2023 health care policy forecast: Gridlock with a chance of cooperation

Jennifer Young
_{Tarplin, Downs & Young LLC}

Chris Jennings
_{Jennings Policy Strategies Inc.}

With a Democratic president and just slim majorities in the Senate and House of Representatives, how likely is gridlock on federal health care policy in 2023?

It depends on the issue, said two experts who made their forecasts in “What’s Next for Health Policy After the Election?” KFF sponsored the webinar with KFF Executive Vice President for Health Policy Larry Levitt and analysts Chris Jennings, founder and president of Jennings Policy Strategies Inc., and Jennifer Young, cofounder and partner with consultant Tarplin, Downs & Young LLC.

Votes were still being counted when the online meeting began at noon Nov. 15, and Georgians will have a runoff election for a Senate seat, so exact divides were not available for either the House of Representatives or the Senate.

Whatever the outcomes, Young and Jennings predicted the federal lawmakers and the White House could make progress on some health care issues, but others will stall.

ACA

Repealing and replacing the Affordable Care Act are no longer the defining backbone of health care policy for congressional Republicans, Young said. It’s not a winning issue and a Democratic president won’t sign it into law, she said.

The GOP’s Health Future Task Force has members thinking about a positive, constructive, proactive health care agenda “that lives in the realm of the doable, rather than the hypothetical,” Young said. That group has had participation from caucus members to coalesce around core themes of security for pandemic preparedness and supply chains; affordability, focusing on transparency and competition; treatments, including research, development, innovation in medicine and access to American-made medicines; lower drug costs; electronic health records; prior authorization; and modernization.

Common grounds

With Democrats barely controlling the Senate and Republicans controlling the House, issues such as mental health policies, opioid treatment programs, telehealth and technology, are some issues most likely to gain bipartisan support, Jennings said. Some members of the Senate could continue advocating for vision, hearing, and dental expansions in Medicare, he said.

Possible gridlock?

Election campaigning was rancorous, Levitt said, and both analysts talked about “gridlock.” He asked about prospects for moving forward with bipartisan legislation.

“I think decent as long as people’s expectations are appropriately set,” Young said. “You know, this is not going to be a Congress in which you can accomplish bold coverage goals in a bipartisan way.”

But Congress could buy time to analyze possible long-term solutions for telehealth program integrity and sustainability, Young said. She agreed bipartisan support could emerge for mental health support, changing Medicare payment rules to physicians, and new drugs for Alzheimer’s disease.

Administrative action

In the next two years, the administration of President Joe Biden will use its authority to pursue and promote its own agenda, Jennings said. When there is a polarized government and a perception of stagnation in Congress, the administration the executive branch pushes its agenda, no matter the party in the White House, he said.

The administration must deal with significant changes in benefits and design of Medicare, restructuring the extension of the ACA health insurance marketplace, and eliminating or sunsetting the COVID-19 pandemic public health emergency. Expect pharmaceutical companies to head to court, leading to actions by the judiciary, Jennings said.

Post-Hobbs issues

Levitt predicted little agreement on abortion rights by Democrats and Republicans. Young and Jennings predicted there could be bipartisan support for expanding Medicaid for the post-partum period, but there is a complication.

Some Republicans will be “very focused on any Medicaid money going into states, (that) could displace existing state dollars which could then be used to finance their own support for choice-related issues,” Young said. “And I know that sounded convoluted as I explained it, because it is convoluted inherently.”

Some Republicans will agree with aggressive positioning on abortion, but behind the scenes, others will think the most aggressive rules do not appear to be consistent with what voters are saying, Young said. That likely won’t translate into an immediate and dramatic pivot in party positioning, Levitt said. But as long as Republicans overreach on that issue, Democrats will try to take advantage of that, Jennings said.

COVID-19 pandemic relief

Between now and the next Congress, prospects are slim for additional federal spending for COVID-19 response, Jennings said, for a number of reasons:

• The public has complete exhaustion with COVID-19.
• People are ignoring almost all guidance on the virus.
• The president indicated the country is moving beyond COVID-19.
• There is federal money on the table for COVID-19 response, that Republicans are saying has not been spent yet.
• The lame duck Congress generally doesn’t act until and unless something absolutely has to happen, and there’s bipartisan consensus.

“But that would be my unfortunate read,” Jennings said. “Even though I believe the resources are necessary and we my rue the day that we did not allocate resources for this, and I’m going to say that for the record now. But it doesn’t look very good, looking at the Congress.”