Nov 10, 2022 - Health

Republicans poised to take power with limited health care agenda

Illustration of a path avoiding plus shaped holes.

Illustration: Gabriella Turrisi/Axios

For the first time in more than a decade, a party without a definable health care agenda is on the cusp of a new congressional majority, all but ensuring that next year's agenda will be driven by real-world events more than campaign promises.

Why it matters: Republicans have been eager to move on from health care for years, but a series of jarring events may draw them back in. The narrower the majority, the worse news that is for the party — and potentially for patients.

State of play: Several House races are still too close to call, but at this point, the most likely outcome is that the GOP ekes out a narrow majority.

  • Which party has control of the Senate may not be clear for another month if it comes down to who wins the Georgia seat, which is headed for a runoff.

The big picture: The Affordable Care Act — both its passage and Republicans' attempt to scrap it — was a rallying point for both parties until 2018, when the GOP's failed repeal attempt helped cost it control of the House.

  • Health care remained central to Democrats' agenda over the last four years, culminating under the Biden presidency in enhancements to the ACA and a new law allowing Medicare to negotiate drug prices.
  • House Republicans' vaguely worded health agenda references price transparency, telehealth and health savings accounts, hinting that the party's goals are more small-bore than in the past. They're also eyeing steps like eliminating any lingering COVID restrictions.

Reality check: Avoiding health care assumes the issue will largely be background noise to voters. But economic circumstances and policy cliffs will make it hard for a sector accounting for nearly 20% of the economy to just run on autopilot.

  • Inflation will be increasingly reflected in health care prices, particularly if hospitals successfully pass along rising underlying costs to insurers next year. Those will translate into large premium increases, borne either by patients or employers.
  • If hospitals and providers can't pass along these rising labor and supply costs, some will experience severe financial challenges and will undoubtedly look to the government for help.
  • The lifting of the COVID public health emergency — whenever that happens — will begin a process in which millions of people will get purged from Medicaid rolls and the uninsured rate will spike.
  • New multi-million dollar drugs are already hitting the market, threatening state Medicaid program and small employers' balance sheets.
  • The expected recession the U.S. is facing will complicate all of the above, if only because it will make paying for health care even tougher for patients.

What we're watching: Whether some combination of factors will create enough pain to force Republicans to return to one of their least-favorite subjects.

  • That would be extremely tough for leadership to maneuver with a narrow majority. Finding consensus on any problem — let alone one as vexing as health care — may be near impossible.
  • Democrats, who are increasingly unlikely to keep the House, don't exactly have a unified health care agenda waiting in the wings, either, after picking all of the lowest-hanging fruit this past Congress.

Yes, but: Under a GOP majority of any size, expect plenty of political noise around health care-related investigations and oversight, particularly surrounding the pandemic.

  • Republicans will also likely probe Biden administration actions like fixing the Affordable Cart Act's "family glitch" and implementation of Medicare drug negotiations.

The intrigue: Democrats have cast congressional Republicans as intent on making cuts to Medicare and Social Security, but entitlement cuts are far from unifying among Republicans and would be dead on arrival in a majority where every vote counts.

Go deeper: The second and final pre-launch edition of Health Care Pro will dive into more detail on the GOP health agenda and leadership once we have firmer results. Sign up here.

Editors note: The headline has been changed to more accurately reflect the story’s characterization of the GOP health agenda.

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