In the 2018 mid-term elections, Democrats won the majority of seats in the House of Representatives, creating a potential source of legislative gridlock. In the context of a so-called “divided government,” some Congress-watchers tend to predict that the President’s policy objectives would be halted or at least slowed to a crawl. Nevertheless, historically, gridlock is not always inevitable. In fact, for key healthcare initiatives, there are at least five goals that the new Congress and the President should be able to reach together.
1. Drug pricing
Both parties in the House and the President have indicated that reigning in soaring drug prices will be a major priority. The incoming Speaker of the House, Nancy Pelosi (D), has referred to drug pricing reform as a “caffeinating issue” for the Democrats. The President in turn has proposed requiring pharmaceutical companies to reveal the selling price of prescription drugs in television ads. This suggestion received some understandable pushback from the industry, which argued that such a requirement would not be legal. Nevertheless, even the threat of such a move may persuade the industry to proactively increase price transparency, an outcome that will surely benefit consumers.
2. Maternal health
Both Democrats and Republicans are feeling pressure to respond to an incipient crisis in maternal health. Between 1987 and 2014, the maternal mortality rate more than doubled, from 7.2 to 18.0 deaths per 100,000 live births. For black women, the rate was 40.0 per 100,000. A bipartisan group of Senators formed in December 2018 requesting that the President direct funding toward reducing maternal mortality back to 1987 levels. One approach with a proven track record would be augmenting prenatal care in the form of home nursing visits, with possible funding available from the 21st Century Cures Act that was introduced in 2015.
3. Biomedical research and innovation
In the past, funding for basic science research has been championed on both sides of the aisle, and there is no reason to believe that the new Congress will be any different. The probable new chairman of the House Committee on Appropriations will be Nita Lowey, Democrat from New York. Rep. Lowey has long been an advocate for increased research funding for diverse programs from diabetes basic research to pandemic preparedness. In mid-2018, the President signed a bipartisan bill authorizing a $2 billion funding increase for the National Institutes of Health (NIH). With Rep. Lowey as the chairman of Appropriations, we are likely to see support for NIH remain strong, at least for the next two years.
4. The opioid crisis
It appears that the momentum in the fight against the opioid crisis will continue unabated during the next Congress. The recently passed opioid package bill continues to enjoy bipartisan support. Democrats have been pushing for increased funding, and they are likely to find kindred spirits from the minority party, including Republican Freshman Guy Reschenthaler of Pittsburgh, who ran on opioid policy reform during his successful campaign. An often neglected angle that the President and Congress might consider is opiate use by the elderly, particularly at home. This is one area where increased funding for home health monitoring may reduce deaths and toxic side-effects that plague the elderly.
5. Marijuana policy
The Gallup polling organization recently reported that, in October 2018, 66% of Americans supported legalizing marijuana, up from 50% in 2012. The President himself has stated that he would support efforts of individual states to determine their own marijuana policies. Whereas the Republican-led Senate may resist, an enlarging pro-marijuana caucus in the House is likely to work with the President to achieve liberalization of marijuana laws. This is particularly the case now that anti-marijuana Attorney General Jeff Sessions is out of the picture. The prospects for expanding the number of states permitting medical marijuana are looking more positive.
Despite the fact that thornier issues such as immigration policy are not likely to generate alliances between the executive and legislative branches this year, healthcare policy is one area where gridlock is not likely to occur. The US will likely emerge healthier as a result.