News: Your guide to health care election viewing

Tuesday, November 5, 2024

Your guide to health care election viewing

Nov 05, 2024

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By Ben Leonard and Chelsea Cirruzzo

Driving The Day

Kamala Harris and Donald Trump speak at separate rallies.

Presidential candidates Kamala Harris and Donald Trump present opposing visions for their health care agenda. | AP

AT STAKE — Vice President Kamala Harris and former President Donald Trump offer starkly different visions for the future of U.S. health care.

Harris has leaned into health care in her campaign, pledging to safeguard reproductive rights and build on the Biden administration’s accomplishments on drug pricing and Obamacare . Trump has focused significantly more on other issues like border security and the economy, said abortion rights would be up to the states and has cozied up to Robert F. Kennedy Jr.’s ideas for health care policy.

Here’s what could happen depending on who wins the race:

A Harris victory: Harris would look to increase the federal role in health care and strengthen safety-net programs like Medicaid.

Harris is expected to continue several Biden administration priorities, including maintaining measures to expand abortion access, including rules allowing abortion pills to be delivered through the mail, and policies intended to boost Obamacare enrollment.

She has a number of priorities that would require Congress’ support, including expanding Medicare drug price negotiations, which would likely require Democratic control of the House and Senate. She would also need Congress’ buy-in for expensive proposals like extending enhanced subsidies for Obamacare plans that expire at the end of 2025 and creating a Medicare home care benefit.

Personnel: Potential names who could lead HHS under Harris include CDC Director Mandy Cohen, CMS Administrator Chiquita Brooks-LaSure, Surgeon General Vivek Murthy, HHS Deputy Secretary Andrea Palm and New Mexico Gov. Michelle Lujan Grisham.

A Trump victory: Trump’s vision for health care is less clear, but he would be expected to pull back on policies that strengthen Obamacare enrollment as he did when president and end Biden administration policies expanding access to abortion.

He’s gestured to bolstering transparency and competition in health care and lowering medical costs with few specifics. A Trump win could be a blow to supporters of continuing the Affordable Care Act subsidies.

Trump has been largely silent on Medicaid , though he has said large-scale deportations would “end the financial drain” on the health care system and ensure Medicaid is available for citizens. His administration is expected to approve states’ requests to tie Medicaid to employment and could move to allow states to convert a portion of Medicaid funding into block grants, which he pushed for as president.

Personnel: Under Trump, HHS could be led by former Louisiana Gov. Bobby Jindal, Paragon Health Institute President Brian Blase, former HHS Deputy Secretary Eric Hargan, former HHS Deputy Chief of Staff Paul Mango or former Trump Domestic Policy Council Director Joe Grogan. Trump has suggested Kennedy could play a major role in a Trump administration.

WELCOME TO TUESDAY PULSE. It’s finally here. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.

In Congress

Sen. Tammy Baldwin arrives at the U.S. Capitol.

Democrats risk losing Senate control, with health policy implications hinging on key races like that of Wisconsin Democratic Sen. Tammy Baldwin who's up against Republican Eric Hovde. | Tierney L. Cross/Getty Images

SENATE RACES WE’RE WATCHING — Democrats have an uphill road to maintain control of the Senate. If Republicans win the majority, its size would impact their ability to move policy.

We’re watching key races for their potential consequences for health policy, including in these states:

Montana: Senate Veterans’ Affairs Chair Jon Tester (D-Mont.) is in a tough race against businessperson and former Navy SEAL Tim Sheehy in what’s likely the most difficult competitive seat for Democrats to win. Tester’s defeat could not only shake up committee leadership but also determine the balance of power in the chamber. Cook Political Report rates the race as leaning GOP.

Ohio: Sen. Sherrod Brown (D-Ohio) is betting that emphasizing abortion rights will help him keep his seat in a state that Trump won by eight points in 2020. He’s running against businessperson Bernie Moreno. Brown sits on the Finance and Veterans’ Affairs committees. CPR rates the race as a toss-up.

Wisconsin: Sen. Tammy Baldwin (D-Wis.), who serves on the Senate Health, Education, Labor and Pensions Committee, is in a tight race against businessperson Eric Hovde. Baldwin leads the appropriations subcommittee for HHS. CPR rates the race as a toss-up.

Pennsylvania: Sen. Bob Casey (D-Pa.), who sits on the HELP Committee, is taking on former hedge fund CEO Dave McCormick in a key swing state. Casey also chairs the Aging Committee and sits on the Finance Committee. CPR rates the race as a toss-up.

HOUSE RACES WE’RE WATCHING — Control of the closely divided and GOP-controlled House is up for grabs, with several races that could impact health policy outside of what party wins the majority. Here are some key races to watch:

Arizona’s 1st District: Rep. David Schweikert (R-Ariz.), who chairs the Ways and Means Oversight Subcommittee and is a top telehealth advocate, is taking on Democratic Dr. Amish Shah in a race that CPR rates as a GOP toss-up.

