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Did Mid-Term Elections Put Health Care in the Crosshairs?

By John R. Roth, MS, CAE, Executive Editor, Journal of Contemporary Pharmacy Practice (Fall 2018 issue)

Unless you are one of those folks who don’t own a television or refuse to open your mailbox, then you were undoubtedly like the rest of us and were inundated with political ads the past several months leading up to the 2018 mid-term elections. This election cycle is likely to go down as the most expensive political cycle in our country’s history. According to the Washington Post, over $1 billion was spent in congressional races alone; that doesn’t count the number of state legislative and governor races. In California, as an example, at the end of the day over $1 BILLION was spent on all the elected offices in that state. Other states such as New York, Florida, and Georgia also saw jaw-dropping money being spent by both parties to place their candidates in the winning seat. 

For all the talk about a “blue wave” expected to sweep across the country, just about every political commentator I heard from summarized the aftermath as more of a blue ripple rather than a blue wave. Depending on the political leaning of the commentator you listen to, the degree to that ripple varied. But at the end of the day it does beg the question, “Was all that money worth it?” I don’t mean was the money worth it in terms of the resultant blue wave or not, but more generally, was the money worth it when the election results really ended up as expected with the Democrats winning about the number of House seats that were predicted and the Republicans picking up several Senate seats – as expected. So in the end it was all a big to-do about nothing. Is that what we should be spending billions of dollars on in our country? A rhetorical question, I admit, but it does make you stop and think. 

I suppose some would argue that it was the hyper-spending by the parties that more, or less, guaranteed the results that were predicted a month before the election. But I would argue that a good amount of that money spent was within the final few weeks, so given that the election met the projections, did the money really change any hearts or minds of the good folks back home? 

Now that the frenzy is behind us, let’s take a look at the political backdrop in the context of how it may, or may not, impact health care. I will start with the end in mind and predict that the status of health care as we know it today is going to remain “as is” for the next two years. There is a divided Congress and the President has had two previously failed attempts at substantial derailment of the Affordable Care Act (ACA) when the Republicans held both houses and the executive seat. Yes, the President and Congress were able to tinker and nibble at the edges of the ACA in 2017 with changes such as eliminating the individual mandate. I would call what they left us with as perhaps the ACA-lite.

It is not the fully loaded version as signed into law by President Obama, but it certainly was not a “repeal and replace” either. In large part the major components of the ACA are still intact. Those components are Medicaid expansion in the states and state insurance coverage programs. That was always the bread-and-butter of the ACA, and those remain ongoing as of today. But given the dynamics of a split Congress there is not going to be a wholesale attempt at major health care reform until after the 2020 Presidential election. And even then it will likely only be attempted if President Trump wins re-election and the Congress shifts back to a dual Republican majority in both houses. Even then I give a major reform only about a 50-50 chance of success. History is not on the reformers’ side. 

For pharmacy practice, I predict this is good news. Why? Well, if both the executive and legislative branches know that they won’t need to be jockeying for a major reform attempt, then perhaps we can get to work on some of the pharmacy-centric administrative fixes that are needed. These would be items such as the great, early success that the national pharmacy associations are having with advancing discussions with the Secretary of Health and Human Services (HHS), Alex M. Azar, II.

These discussions and educational meetings have proven beneficial at demonstrating several of the areas that are in need of correcting, such as DIR fees, the opioid epidemic, and financing for pharmacist patient care services. Secretary Azar has been very engaged in understanding the complex, and complicated, way in which medicines are purchased, paid for, distributed, and reimbursed. This has helped the Trump Administration place pharmacy reforms as a key priority in what the Secretary has announced is his blueprint– or priorities – for the administration. HHS has identified four challenges in the American drug market: 

  • High list prices for drugs

  • Seniors and government programs overpaying for drugs due to lack of the latest negotiation tools 

  • High and rising out-of-pocket costs for consumers 

  • Foreign governments free-riding off of American investment in innovation 


Without the distraction of a major political battle on a larger health care reform effort, there is an opportunity to continue making traction on these important administrative areas that would be tremendous wins for pharmacy practice. Two years seems like a long time for us to make gains on these priorities, but we must also remember that the election cycle for the 2020 Presidential campaign will begin in 2019, most likely within a year of you reading this article. So time will move quickly, and so must we in order to achieve these intermittent wins.

We all felt what the mid-term election cycle brought, and as you can imagine, the next Presidential cycle will be all that – on steroids. So I encourage you to dig in and participate in the process by joining your state and national pharmacy associations, host a member of Congress in your pharmacy, and donate to one of the pharmacy Political Action Committees. We will need all hands on deck to ensure we have a voice in the process before the chaos ensues.

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