Senate results signal rightward shift on health
Illustration: Natalie Peeples/Axios
With President-elect Trump back in the White House and a strong Senate majority, Washington will be ripe for a major turn rightward in health policy.
Why it matters: A host of policies could be on the table, including cutting Medicaid, reforming Medicare drug pricing measures and overhauling the Affordable Care Act — especially if Republicans maintain their majority in the House and cement a GOP trifecta.
- At the very least, the outlook does not look good for extending the enhanced ACA subsidies next year.
Between the lines: There is also the possibility that Robert F. Kennedy Jr. and others in his sphere get prominent health positions, giving them new power to possibly undercut vaccines or make other public health changes.
State of play: Republicans so far have won 52 Senate seats.
- Adding one or two more could be the difference between enacting major cuts to federal health programs and confirming RFK Jr. or having to court the support of moderate Sens. Lisa Murkowski and Susan Collins.
- Senate races are still close in Michigan, Wisconsin, Nevada and Pennsylvania.
A 53- or 54-seat majority could enable Republicans to use a reconciliation bill to scale back ACA subsidies, weaken plan requirements or overhaul other aspects of the law, if Trump signals that he wants to go there.
- Extending the 2017 tax cuts in a reconciliation bill will also certainly be a priority, and it's also possible that cuts to Medicaid or those ACA changes could be used to help pay for it.
- Even though Trump has said he won't sign a national abortion ban, a robust majority in the Senate could encourage antiabortion groups to push for a vote on one — even if 60 votes still are needed to overcome a filibuster.
Between the lines: John Thune or John Cornyn is the likely next Senate GOP leader, adding more twists to the health policy outlook.
- Thune has been active on 340B reform, which is also a target for likely HELP Committee Chair Bill Cassidy, though it remains to be seen if the two can align on what that would look like.
- Cornyn has some interesting drug pricing ideas, such as a bipartisan bill that's passed the Senate targeting "patent thickets" that would delay generic competition.
- Still, Cornyn aligns with GOP orthodoxy, including opposing the IRA's Medicare negotiations, which could potentially undergo changes.
- One possible change short of outright repeal is lengthening the time until biologics are subject to negotiations to align with small molecule drugs.
The other side: One thing certain is that the visions of Senate Democrats and Vice President Harris of expanding drug price talks or adding Medicare vision, hearing or home health benefits are dead, at least for now.
- If Democrats are able to flip the House, they would be the last line of defense against GOP health care priorities, though Trump could still turn to executive actions.
