Taken from the January/February 2019 issue of The Women's Health Activist Newsletter.
The 2018 elections were a historic victory for health care and for women. You marched, called, wrote, protested, canvassed, and spoke out. And it worked! In exit polls nationwide, voters confirmed that health care was their top priority, and they punished officials who had sought to take it away. Even in races where health care proponents ultimately lost, the margin of victory was often significantly closer than anyone would have predicted two years ago in states won handily by Donald Trump—thanks to health care voters. Strikingly, a number of the Affordable Care Act’s (ACA) harshest foes were forced to lie about their opposition to the law’s consumer protections in a sweeping reversal of health care politics from previous election cycles.
In Arizona, for example, Congresswoman Martha McSally (R-AZ) famously rallied her GOP House colleagues to pass the bill gutting protections for pre-existing conditions in 2017 by urging them to "get this f****** thing done." But in 2018 she falsely claimed to be "leading the fight to force insurance companies to cover pre-existing conditions." She lost a Senate race against a fellow House member, Congresswoman Kyrsten Sinema (D-AZ), who had opposed GOP repeal attempts.
With Democrats taking control of the U.S. House of Representatives by a large margin, the door has been firmly closed on further legislative attempts to repeal the ACA, gut Medicaid, block low-income patients from receiving care at Planned Parenthood, and cut Medicare to pay for the GOP’s tax cuts. The change in power also has significant implications for the kinds of oversight the House will conduct. House committees are now expected to investigate the administration’s efforts to sabotage the ACA and its refusal to defend the law in court. And with newly confirmed Supreme Court Justice Brett Kavanaugh an ongoing threat to women’s health, we may even get the full investigation from the House Judiciary Committee this year that the Senate Judiciary Committee refused to conduct last year.
The next two years could be particularly turbulent for House Republicans, two-thirds of whom have never served in the minority before. The 2006 wave elections, where a similarly long-standing Republican majority was defeated, may provide a good historical analog. Chafing in the minority and facing another tough re-election fight defined by an unpopular president, large numbers of Republicans who had survived 2006 announced their retirement for 2008. We’ll have to see how such a scenario could affect a smaller, Trumpier GOP conference’s approach to health care. With the possibility of ACA repeal dead, there is some hope that the incoming Congress could pursue bipartisan initiatives to lower health care premiums and curtail rising drug prices—but only if advocates keep up the pressure.
In the Senate, where Democrats were defending ten seats in states won by Trump (and Republicans were defending only one seat in a state won by Hillary Clinton), Republicans only increased their narrow majority by two seats. The loss of the House neuters Senate Republicans’ ability to pass harmful legislation, but the increase from 51 to 53 seats gives them a larger buffer to confirm extremist conservative judges. Senate Majority Leader Mitch McConnell (R-KY) is expected to spend the next two years aggressively attempting to remake the Federal judiciary in Trump’s image. As disturbing a prospect as this is, however, it’s still a marked reversal in fortune from the filibuster-proof majority that Republicans had once envisioned for 2019.
There was good news on the state level, as well. In Nebraska, Idaho and Utah, voters overwhelmingly passed Medicaid expansions by ballot initiative, closing the coverage gap for more than 360,000 people. In Kansas and Maine, voters elected pro-health care governors, potentially easing the path for their states to expand Medicaid, which would cover an additional 200,000 people. Kansas had previously passed Medicaid expansion legislation through its Republican-controlled legislature only to see its extremist governor veto the bill. In Maine, the outgoing Republican governor, Paul LePage, had not only vetoed multiple expansions passed by the legislature, but also had been illegally blocking a 2017 voter-passed Medicaid expansion. Pro-expansion gubernatorial candidates also won in states like Wisconsin (which currently has a partial expansion) and Michigan (which has sought to undermine its existing expansion through the waiver process).
In Nevada and New Mexico, newly-elected state leaders are considering Medicaid buy-in programs. These would allow residents with incomes above the threshold for Medicaid eligibility to use their own funds and ACA premium assistance dollars to purchase Medicaid coverage instead of a private plan. Nevada’s legislature passed Medicaid buy-in in 2017, but the program was vetoed by outgoing Republican Governor Brian Sandoval. Incoming Governor Steve Sisolak (D-NV) is supportive of the program.
We are also celebrating a number of historic firsts for women. Debra Haaland and Sharice Davids became the first Native American women elected to Congress. Ayanna Pressley and Jahana Hayes became the first Black women elected to Congress from their respective states. And Rashida Tlaib and Ilhan Omar became the first Muslim women in Congress. The U.S. House will have more than 100 women members for the first time in history, up from 84 in 2018—although that’s still less than a quarter of its total membership.
But, even as we celebrate our health care victories, we know our work is far from over. A lawsuit to gut the ACA’s consumer protections, including those for people with pre-existing conditions, is likely headed to the Supreme Court. The Trump administration continues to sabotage ACA marketplaces, push “junk” insurance plans on unsuspecting consumers, and promote bureaucratic obstacles to coverage in the Medicaid program. And, of course, the administration continues to attack private insurance coverage for both contraception and abortion. Fighting against these attacks while using Congress’s power of the purse and power of oversight for the first time in the Trump presidency will be our unwavering focus over the next two years.
Sarah Christopherson, MA, is the Legislative Director for the social justice campaign, Americans for Tax Fairness, and the NWHN’s former Policy Advocacy Director. Her 10 years working for Congress and her deep knowledge of health policy and consumer protection make her the NWHN’s issue area expert on federal health reform implementation and defense, drug and device safety and efficacy, and sexual and reproductive health.
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