Midterm Elections Spell End of Obamacare Repeal and Replace Efforts

Published November 20, 2018


Exit polls consistently showed health care was the number-one issue on voters’ minds, indicating the topic will be debated widely for the next two years. Citizens and lawmakers will be focusing on issues such as Medicaid expansion and work requirements, the Trump administration’s reforms providing alternatives to Obamacare, proposed changes to Medicare drug pricing processes, and the Democrats’ push for socialized health care.

The Democrats won a majority of seats in the U.S. House of Representatives, which means the Republicans’ inability to repeal and replace Obamacare will remain. Republicans’ recent health care victories have largely been limited to actions by the executive branch and the states, with President Donald Trump leading the way with administrative rule changes allowing for expanded access to short-term, limited-duration health insurance plans and association health insurance. The Trump administration has also worked to reduce prescription drug costs by speeding approval of generics and encouraging companies to develop them.

Political Turbulence

Before the election, 225 Democratic candidates running for House seats said they supported some version of Sen. Bernie Sanders’ (VT-I) Medicare for All plan. With Republicans retaining control of the Senate and Trump as president, a national, government-run health care system is a non-starter, despite Democrats’ numerous campaign pledges. 

After the election results were in, Senate Majority Leader Mitch McConnell (R-KY) acknowledged repealing and replacing Obamacare is off the table. Success of a pending lawsuit claiming the Affordable Care Act is unconstitutional could push McCon- nell and Rep. Nancy Pelosi (D-CA), who is expected to be named speaker of the House of Representatives, into new discussions aimed at reforming the current system at the federal level. Otherwise, there is little chance of an agreement being struck between Republicans, who are pressing for free-market solutions, and Democrats, who want a nationwide, government-run health care or health insurance system.

Action in the States

On the state level, Democrats were unsuccessful in gubernatorial races in Florida and Georgia, where both candidates embraced Medicaid expansion during the campaign. At press time, both races were undergoing recounts. Democrats unseated Wisconsin Gov. Scott Walker, who had implemented historic health care reforms, including a push for Medicaid work requirements and a federally funded program to help lower the cost of health insurance. 

Maine Gov. Paul LePage, a Republican, was also defeated. LePage had been fighting to overturn the state’s decision to expand Medicaid, which will effectively bankrupt the state unless the legislature approves a plan to pay for it—meaning a huge tax increase. Idaho, Nebraska, and Utah included Medicaid expansion initiatives on the ballot, and all three passed. An initiative in Montana to expand the program was contingent on the state government finding a way to pay for it. The initiative failed, but health advocacy groups supporting Medicaid expansion in the state continue to analyze possible ways to fund it.

Expects Medicare Cost Hikes

Arianna Wilkerson, a government relations coordinator with The Heartland Institute, which publishes Health Care News, says Democrats’ win in the House means the cost of Medicare will continue to grow.

“The flip of the House to Democratic control means that nothing will be done to cut or slow the growth of Medicare, a $600 billion federal program for seniors and the disabled,” Wilkerson said. “In fact, increasingly more Democrats favor an expansion of Medicare so that it would cover all Americans. Not only would a Medicare for All scheme cost a gargantuan $32 trillion over a decade, it would also jeopardize the quality and quantity of benefits enjoyed by vulnerable people who depend on Medicare.”

Trying Every Avenue

Charlie Katebi, a state government relations manager with The Heartland Institute, says the votes for Medicaid expansion in Idaho, Nebraska, and Utah will impose huge costs on taxpayers in those states.

“November’s election has shown Obamacare advocates they can subvert the will of democratically elected representatives through ballot initiatives,” Katebi said. “Lawmakers in red states know Medicaid expansion has diverted funding away from health care for the most vulnerable, and they have no interest in replicating these failures in their own states. So rather than respect the will of these elected representatives, Medicaid advocates have decided to simply go around them. This will cost taxpayers, patients, and states dearly.”

Turning to the States

Justin Haskins, an executive editor and research fellow at The Heartland Institute, says Obamacare is here to stay and the only hope for reform lies with the states and the Trump administration.

“Once Democrats take control of the House of Representatives, it’s extreme- ly unlikely the disastrous Obamacare system will be replaced,” Haskins said. “Failing to end Obamacare has some important long-term implications for the U.S. healthcare system, but it also means the only path toward enacting much-needed reforms in the short term will shift to the states, which can work with the Trump administration to lower health insurance premiums.

“That’s the only hope Americans now have to gain greater access to a more effective and affordable health insurance marketplace,” Haskins said.



Tom Howell, “GOP Hopes to
Ax Obamacare Are Gone,”
The Washington Times, November 7, 2018: https://www.washingtontimes.com/news/2018/nov/7/mitch-mcconnell-gop-hopes-to-ax-obamacare-are-gone