What voters want Congress to fix about health care

Key factors that helped Democrats take House

Health care was the top issue for voters in Tuesday's midterm elections. Just under half of surveyed voters mentioned it, while 70 percent said the health care system needs major changes. Voters' fears about health care may even have propelled the Democrats to win control of the House of Representatives: More than half of voters surveyed said the Democratic Party would be better able to protect people with preexisting health conditions.

But now the hard work begins. Partisan lines are still solid, with Senate Majority Leader Mitch McConnell and likely new House Speaker Nancy Pelosi digging in on opposite sides of almost everything. In the end, health care improvements for consumers will likely be slow in coming and incremental, happening one issue at a time, if any happen at all. 

Here's a look at three of the most important issues that motivated voters and what lies ahead for each:

Protect patients with preexisting conditions

Despite just about every candidate from either party and President Donald Trump saying they would support coverage for people with preexisting conditions, the new Congress may have to deal fairly soon with a serious threat to this important protection.

In September, a federal judge heard arguments from 18 state attorneys general and two governors in a lawsuit designed to eliminate the Affordable Care Act once and for all. The state AGs argue that because the new tax law eliminated the individual mandate fine, the mandate is deemed unconstitutional and the entire law is no longer valid. 

Justice Department: We will not defend Obamacare

In June, the Trump administration decided not to defend the ACA against this lawsuit, and it agreed in part that protections for people with preexisting conditions should be overturned.

Now that the midterms are in the past, the judge's ruling is expected soon. If he decides in favor of the argument, all protections under the ACA, including protections for preexisting conditions, would no longer exist.

Congress may be able to pass bipartisan legislation that would negate any positive ruling in the suit, which could proceed to a Supreme Court that has two new sitting justices. Legislation could create preexisting condition protections separate from the ACA. But Democrats and Republicans have differed in the past on how to get that done. 

And Mr. Trump's executive orders expanding the use of short-term and association health care policies that would not have to provide ACA protections -- including coverage for preexisting conditions -- continue to undermine the health care law.

Lower prescription drug prices 

Some analysts say this is an issue that Democrats and Republicans can come together on to pass effective legislation. Lots of ideas are on the table, such as introducing laws that would regulate the rebates drug companies give to third-party pharmacy benefit managers, which are widely blamed for inflating drug prices.

Trump announces plan to lower drug prices

The one big sticking point? Direct government negotiation with pharmaceutical companies through programs such as Medicare and Medicaid.

Last month, President Trump announced a plan under which the federal government would use a global pricing index to price the drugs administered by physicians and paid for through Medicare Part B. The U.S. pays far more than other industrialized nations for these drugs. 

It's a bold move. But by using a price index, the Trump administration skirts the issue of negotiating directly with drug companies, who maintain a large lobbying effort and make generous campaign contributions. He's taking the price index route, even though on the 2016 campaign trail, Mr. Trump promised that his administration would implement negotiation with drug companies.

As a result, drug prices became a focal point of the midterms. And so did Big Pharma's money. This year, 72 percent of candidates on the Democratic Congressional Campaign Committee list rejected corporate PAC money, including funds from drug companies, according to Roll Call. 

This may signal that those elected won't be reluctant to take on the giant industry. And in her post-election remarks, Pelosi pledged that Democrats would take "very, very strong legislative action" to lower the cost of prescription drugs.

Expand Medicaid 

Medicaid expansion was a calling card of Obamacare. After court battles, states were allowed to decide whether they would loosen income restrictions to offer extended Medicaid coverage to low-income individuals as described under the law. A total of 18 states decided against Medicaid expansion.

Major ballot measures that passed in 2018 midterm elections

In the midterms, however, three of those states -- Idaho, Nebraska and Utah -- passed ballot initiatives to expand Medicaid. In three more states -- Kansas, Maine and Wisconsin -- voters elected governors who supported Medicaid expansion, increasing the likelihood that these states will also offer the extra benefits.

While these are state initiatives, the results send a message to Congress that many voters still favor ACA Medicaid expansion. 

Along those lines, 28 states also have taken actions to strengthen their ACA individual insurance marketplaces, according to a report from the Commonwealth Fund. These actions include implementing reinsurance programs and rules that limit or ban the health care plans the Trump administration recently introduced that don't comply with the ACA.