Electronic Health Reporter

By Ken Perez, vice president of healthcare policy and government affairs, Omnicell, Inc.

Although it took eight days for most of the dust to settle after the 2022 midterm elections, it is now clear that the following conclusions can be drawn:

• The widely predicted “red wave,” in which Republicans were to take back both the House and the Senate, did not materialize.

• The Democrats have at least 50 seats in the Senate, and thus will retain the majority in that chamber, with Vice President Kamala Harris serving as the tiebreaker.

• The Republicans have taken back the House, though with a very slim margin.

Divided government

Given the Republican majority in the House, the U.S. will have a divided government for the next two years. A divided government describes a situation in which one party controls the White House (the executive branch), while another party controls one or both chambers of Congress (the legislative branch).

In recent decades, a divided government has become quite common. The U.S. has had a divided government in 20 of the 32 years since 1990.

What’s good and what’s bad about divided government?

Those in favor of divided government contend that it encourages more policing of those in power by the opposition, and it limits spending and the proliferation of undesirable laws. Conversely, critics of divided government argue that it often results in gridlock.

What does the future hold with this latest occurrence of divided government?

In the wake of the 2022 midterm elections, business publisher Kiplinger stated, “After the midterms, expect gridlock to reign on Capitol Hill. A bitterly divided Congress will fight over everything. Plus, a GOP House will be eager to launch investigations.” Investment management company T. Rowe Price predicted, “With Republicans expected to take control of the House of Representatives and Democrats securing control of the Senate in the midterm elections, we anticipate limited legislative achievement in the next Congress.”

Customary post-midterm elections rhetoric

When the party in the White House and with majorities in the House and Senate loses majority control of one or both chambers of Congress, the president, not wanting to appear oblivious to the message delivered by a majority of the electorate, usually makes some statement indicating a desire to find common ground with the opposition party. For example, after President Barack Obama suffered what he called “a shellacking” in the 2010 midterms, he pronounced himself humbled and pledged to negotiate with Republicans on a much less aggressive agenda.

In like manner, two days after the recent elections, President Joe Biden said, “…I’m prepared to work with Republicans…” though he quickly added, “But the American people have made it clear they expect Republicans to work with me as well.”

Despite Biden’s statement about working with Republicans, the fact that the expected red wave did not materialize and the evident division between those for and against former President Donald Trump within the Republican party seem to have emboldened the Democrats.

A Morning Consult poll of 6,000 U.S. adults conducted on Nov. 9 found that 72% of those polled feel that things in the country have pretty seriously gotten off on the wrong track. Nevertheless, when asked by a reporter on that same day what he plans to do in order to change the opinion of voters on the direction of the country, Biden responded, “Nothing, because they’re just finding out what we’re doing,” and he repeated that he wouldn’t “change the direction.”

In addition, new Speaker of the House Kevin McCarthy (R-Calif.) will find it difficult to find common ground with Democrats, due to the GOP’s narrow majority—which allows the very conservative Freedom Caucus, which has about 40 members, to be more influential—and the Republicans’ priority of renewing the individual and business tax provisions enacted in the Tax Cuts and Jobs Act of 2017 that expire in 2025, which will be opposed by all House Democrats.

Implications for health policy

So what will it be with the 2023-2024 version of divided government—absolute gridlock, with virtually no significant legislation accomplished or alternatively, passage of limited legislation, with bipartisanship as an absolute requirement?

Biden has already declared that undoing the Inflation Reduction Act’s prescription drug pricing reforms is off limits. But if the latter scenario were to materialize, certain less-controversial health policy changes with bipartisan support could gain passage during the 118^th Congress. Examples include pharmacist provider status (e.g., The Pharmacy and Medically Underserved Areas Enhancement Act, which apparently has died in committee during the current 117^th Congress) and an amendment to the 340B law (The Veterans Health Care Act of 1992) that would grant the Secretary of Health and Human Services greater authority to modify the program (e.g., allowing and enforcing the use of contract pharmacies). Saliently, both of those initiatives would promote greater health equity, a Biden administration priority.