2018 Election Recap: What Does It Mean for Public Health?

By Adriane Casalotti, MPH, MSW, Chief of Government and Public Affairs, and Eli Briggs, MA, Senior Government Affairs Director, NACCHO

As expected, Tuesday’s election results will bring great change to Congress in January 2019. But the impact of the changes in Washington have a ripple effect in local communities. Here is a rundown of what happened and what it means for public health.

The House of Representatives

In the House, Democrats gained control and now have a 53% majority, picking up 30 seats.* In 2019, there will be more than 80 new House members—at least 52 Democrats and 31 Republicans. The new class includes a record number of women Members of Congress (100 at press time), including the first two Muslim women, the first two Native American women, and the youngest woman ever elected to Congress. Seven of the new members are scientists, including a nuclear engineer and a biochemist. Of note, Lauren Underwood, a nurse, won in Illinois’ 14th district, and former Health and Human Services (HHS) Secretary Donna Shalala won in Florida’s 27th district.

Control of the House shifting to the Democrats will have an immediate impact on the priorities brought up in the chamber, as the majority party sets the agenda for hearings and legislative consideration. Representative Nancy Pelosi (D-CA) is likely to win election by her peers to be the Speaker of the House. With the retirement of Representative Paul Ryan (R-WI), current Majority Leader Kevin McCarthy (R-CA) is expected to become Minority Leader in 2019.

Leadership on House committees will switch to the Democrats, and they will gain additional seats on committees. In many cases, but not all, the current ranking member will become the chair of the respective committee come January. For example, Representative Nita Lowey (D-NY) is expected to become the first woman House Appropriations Chair, and Representative Rosa DeLauro (D-CT) will lead the House Labor, HHS, Education Appropriations Subcommittee, which has control over most of HHS’s budget. Representative Frank Pallone, Jr. (D-NJ) will take over leadership of the Energy and Commerce Committee, which has oversight of many public health issues, and Representative Richard Neal (D-MA) will take the gavel in the Ways and Means Committee.

The Senate

In the Senate, Republicans remain in control and strengthened their majority, adding a total of four new members after Republicans won seats in Indiana, Missouri, and North Dakota (Arizona and Florida are too close to call as of press time).

Party leadership in the Senate is not expected to change; however, with the retirement of Senator Orrin Hatch (R-UT), chairmanship of the Finance Committee may return to former Chairman Chuck Grassley (R-IA). This committee has jurisdiction over government-financed healthcare programs like Medicare.  Senator Lamar Alexander (R-TN) is expected to retain the top slot of the Health, Education, Labor, and Pensions Committee, and Senator Richard Shelby (R-AL) is expected to remain Chair of the Senate Appropriations Committee.

Public Health in the 116th Congress

Healthcare and health issues—which were top-of-mind for a large percentage of voters—played a large role in helping Democrats to achieve their victories this year and will figure prominently in next year’s agenda. Democrats will not be eager to reopen the Affordable Care Act debate, but may try to shore up the law with some market stabilization measures that have gained bipartisan support in the past. In addition, shifting control of the House means that Democrats will have the power to call hearings and conduct oversight on a host of issues including health and healthcare topics. Senate Majority Leader Mitch McConnell (R-KY) has indicated a willingness to work with Democrats on drug pricing, an issue that has been getting increased bipartisan attention. The Trump Administration released a plan in May to tackle drug pricing.

It is unclear right now what impact the electoral shifts will have on budget and appropriations. Incoming House Appropriations Committee Chairwoman Lowey has spoken about the need to shore up spending on domestic priorities, and many Democrats who will be in leadership positions have vowed to do away with budget rules that keep spending artificially capped.

Majority Leader McConnell has admitted that there is little chance of reforming Medicare and Medicaid with a Democratic House. Inevitably, there will be limits to the areas where the two parties can find common ground. As we get closer to the 2020 presidential election, bipartisanship is likely to decline as the two parties position themselves to compete for control of the White House. This may lead to gridlock and a lack of significant achievements during the 116th Congress. Several senators, including Senators Elizabeth Warren (D-MA), Sherrod Brown (D-OH), and Kamala Harris (D-CA), have been mentioned as potential 2020 presidential candidates, which will add to partisanship if they decide to run.

In the States

Voters considered a wide array of ballot measures on Tuesday. Of particular note, three states passed Medicaid expansion provisions (Idaho, Nebraska, and Utah). Medicaid expansion will grant insurance coverage to at least 300,000 people. In addition, newly elected governors in Wisconsin and Kansas have vowed to expand Medicaid in their states.

Other ballot measures included provisions on abortion and marijuana legalization. A full list of health-related ballot measures can be found here.

What You Can Do

As a non-partisan organization, NACCHO is accustomed to working with Members of Congress on both sides of the aisle and getting results. NACCHO will continue to find ways to champion public health issues and be the voice of local health departments on Capitol Hill.

A simple and effective way to join us in this effort and make your voice heard is to become involved in NACCHO’s Congressional Action Network. Learn more about opportunities for educating Members of Congress and their staff by signing up here. In addition, you can get regular updates on what is happening in Washington by listening to NACCHO’s podcasts and by signing up for our News from Washington weekly e-newsletter.

*Note: Some races have yet to be finalized at press time.