November 8, 2018

Election Results in More Medicaid Expansion

The midterm election results will have numerous consequences, one of which is that five more states are now expected to adopt Medicaid expansion.

In three states – Idaho, Nebraska and Utah – voters passed ballot initiatives for Medicaid expansion. According to CNBC, this will increase the number of people eligible for Medicaid by 302,000 in those states. Exit polls showed that, over all, a plurality of voters (41%) identified health care as their most important issue, exceeding both the economy and immigration.

Montanans had a chance to extend their Medicaid expansion (started as a pilot program in 2015) for another four years. It was defeated (55% voting against and 45% for) because of the stipulation that it would be funded, in part, by a tax on cigarettes. Vox reports that “Altria Client Services, which represents tobacco company Philip Morris, spent $12 million opposing the Medicaid ballot” and defeated it in Montana. So the 120,000 Montanans now receiving Medicaid through the expansion may be, again, uninsured if alternate funding is not located.

In addition to the states expanding Medicaid via ballot initiative, Maine and Wisconsin are also expected to expand via their election of new governors. Maine passed its Medicaid expansion ballot initiative in 2017 but Governor Paul LePage refused, even in the face of a court order, to implement it (see WA 8/23/2018 for details). Maine’s incoming governor, Janet Mills (D), has pledged to make implementation of Maine’s Medicaid expansion one of her first priorities. According to the New York Times, this will provide coverage to at least 80,000 more Mainers.

In Wisconsin, gubernatorial candidate Tony Evers (D) beat incumbent Scott Walker (R) in a race so close that, according to the Chicago Tribune, the “margin of victory stood just above the 1 percentage point threshold that would allow Walker to seek a recount”. Evers, a staunch supporter of Medicaid expansion, is also expected to prioritize its implementation which will benefit 176,000 more Wisconsinites.

All together, Medicaid expansion in these five states could result in over half a million (558,000) people gaining access to Medicaid coverage in 2019.

Will Drug Prices Be Affected by the Election?

On November 7,  Bloomberg reports, Senate Leader Mitch McConnell (R- KY) speculated that “Congress’s health-care priorities are likely to focus on drug prices as Obamacare repeal becomes a non-starter for a split legislature.” Pharmaceutical and biotech stocks have dipped in the last month, according to CNBC. The President’s public pledge to bring down drug prices, in combination with the new Democratic majority in the House of Representatives, should result in an environment capable of “real action on drug prices”, as StatNews put it.

Despite public commitments by the White House, little has actually happened in the last year to lower drug prices. The newest proposal, focused on Medicare Part B, would actually, “benefit relatively few Medicare beneficiaries and would take five years to implement fully”, StatNews observes, adding that Congressional inaction on drug prices to date “might have something to do with the record lobbying expenditures and campaign contributions given by big pharmaceutical companies.”

The Commonwealth Fund points out that a Democrat-controlled House will have several options for addressing this. Among them are holding hearings on allowing Medicare to negotiate prices with drug manufacturers, reforming Medicare Part D catastrophic coverage for outpatient drugs, and taking action to “lower drug prices for all consumers by banning anticompetitive practices that manufacturers use to delay cheaper generic and biosimilar versions of their drugs from coming to market.” 

Who’s Who among Health Care Advocates in the New House?  (excerpts from Kaiser Health News)


Rep. Frank Pallone (D-NJ): in Congress for 30 years and leading Democrat in the House Committee on Energy and Commerce since 2015. If he becomes Chair of the committee, he will be responsible for the broadest health portfolio in the House, which includes Medicaid, public health, insurance and drug safety.

Rep. Elijah Cummings (D-MD): Has been a ranking member of the Committee on Oversight and Government Reform since 2011. In collaboration with colleagues, he has demanded information from pharmaceutical companies about their drug pricing strategies and has released his own reports of drug costs, asserting that “credible, responsible oversight… means investigating skyrocketing prescription drug prices, actions that would threaten protections for people with preexisting health conditions, and efforts to undermine the Medicaid program.” 

Rep. Richard Neal (D-MA):  In 2017, became the top Democrat on the Ways and Means Committeewhich oversees Medicare and influences health policy through its jurisdiction over taxes. He played a part in crafting the Affordable Care Act and became the top Democrat on Ways and Means in 2017. The health sector was by far one of the top contributors to Neal’s re-election campaign this year, giving more than $765,000, according to the Center for Responsive Politics.

Rep. Nita Lowey (D-NY): She will be the first woman to chair the Committee on Appropriations.First elected to Congress in 1988, she became the committee’s top Democrat in 2013. She is a dedicated and effective advocate for investing in biomedical research into major diseases like diabetes and Alzheimer’s, and for public health programs like pandemic preparedness. A long time champion of women’s health issues, she actively opposes the Trump administration’s proposed gag rule on Title X funding, among other policies.


Health Sub-committee of the House Ways and Means Committee

Mike Thompson (D-CA): Senior member of the sub-committee and candidate for chair. Has co-sponsored bills including HR 3727 to expand telehealth technology use by Medicare beneficiaries, and HR 3120, a bill to ease the burden on medical providers by including telehealth services as a basic benefit for Medicare Advantage enrollees and by allowing plans to incorporate telehealth services into their bids.

Health Sub-committee of the House Energy and Commerce Committee

Jan Schakowsky (D-IL): In 2018, offered two separate amendments dealing with the skyrocketing costs of naloxone, both of which were blocked by Republicans on the subcommittee. With Rep. Francis Rooney (D-FL), introduced H.R. 2439, the FAIR Drug Pricing Act, an unsuccessful attempt to address skyrocketing prescription drug prices by requiring basic transparency for pharmaceutical companies that drastically spike the price of a drug. 

Healthcare, Benefits, and Administrative Rules Sub-committee of the Oversight and Government Reform Committee

Raja Krishnamoorthi (D-IL): Ranking Democrat on the sub-committee. In September 2018, joined Rep. Elijah Cummings in requesting Congressman Trey Gowdy (Chair of the House Oversight Committee) to subpoena DHHS and CMS for their documents regarding Medicaid Work Requirement rules. This request was sent the week after more than 4,000 Arkansas residents lost Medicaid coverage due to work rules in the state.

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