In one month, the results of the election will determine which party will hold the majorities in the House of Representatives and the United States Senate. Since the majority parties ultimately control the respective agendas for Congressional committees, the outcomes of the election can, and undoubtedly will, have markedly different impacts on policy decisions. Priorities drive agendas and as always, there are distinct differences between opposing parties. This is especially true on issues related to Medicaid.
Currently, Republicans hold the majority in the House, with Democrats narrowly controlling the Senate. This means that the Senate committees with jurisdiction over Medicaid including Finance and Health, Education, Labor and Pensions (HELP) are led by Democrats, while Republicans are leading key committees in the House including Ways & Means and Energy & Commerce. This divided control has led to something of a stalemate, with very little major legislation advancing.
If the election maintains the status quo (with divided control), many believe that we can anticipate a similar lack of movement. There are very few areas of agreement and those include enhanced funding for behavioral health and workforce development efforts, given the bipartisan support that exists for these issues. However, if either party gains control over both chambers, there are a number of changes including to Medicaid we would expect to see move forward.
Under unified Democratic control, legislation is likely to be introduced that would strengthen eligibility and enrollment (E&E) policies to reduce enrollee administrative burdens and improve coverage access. Efforts could include aligning E&E statutory requirements across healthcare programs as well as working to fill the Medicaid “coverage gap” for individuals living in the 10 states that have not expanded Medicaid eligibility under the ACA. Another area of focus is expected to be reforms to the provider tax and state directed payment policy.
Under unified Republican control, we could see bills to roll back E&E-related rulemaking and regulation. Efforts are likely to focus on eligibility restrictions aimed at shifting the “entitlement” nature of Medicaid including through instituting work requirements and premium payments. Other bills could seek to reduce provider administrative burdens; modify current waiver processes; repeal the Medicaid expansion program; and while less likely, change the way Medicaid is financed by moving to block grant the program’s funding.
In either case, finalizing these types of changes would also require the signature of the President—and if there are differences in control between Congress and the White House that will also certainly slow passage of bills with any major changes.
At present, given the makeup of which Senate seats are up for re-election this year, most polling anticipates a Republican-controlled Senate post-election, with the outcomes of the House and Presidential elections much less clear.
If you have questions or want to get more engaged with us in policy and advocacy, please contact Sarah Dobson at SDobson@lutheranservices.org.
Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.
