A 2024 Election Summary and the Expected Impact on O&P and Health Policy

[caption id="attachment_261065" align="alignright" width="453"] Julija AI/stock.adobe.com[/caption] The 2024 US election results create significant uncertainty for O&P and healthcare policy as the White House and the Senate transition from Democratic to Republican control and the House remains in Republican hands by a slim margin of votes. This article provides a detailed analysis of the election results and their implications, including the impact on healthcare and O&P policy, what to expect in the lame duck session of the 118th Congress, a preview of the 119th Congress, and a summary of what is known of incoming President Trump’s healthcare priorities for his second administration. Election 2024 Overview of Election Results President Former President Donald J. Trump (R) won the 2024 presidential election, defeating current Vice President Kamala Harris (D) by winning both the Electoral College and popular vote by sizable margins. President-elect Trump won 312 Electoral College votes, surpassing the 270 majority needed for election, and received approximately 2 million votes more than Vice President Harris. President-elect Trump earned more than 76 million votes to Vice President Harris’ 74 million. President-elect Trump won key battleground states that he also won in 2016, including Georgia, North Carolina, and the so-called “blue wall,” Pennsylvania, Michigan, and Wisconsin. President-elect Trump also won Arizona and Nevada, states that President Biden flipped in 2020. Voter turnout for the 2024 election was expected to be near the record high turnout of the 2020 election; although it was not uniform across all states, it did not exceed 2020 numbers. 1 Congress The Republican party will serve as the majority party in the both the House and Senate. Republicans flipped the Senate from the current Democrat majority by winning seats in red states against incumbent Democratic Senators in Montana (Sen. Tester) and Ohio (Sen. Brown) and picking up a seat in West Virginia from retiring Sen. Joe Manchin (I-WV). Republicans also gained a seat in Pennsylvania, where Sen. Bob Casey (D-PA) conceded to David McCormick nearly three weeks after Election Day. The loss of Senator Casey is a blow to the disability community, which views Senator Casey as their primary champion for disability rights. Republicans secured 220 victories in the House, two seats more than necessary to give them control of the chamber. As of this writing, one seat is still uncalled in California. The 2022 midterm election left Republicans with a very slim majority in the House. That slight majority and several factions in the Republican party led to a protracted election of the Speaker of the House and the downfall of Speaker Kevin McCarthy (R-CA) in 2023. Despite a similarly slim margin in the incoming House, the House Republican conference unanimously voted in a closed-door session to make current Speaker of the House Mike Johnson (R-LA) their nominee for Speaker in the 119th Congress. A full floor vote will take place in early January. Detailed Analysis of Election Dynamics (as of November 30, 2024) 2 Senate: Republican Majority Assured The current count has Republicans with a majority of seats in the Senate (53) compared to Democrats and the two Independents who caucus with them (47). Republicans flipped four seats (Montana, Ohio, West Virginia, and Pennsylvania). Vice President-Elect J.D. Vance will vacate his Ohio Senate seat when he assumes office, and the Ohio governor will appoint a replacement who is expected to be a Republican. Earlier this year, Republican Senate Minority Leader Mitch McConnell (R-KY) announced his retirement from leadership after more than twenty years as a Senate Republican party leader, either as Majority Leader or Minority Leader. Despite a late surge by Trump-backed candidate Rick Scott (R-FL), Senate Whip John Thune (R-SD) was elected as the new Senate Majority Leader in a secret-ballot vote on November 13. Democratic leadership votes are scheduled for early December, and current Majority Leader Chuck Schumer (D-NY) is likely to remain his party’s leader as the Senate Minority Leader for the 119th Congress. Of the 100 Senate seats, 33 were up for election this cycle. Of these, the following 11 races were, at most times during 2024, the most competitive: Key Changes to Congressional Committees Overseeing Health Policy The four primary authorizing committees with jurisdiction over healthcare issues, programs, and policies in Congress will experience significant changes in membership due to election