How the ‘red ripple’ could impact health policy in 2023 and beyond

Rather than a red wave, the 2022 congressional midterms brought a ‘red ripple’. 

With races still being decided and votes counted, Democrats have won control of the Senate, despite a runoff in Georgia. It looks like Republicans will take back the House — albeit with a much smaller majority than they had hoped. 

What does this all mean for health policy? With a divided Congress, President Biden’s ability to pass major, sweeping legislation along party lines (like the Inflation Reduction Act) falls to the wayside. But it doesn’t mean legislating comes to a standstill. Contrary to popular opinion, Congress has passed major health-related legislation with bipartisan support in recent years. This includes:

• The No Surprises Act, which passed as part of 2020 appropriations legislation, established new federal protections against surprise medical bills;
• Major opioid legislation of 2018, the SUPPORT for Patients and Communities Act;
• The 21st Century Cures Act of 2016, which modernized the development and delivery of drugs and medical devices and advanced research into serious illness;
• And the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed the Medicare Sustainable Growth Rate formula and changed the way that Medicare rewards clinicians for value over volume.

Even the lightning rod issue of ObamaCare, which once saturated campaign debates, has lost some of its polarizing energy. This cycle, we saw red state South Dakota approve a ballot measure to expand the state’s Medicaid program under the Affordable Care Act, opening coverage up to an additional 40,000+ residents.

Assuming a divided legislature, here are five areas where we could see action in the healthcare space in the 118th Congress:

1. Maternal and child health: The U.S. is facing a maternal mortality crisis, with a recent Centers for Disease Control and Prevention report finding that 4 in 5 pregnancy-related deaths in the U.S. are preventable. Maternal health is increasingly an issue as abortion access has changed following the Dobbs decision;
2. Telehealth: The regulatory flexibilities authorized during the COVID-19 public health emergency are set to expire, and there’s bipartisan interest in extending these regulatory changes;
3. 21st Century Cures 2.0 — building on the 2016 bipartisan version of this legislation, this has broad congressional support, as well as the backing of key industry stakeholders and national medical organizations;
4. Medicare provider payment: Providers want to see Medicare payment reform, with many still struggling financially as a result of the pandemic, and now with inflation and skyrocketing labor costs;
5. Mental health: COVID-19 exacerbated the nation’s mental health crisis, and lawmakers of both parties are interested in providing additional coverage, support and resources for mental health and addiction.

With expected GOP control in the House, there will also be a notable increase in government oversight. House Republican leadership has already been vocal about a desire to investigate Hunter Biden’s business dealings with the Biden administration’s withdrawal from Afghanistan, but there may be some health-related investigations as well. Criticism of President Biden’s federal COVID-19 response, as well as the CDC’s and National Institutes of Health’s response, could be up for investigation, with some GOP leaders calling to subpoena outgoing National Institute of Allergy and Infectious Disease Director Dr. Anthony Fauci. And the use of the $1.9 trillion COVID relief legislation signed at the start of Biden’s presidency could also be up for scrutiny for wasteful spending.

While undoubtedly Congress is more polarized than my time in office, there are healthcare issues we will continue to be able to bridge the divide on. Rising healthcare costs will persist as a top issue impacting Americans. Unpaid medical bills are the largest source of debt in America and the number one cause of bankruptcy.  A recent McKinsey report found that spikes in labor costs plus rising supply costs from inflation are now being borne by providers, but in coming years will trickle down to employers and consumers, predicting a $370 billion increase in U.S. health expenses by 2027.  

Voters will feel this pinch, and their elected leaders will want to show they are acting in response.

Bill Frist, MD is a heart and lung transplant surgeon, a senior fellow at the Bipartisan Policy Center, and chairman of The Global Board of The Nature Conservancy. He represented Tennessee in the U.S. Senate for 12 years and served as Senate majority leader from 2003 to 2007.