Elections that occur in the middle of a presidential term may provide useful insights regarding directions in which voters prefer to have some corrective measures implemented. Typically, the party that occupies the White House experiences mid-term losses in both congressional and state contests. The year 2018 was no exception insofar as Democrats in Congress regained having a majority in the House of Representatives. Much of what they may hope to achieve will be tempered to a certain extent, however, by the fact that not only will Republicans maintain control of the Senate for the next two years, they will do so with more members than they had prior to the election.

Health was the number one issue for many individuals casting ballots throughout the U.S. Democrats running for office campaigned on promises to protect key provisions of the Affordable Care Act, such as defending protections for patients with pre-existing conditions and preventing future Republican efforts to repeal the ACA. Members of the G.O.P emphasized the risk of heightened fiscal dangers that will occur if either Medicare for All legislation or any single-payer health insurance variation aimed at making health care available at little or no cost for patients ever is enacted.

One policy area of concern may lend itself to some bipartisan agreement. Key members of the Democratic party and President Trump have expressed interest in curbing pharmaceutical price increases. Generally, Republicans tend to oppose government action to set or influence prices. Yet, it would come as no surprise if House Democrats try to require direct government negotiation of Medicare Part D drug reimbursement policy. Democrats also can be expected to be more aggressive when it comes to investigating drug manufacturers suspected of being responsible for initiating price increases of their products. The pharmaceutical industry may not be alone, however, in attracting greater congressional scrutiny. An example involves what is called “surprise bills” that may arise unexpectedly after patients are discharged from hospitals. This issue also has some potential to attract bipartisan support in search of a remedy.

Marijuana legislation usually generates more attention at the state rather than the federal level, but the topic remains of interest to Democrats on Capitol Hill. Republican Pete Sessions of Texas was defeated earlier this month after serving as Chairman of the important House Rules Committee. While in that position, he was able to block proposals from being considered on the House floor, such as allowing states to develop their own approaches to marijuana regulation. His departure may signal increased efforts in that chamber to advance marijuana policy reform measures.

Apart from what occurs in Washington, DC significant actions will continue to occur at the state level. Michigan will move forward in legalizing adult recreational marijuana use, while a medical marijuana ballot measure was approved in Missouri. Voters in Idaho, Nebraska, and Utah approved ballot referenda to expand their Medicaid program coverage under the Affordable Care Act. Newly elected governors in Kansas, Maine, and Wisconsin can be expected to take action to expand their respective Medicaid programs.

Meanwhile, whatever unfolds in the coming two years will serve as an important prelude to identifying key debatable propositions that will manifest themselves in the next election scheduled for 2020.

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