results and retirements, outlined below. Committee leadership assignments and committee appointments to fill vacancies have not yet been announced. While many senators and representatives make their committee intentions known to their respective party leaders before the start of a new Congress, it was unlikely all committee assignments would be finalized before the end of 2024. [caption id="attachment_261066" align="alignleft" width="430"] clsdesign/stock.adobe.com[/caption] Senate: Impact on Committee Membership With Republicans in the majority, Sen. Mike Crapo (R-ID) is poised to assume Chairmanship of the Finance Committee, responsible for addressing Medicare and Medicaid policy as well as tax policy, among other issues. Crapo, currently ranking member of the committee, has a banking background, tends to focus on rural issues, and will play a pivotal role in the new Congress on tax-related policies. He has worked closely with the current Committee Chairman Ron Wyden (D-OR) on major health issues, bringing Republicans on the committee along for high-profile votes on traditionally Democratic healthcare policies. Ron Wyden (D-OR) is expected to serve as ranking member in the 119th Congress. The committee has three retirements with Sens. Tom Carper (D-DE), Ben Cardin (D-MD), and Debbie Stabenow (D-MI). Additionally, Sens. Sherrod Brown (D-OH) and Bob Casey (D-PA) will be leaving Congress following election defeat. Sen. George Helmy (D-NJ) will be leaving the committee and the Senate in December 2024, following his three-month appointment to fill the seat of Sen. Bob Menendez (D-NJ) who resigned in August after his federal conviction on bribery charges. In all, there will be as many as six vacancies to fill in the Senate Finance Committee, all formerly held by Democrats. This is significant as Republicans prepare to move an enormous tax bill through this committee and Congress next year, potentially in the first 100 days of the president’s new term. With Republicans reclaiming Senate control, Ranking Member Bill Cassidy (R-LA), a physician, is set to chair the Senate Health, Education, Labor, and Pensions (HELP) Committee. Current HELP Committee Chairman Bernie Sanders (I-VT), whose tenure was marked by a hard stance on reducing drug costs and advancing Medicare for All, would likely have been the Committee’s Ranking Member but has indicated a preference to join the Finance Committee. The HELP Committee was not able to advance much legislation in a bipartisan fashion given the partisan divide on the Committee. Sen. Cassidy has expressed reluctance to pursue an Affordable Care Act (ACA) repeal, emphasizing the challenge of securing the 60 votes required to overcome a filibuster, a contrast to Trump’s continued calls to dismantle the 15-year-old law. Several members of the HELP Committee had close races this year. Sen. Tammy Baldwin (D-WI) won her race, while Sen. Bob Casey lost. Sen. Mike Braun (R-IN) ran for and won the Indiana governor’s race and Sen. Mitt Romney (R-UT) retired, leaving several vacancies on the committee. House of Representatives: Impact on Committee Membership In the House, there will be a significant shuffling of seats on key committees with jurisdiction over healthcare programs and policies due to the high number of representatives retiring or who ran for other offices. Several healthcare professionals newly won seats in the House, including pulmonologist Maxine Dexter (D-OR), family medicine physician Mike Kennedy (R-UT), obstetrician-gynecologist Kelly Morrison (D-MN), allergist-immunologist Bob Onder (R-MO), and psychiatric nurse practitioner Sheri Biggs (R-SC). Four members of the House Ways and Means Committee are retiring, including Reps. Drew Ferguson, (R-GA), Dan Kildee (D-MI), Brad Wenstrup, MD (R-OH), and Earl Blumenauer (D-OR). Brad Wenstrup was a champion of O&P legislative issues, and Ferguson is a doctor of medicine in dentistry. Over a dozen House Energy and Commerce Committee members did not run for reelection in 2024 including current committee chair, Cathy McMorris Rodgers (R-WA), Health subcommittee Ranking Member Anna Eshoo (D-CA), and physicians Reps. Larry Bucshon (R-IN) and Michael Burgess (R-TX). Reps. Brett Guthrie (R-KY) and Bob Latta (R-OH), and possibly Richard Hudson (R-NC), are vying to become the next Energy and Commerce Committee chair, and Rep. Frank Pallone (D-NJ) is expected to serve as the Committee’s ranking member. Rep. Buddy Carter, a pharmacist, is vying to chair the Health Subcommittee and Rep. Diana DeGette (D-CO) is likely to attain the role of ranking member on the Health Subcommittee. Healthcare Impact and