Where Does The Nation Stand After The 2020 Elections and What Does It Mean For The Prospects For Health Policy Changes?

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

Ken Perez

A record 158 million Americans voted in the 2020 presidential election, a staggering increase of 17% versus 2016. Joe Biden garnered 81.3 million votes, while Donald Trump received 74.2 million—both more than any U.S. presidential candidate in history. In the Electoral College, Biden received 306 votes, while Trump got 236.

In the U.S. Senate Georgia runoff elections, Democrat Jon Ossoff defeated Republican incumbent David Perdue, 50.5% to 49.5%, and Democrat Raphael Warnock prevailed over Republican incumbent Kelly Loeffler, 50.9% to 49.1%.

The Democrats’ sweep of the two Georgia runoff elections resulted in a 50-50 split between the Democrats and the Republicans in the Senate. Because Vice President Kamala Harris serves as president of the Senate and holds the tie-breaking vote, the Democrats are the majority party in the upper chamber, allowing Sen. Chuck Schumer (D-N.Y.) to become the Senate Majority Leader and giving the Democrats the chairmanships of the Senate’s 24 current committees.

In the House, the Republicans registered a net gain of 11 seats, narrowing the Democratic majority to 10 seats. Currently, the Democrats have 221 representatives, the Republicans have 211, and there are three vacancies.

With Biden’s win, the Democrats’ sweep of the U.S. Senate Georgia runoff elections, and the Democrats’ retention of their majority in the House, the Democrats have control of the White House and majorities in both chambers of Congress for the first time since 2010.

As for the judicial branch, with Amy Coney Barrett’s confirmation by the Senate on Oct. 26, 2020, there are six conservatives and three liberals on the Supreme Court.

Citing former President Barack Obama’s famous triumphal statement in 2009, “Elections have consequences,” many Democrats view their control of both the executive and legislative branches as a clear mandate to aggressively pursue their agenda. Some from the progressive wing of the Democratic party are urging Biden to “go big” and use his “honeymoon” period to drive his most aggressive reforms, including a public option plan, expanding Medicaid, enhancing the Affordable Care Act’s health insurance marketplaces, lowering the Medicare eligibility age to 60, and promoting unionization and collective bargaining for healthcare workers.

Others, including moderate Democrats, advocate pursuit of a less-ambitious, more moderate bipartisan agenda, including reversal of many of former President Donald Trump’s executive orders, supporting telehealth, promoting value-based care and alternative payment models, increasing price transparency, and somehow tackling prescription drug prices.

Whether the aggressive or moderate scenario will come to pass will be largely determined by several factors.

First is the effectiveness of the COVID-19 vaccine rollout. In Biden’s inauguration speech, he rightly said, “Our work begins with getting COVID under control.” It is job one for the Biden administration for 2021 and perhaps 2022. It is not an overstatement to say that most everything—the nation’s public health, economic recovery, and the political climate in the nation’s capital—hinges on the success of the coronavirus vaccine rollout.

The level of bipartisanship in Washington is the second factor. How Biden engages with moderate Republican senators and how the power-sharing between Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.) goes will determine whether there is productive legislative compromise or gridlock.

Third, this spring the Supreme Court will rule on Texas v. California, the latest challenge to the constitutionality of the Affordable Care Act (ACA). The justices are considering whether the ACA can stand without the individual mandate penalty, which was reduced to zero by the Tax Cuts and Jobs Act of 2017. A core issue is whether the individual mandate is severable from the rest of the statute. Most legal analysts have predicted that the Court will uphold the ACA, but in the unlikely event the Court strikes down the law, the Biden administration and the Democrat-controlled Congress would scramble to pass legislation to restore the ACA, which would be challenging, given the Republicans’ 50 seats in the Senate.

The depth and duration of division in the Republican Party is the fourth factor. If Trump continues to exercise significant influence in the GOP and the party splinters, the nation would likely continue its leftward shift through the 2022 and 2024 elections, potentially paving the way for realization of more progressive reforms by the Biden administration.

And fifth and finally, the outcome of the 2022 midterm elections could advance or block the Biden administration’s efforts to pursue its policy agenda. While the Democrats are basking in the glow of the 2020 election results, it’s important to remember that the pendulum of American politics often swings back and forth. For example, in 2010, then-President Barack Obama saw the GOP gain 63 seats in the House—the biggest shift since 1948—taking over control of the House, and seven seats in the Senate, though not enough for a majority in the upper chamber. A humbled Obama said Republicans gave Democrats a “shellacking.” If the GOP retakes either chamber of Congress in 2022, the Biden administration’s ability to advance its policy agenda would be severely limited during 2023-2024, making pursuit of moderate policies with bipartisan support more likely.

The prospects for accomplishing health policy changes during the next four years are clouded by the confluence of three mammoth societal challenges—the coronavirus pandemic, a severe economic downturn, and a deeply divided populace—as well as multiple factors that will impact the tenor of politics in America.

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