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Stephanie Pellitt

, National Council for Behavioral Health

Health Care Emerges as Top Issue in Midterms

November 8, 2018 | ACA | Medicaid | Mental Health | Comments
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With historic levels of voter turnout, Tuesday’s midterm election results saw Democrats regain control of the House of Representatives, while Republicans strengthened their majority in the Senate. Health care emerged as a clear priority for voters and Medicaid expansion proved to be a big winner on election night. With power now divided in Congress, the next two years could feature intense political gridlock or force bipartisan compromise. Right now, one thing is clear – the 2018 midterms will send one of the largest classes of freshmen Members to Washington in recent history – and with them come new advocacy opportunities for the National Council and its members.


According to a CNN exit poll, about four in 10 voters chose health care as the most important issue facing the country, ahead of issues like immigration and the economy. A closer look at the data showed health care to be a much bigger driver for Democratic voters than Republican voters. Although the issue may have driven a lot of Democratic voters to the polls, it did not appear that health care was a decisive factor in many of elections results on Tuesday.


With Democrats controlling the House, Congress’ health care agenda will change dramatically. Most importantly, Republican leaders are expected to abandon their efforts to repeal and replace the Affordable Care Act (ACA) and cut Medicaid by converting it to a block grant program. These efforts were strongly opposed by the National Council as they would have resulted in dramatic cuts in funding for behavioral health treatment services and harmed individuals living with mental illness and addiction.

So, what’s next on Congress’ health care agenda? At this point, little is known about the Democrats’ next steps on health care beyond defending the ACA. Notably, Democrats have signaled interest in advancing another opioid-focused package in 2019, as many claimed the recently-signed opioid law does not go far enough for treatment-focused solutions. Each year, Congress has certain “must-pass” bills, including the appropriations bills, which fund the federal government each year. These bills may provide opportunities for bipartisan compromise on health care issues, including the opioid crisis, or we may see these bills fall into political gridlock between the two parties.

Regardless of the political environment, the National Council will work hard to maximize opportunities to advance access to mental health and addiction care for all Americans. We look forward to working with both chambers of Congress to advance key issues like expanding behavioral health treatment capacity through the Excellence in Mental Health and Addiction Treatment Expansion Act (S. 1905/H.R. 3931), strengthening the behavioral health workforce, securing funding for federal mental health and addiction programs, and more.


Medicaid expansion was a big winner at the ballot box this year, representing a great victory for individuals with low-incomes who lack health care coverage and the providers who serve them. Three Republican-led states, Utah, Nebraska, and Idaho passed ballot measures to begin Medicaid expansion. These measures are expected to extend Medicaid coverage to around 300,000 new recipients.

Beyond ballot measures, the outcomes of governors’ races in Wisconsin and Kansas may also clear the way for Medicaid expansion in those states. Further, Maine, the first state to pass Medicaid expansion at the ballot box, may finally have the opportunity to implement its expansion with election of a Democratic governor and the departure of Governor Paul LePage (R), a vehement opponent of Medicaid expansion. This would bring the total number of Medicaid expansion states to 37 (with the potential addition of 2 states – Wisconsin and Kansas). These new Democratic governors may also have a big impact in the rollout of their more conservative predecessors’ waiver requests, which included Medicaid work requirements and drug testing/screening.


With each new Congress comes opportunities for the National Council and its members to forge new relationships with Members of Congress, who can champion our issues on Capitol Hill. Do you have a relationship with any of the new or existing House or Senate members? Tell us about any key relationships you may have with Members of Congress or their staff. Successful advocacy often comes down to the strength of our relationships with legislators, so we’d love to hear from you!

Finally, be sure to stay tuned to Capitol Connector for future news and advocacy opportunities!