Analysis End of Session Preview Following the election, Congress holds leadership elections for the new Congress and begins to plan its agenda. With a Republican majority in the House and Senate and a Republican president, there will be a sense that the party has a mandate to implement significant policy changes. The period between returning from the election and the end of the calendar year is referred to as a lame duck session of Congress. In December, President-elect Trump was expected to play a key role in directing what legislation was prioritized. However, since Republicans retained the House, the likelihood increased that any end-of-year legislative package would be by a narrower margin than initially expected or hoped for before the election. It was expected that Republicans might decide to push pending bills, including government funding (appropriations), into this year when they have full control to make decisions. 2025 Appropriations With funding for federal government agencies and programs expiring on December 20, 2024, Congress had to agree to either a final fiscal year 2025 appropriations package or a continuing resolution to fund the government at current levels for a defined period of time, or otherwise risk a government shutdown. With the change in political dynamics and little time left to negotiate all the appropriations bills, it is likely that Congress would pursue a continuing resolution in December to temporarily fund the federal government into next year, probably March 2025. Typically, appropriations bills act as a legislative vehicle on which other bills, especially Medicare-related bills, are attached. Additionally, as some legislators prepared to leave Congress and others looked to wrap up their 2024 agendas, there may have been an opportunity to attach bipartisan, bicameral, and low- or no-cost health policy bills. Such bills could have included a package of Medicare proposals to limit the expected 2025 cut to the physician fee schedule, extend current coverage of telehealth and telerehabilitation services, as well as other Medicare “extenders” to assist certain hospitals and other providers. Also possible were priorities that have long been championed by retiring members of Congress, such as the Improving Seniors Timely Access to Care Act (H.R. 8702/S. 4532), which would codify in statute new rules that Medicare Advantage (MA) plans must comply with pertaining to prior authorization of medical services and other beneficiary safeguards. Unfortunately, in this challenging environment, the likelihood of passage of the Medicare O&P Patient-Centered Care Act is low, but not impossible. ( Editor’s note: As of the time of this writing, the outcome of legislation during the lame duck session was unknown.) Health Agenda Preview The second Trump administration is expected to be more organized and purposeful in their approach to government than in its first term. Trump is planning a flurry of executive orders to implement many of his campaign promises on day one of his presidency that will likely span the federal agencies, including healthcare. The incoming administration is likely to scale back Biden-era policies, particularly those strengthening ACA enrollment (e.g., enhanced subsidies first enacted during the COVID-19 pandemic) and expanding abortion access. Although Trump has discussed increasing transparency, promoting competition, reducing regulation, and reducing medical costs, he has provided limited specifics at this point on how he would achieve these goals. In his first term, Trump proposed Medicare Coverage of Innovative Technologies to grant an initial four years of Medicare coverage for breakthrough technologies designated by the Food and Drug Administration (FDA). This proposed regulation was pulled back and modified by the Biden administration, but it may be revisited to bolster the current regulation in his next term. President-elect Trump has stated during the campaign that he would protect Medicare and Social Security, but many entitlement proposals may be up for negotiation if Congress passes a major tax bill that may require offsets in spending. He has been mostly silent on Medicaid policy specifics but has stated that large-scale deportations would alleviate what he describes as a “financial drain” on the healthcare system, theoretically reserving Medicaid for US citizens. His administration might approve state initiatives linking Medicaid eligibility to employment and consider Medicaid block grants to reduce Medicaid spending, a policy he previously advocated. He is also not expected to renew enhanced federal subsidies to