Midterm Elections: How Will Outcomes Impact Health Equity?

Advancing health equity is one of ASA’s leading priorities. We asked ASA RISE alumna Ryann Hill, who works at the intersection of politics and public policy, for her opinion on how the midterms would impact efforts toward health equity.

As the nation awaits the final outcomes of the midterm elections, the question of how the results may impact health equity remains. The answer is challenging to predict without a clear view of which Party controls the House of Representatives now that Democrats have managed to narrowly maintain their control of the Senate. Despite the unknown, we can expect the Biden Administration to continue to prioritize policies that achieve health equity and eliminate health disparities in 2023 and 2024 and a bipartisan healthcare agenda in Congress that may leave health equity priorities in limbo.

Here are a few ways the different outcomes of the 2022 midterm elections can impact health equity in the 118th Congress:

Republican-controlled House. Democrat-controlled Senate

A Republican-controlled House will likely lead to increased oversight of Medicare, Medicaid, the Covid-19 public health emergency and the Affordable Care Act. In September, Republican leadership announced several policy priorities aimed at lowering healthcare costs, improving healthcare quality, and increasing competition, choice and transparency in healthcare. The ambitiousness of these policy priorities will depend heavily upon the number of seats the Party can secure in their majority. The wider the margin of victory, the less likely the Party will need Democrat votes to advance its policy agenda in the House.

Despite Republican priorities in the House—a split Congress leaves little room for healthcare priorities beyond significant opportunities for bipartisanship (i.e., rising healthcare costs, healthcare transparency, telehealth expansion, etc.). While this limited capacity doesn’t 100% shut the door on health equity, it will make health equity legislation less likely to rise to the level of must-pass, must-do items on the bipartisan shortlist.

Democrat-controlled House and Senate

A Democrat-controlled Congress may only be as productive as the Party’s margin of victory. A tighter margin of victory in either Chamber, similar to that of a Republican-controlled Congress, may lead to a less-ambitious healthcare platform.

What does this mean for health equity? Depending upon the margin of victory, we could see a continuation of the Party’s interest in developing and passing legislation that seeks to achieve health equity and eliminate health disparities. In addition to Party priorities, a Democrat-controlled Congress allows for more opportunities for the Biden Administration to achieve its health equity goals in areas where Congressional action is needed to aid or kickstart the regulatory process.

Despite Uncertainty, the Biden Administration Remains Focused on Health Equity

The good news is that regardless of the balance of power in Congress, the Biden Administration will continue to use its regulatory authority to sprint toward achieving its health equity goals and priorities.

In April 2022, the Centers for Medicare and Medicaid Services (CMS) released its Framework for Health Equity for 2022–2032. The roadmap includes the following priorities:

  1. Expand the Collection, Reporting, and Analysis of Standardized Data
  2. Assess Causes of Disparities Within CMS Programs and Address Inequities in Policies and Operations to Close Gaps
  3. Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
  4. Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services
  5. Increase All Forms of Accessibility to Health Care Services and Coverage

With this roadmap, CMS hopes to further advance health equity, expand coverage, and improve health outcomes for the more than 170 million people receiving care under the Medicare and Medicaid programs, including older adults enrolled in Medicare Advantage and those who are dually eligible for Medicare and Medicaid. CMS is the largest provider of health insurance in the United States, leaving much room for regulatory action to achieve health equity in the event of a harder-to-predict Congressional session.

Beyond the coverage side of CMS, the Biden administration has begun efforts to approach health equity via other policy areas. In September, the White House hosted a national conference on hunger, nutrition and health to end hunger and increase healthy eating and physical activity by 2030. Following the conference, the White House released a national strategy that included several health equity-focused goals and priorities, many of which will directly benefit older adults.

Ryann Hill, MPH, is director of federal relations at the SCAN Health Plan in Washington, DC.