six seats to win the majority in the House.
Due mainly to retirements, we expect to see leadership changes in key House Committees. For example, three members are vying for the position of top Republican on the House Ways and Means Committee, due to the retirement of Rep Kevin Brady (R-TX). We also expect leadership changes in the House Budget Committee and House Oversight and Reform Committee.
Senate
The Senate is currently 50-50, with Vice President Harris as the tie-breaker. Fourteen seats held by Democrats and 21 seats held by Republicans are up for election in November. Six of these seats are open due to retiring Senators (NC, PA, AL, OH, VT, and MO). Democrats cannot afford to net a single loss in order to keep control of the Senate.
Sen. Patty Murray (D-VA) is anticipated to become the top Democrats on the Senate Appropriations Committee, following the retirement of Sen. Pat Leahy (D-VT). If Sen. Murray becomes chair of the Appropriations Committee, then Sen Bernie Sanders (I-VT) is next in lead to lead the Senate Health, Education, Labor and Pensions (HELP) Committee. However, he would likely have to decide between leading the Senate Budget Committee or the HELP Committee. The current Republican lead on HELP, Sen. Richard Burr (R-NC), is retiring this Congress. The next Republican in line to take over the Committee is Sen. Rand Paul (R-KY). This could be a difficult dynamic if Rand Paul and Bernie Sanders are at the helm.
Policy Outlook
Legislative dynamics following the passage of the Inflation Reduction Act and leading up to the midterm elections have muddied the prospects for bipartisan activity on health care for the remainder of 2022. Both parties appear less likely to work together following the recent passage of the Inflation Reduction Act via the budget reconciliation process, though the year-end spending package could still feature certain high-priority bipartisan initiatives (e.g., mental health, telehealth, etc.).
The new Congress next year may move forward on health care legislation, however, as upcoming expirations and legislative deadlines may prompt new activity.
- Dec. 16, 2022: Expiration of continuing resolution for FY 2023 appropriations.
- Dec. 31, 2022: Expiration of 5 percent incentive payment for physicians to participate in advanced alternative payment models.
- January 11, 2023: Potential expiration date for the COVID-19 public health emergency (PHE).
- June 11, 2023: Potential expiration of Medicare telehealth flexibilities if PHE ends on Jan. 11, 2023.
- Sept. 30, 2023: Expiration of PAHPA, last reauthorized under Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (P.L. 116-22). Also, the deadline for FY 2024 appropriations and Farm Bill.
- Dec. 31, 2023: Expiration of various Medicare extenders (e.g., Medicare patient IVIG access demonstration project; independence at home medical practice demonstration program).
In our 2022 midterm elections preview deck, we discuss potential policymaking in the following areas:
- Climate and health
- Behavioral health
- Public health
- Health equity, maternal health, reproductive rights
- Medicaid reform
- Medicare reform
- Cost control
- Delivery reform/primary care
- Coverage/affordability improvements
- Nutrition