assist individuals with low incomes in obtaining Medicaid coverage, as well as health insurance under the ACA. Key Nominations Incoming President Trump’s healthcare nominees inject great uncertainty into how the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) will be run, and what priorities will emerge. With the nomination of Robert F. Kennedy Jr. as HHS secretary, assuming he is confirmed by the Senate, public health agencies such as the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and FDA are expecting great scrutiny of their priorities and operations, let alone their funding levels. Vaccine skepticism, community water fluoridation, and over-reliance on food additives and medications will likely be top issues for consideration should Kennedy be confirmed for this role. Little is known about Kennedy’s views on O&P, let alone the broader field of medical rehabilitation, but he is clearly focused on reduction of chronic illness as a national priority and that potentially creates an opening for O&P and rehabilitation priorities. His views on Medicare, Medicaid, and the insurance marketplaces, which currently cover over 160 million Americans, are also unclear. President Trump promised to preserve Medicare, but Medicaid and ACA health plans—and the federal subsidies that flow to these programs—are very much at risk. Mehmet Oz, MD, has been nominated to lead CMS, the key federal healthcare agency for the O&P profession. Oz is a physician and television personality who ran unsuccessfully for the US Senate seat in Pennsylvania against now-Senator John Fetterman in 2022. He is a big proponent of telehealth, disease prevention, and MA. His favorable views on MA could undermine bipartisan efforts to reign in the current practices of MA plans, such as extensive use and misuse of prior authorization. Other key healthcare nominees include Jay Bhattacharya, a Stanford-trained physician and economist who criticized the COVID-19 lockdowns, whom Trump proposed to head the NIH. Jim O’Neill has been nominated as HHS deputy secretary. He will help Secretary Kennedy implement his agenda. O’Neill is a Silicon Valley investor and former federal health official. Marty Makary, a surgeon at Johns Hopkins, will head the FDA, and former Republican Congressman Dave Weldon, will lead the CDC. Janette Nesheiwat, a family and emergency physician, will be the next surgeon general. All of these nominees are subject to Senate confirmation. Public Health and Research A second Trump administration and Republican Congress is poised to make substantial policy changes involving public health, with a strong focus on deregulation, reducing government involvement, defunding or reducing funding to certain agencies, and promoting alternative health strategies. Details are not yet clear, but Trump campaigned on making significant changes to federal health agencies including the FDA, CDC, and the NIH. In fact, a comprehensive redesign of NIH proposed by the House Energy and Commerce Committee before the election takes on new significance with the transfer of power. Proposed Government Efficiency Commission One of President-elect Trump’s campaign promises was to establish a task force that would cut federal programs and crack down on improper payments. The idea was brought to Trump by tech billionaire Elon Musk, and Trump has since tapped Musk and tech billionaire and former Republican presidential candidate Vivek Ramaswamy to lead a new Department of Government Efficiency (DOGE). The DOGE is likely to be an advisory committee and offer recommendations to federal agencies like the Office of Management and Budget. Creating a commission to trim wasteful spending is not a new concept as both former presidents Ronald Reagan and Bill Clinton established similar task forces, but with mixed results and shortcomings associated with both attempts. Nevertheless, the potential healthcare impact as it relates to the ACA and Medicare and Medicaid spending could be relevant with the creation of this commission. Peter W. Thomas, JD, is general counsel for the National Association for the Advancement of Orthotics and Prosthetics and counsel to the O&P Alliance. Emma Gunter is a legislative project assistant, Powers Law Firm. 1 Voter turnout in 2024: Map shows how they compare by state, The Washington Post 2 House election results 2024 live updates, The Washington Post

A 2024 Election Summary and the Expected Impact on O&P and Health Policy

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A 2024 Election Summary and the Expected Impact on O&P and Health Policy

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