North Carolina’s 1st District: Rep. Donald Davis’ (D-N.C.) district contains part of the so-called Research Triangle. He has been one of the few Democrats willing to blunt the Inflation Reduction Act ’s negotiating power for drug prices in Medicare and is in a race against GOP retired Army Col. Laurie Buckhout. CPR rates it as a Democratic-leaning toss-up.

California’s 45th District: Rep. Michelle Steel (R-Calif.), who serves on the Ways and Means’ and Education and the Workforce’s Health Subcommittees and has been a leader in attempting to extend eased telehealth rules for commercial plans, faces a CPR-rated GOP toss-up race against Democratic attorney Derek Tran.

Iowa’s 1st District: Rep. Mariannette Miller-Meeks (R-Iowa), an ophthalmologist, a member of the GOP Doctors Caucus and chair of the House Veterans’ Affairs Health Subcommittee, is in a CPR-rated GOP toss-up race against law professor Christina Bohannan, a Democrat.

Other health professionals in the running include:

Maxine Dexter (D), Oregon’s 3rd District: Recently a Democratic Oregon state representative and a pulmonologist at Kaiser Permanente, Dexter will likely win a Portland-area seat.

Mayra Flores (R), Texas’ 34th District: The respiratory care therapist won a special election to serve the McAllen-area district for part of a term before Rep. Vicente Gonzalez (D-Texas) beat her in November 2022 by more than 8 points. She’s running against Gonzalez in a race CPR rates as leaning Democratic.

Mike Kennedy (R), Utah’s 3rd District: The family medicine doctor and recent member of the Utah Senate is running for the seat he’s expected to win after Rep. John Curtis (R-Utah) opted not to seek reelection and run for Senate.

Kelly Morrison (D), Minnesota’s 3rd District: An OB-GYN and most recently a Democratic Minnesota state senator, Morrison is expected to win a Minneapolis suburban district.

Bob Onder (R), Missouri’s 3rd District: The allergy and asthma doctor is expected to win the deep-red seat Rep. Blaine Luetkemeyer (R-Mo.) is vacating.

Prasanth Reddy (R), Kansas’ 3rd District: The internist is trying to beat Rep. Sharice Davids (D-Kan.) in a Kansas City-area district that Davids won by 12 points against a different challenger in 2022. CPR rates the race as likely Democratic.

IN THE STATES

THE STATES WEIGHING ABORTION ACCESS — After Roe. v. Wade was overturned two years ago, abortion access is on the ballot in about a dozen states.

Democrats hope the measures can boost turnout and support for their candidates. While previous ballot measures seeking to expand abortion access have largely been successful, that hasn’t necessarily translated to increased support for Democratic candidates.

Here are some states we’re watching:

Arizona: Voters in the Grand Canyon State appear poised to overturn the state’s 15-week abortion ban, but progressives worry that the ballot measure won’t give Democratic candidates the ballot-box boost they need.

Florida: The Sunshine State measure would establish abortion rights until viability — about 22 to 24 weeks — and repeal the state’s current six-week ban on most abortions. Republican Gov. Ron DeSantis has worked to defeat the measure, including using taxpayer-funded resources to push back on it.

Montana: Citizens will decide whether to protect abortion rights until viability. Democrats are betting the initiative will help Sen. Jon Tester (D-Mont.) in a tight race in a deep-red state.

Nebraska: Voters will have two measures on their ballots. One would safeguard abortion rights until viability, and the other would ban abortion in the second and third trimesters.

OTHER BALLOT INITIATIVES — Voters will weigh in on several other health care-related measures nationwide. We’re following some, including:

Medicaid: South Dakota voters will decide whether the state can impose work requirements in the safety-net program. Trump would likely need to win the White House for the rules to be implemented, though, because the federal government has to sign off on the changes.

Psychedelics : Massachusetts voters will determine whether to legalize the recreational use of some psychedelic substances for people 21 and older.

340B: California voters will choose whether the state should further scrutinize spending in the drug discount program. The program mandates drugmakers to sell outpatient drugs at discounts to hospitals, community health centers and many provider-based rural health clinics. Pharmaceutical companies have argued the program has deviated from its safety-net mission.

Marijuana: Florida, North Dakota and South Dakota citizens are voting on whether to legalize recreational marijuana for people 21 and older. DeSantis has fiercely opposed the initiative in his state.

Medically assisted suicide: A West Virginia ballot initiative would amend the state constitution to ban people from using medically assisted suicide in the state.

Names in the News

Elizabeth Hoffman is joining the ONE Campaign as executive director for North America. She was previously at the Center for Strategic and International Studies.

Emily Mace and Dainsworth Chambers are joining AstraZeneca’s federal affairs team. Mace previously worked in Rep. Larry Bucshon’s (R-Ind.) office. Chambers was previously territory manager at Apria Healthcare.

WHAT WE'RE READING

POLITICO’s Carmen Paun reports on the election’s stakes for global health.

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