What the Midterm Results Mean for the 118th Congress

Leading up to the midterm elections, many expected a red wave to sweep across the country, particularly in a year when President Joe Biden’s popularity is extremely low; however, this wave never materialized and several weeks later we are still waiting for some results. In the 118th Congress, Democrats will either control 50 seats in the Senate with Vice President Kamala Harris again serving as the tie breaker, or 51 seats should Senator Raphael Warnock win the runoff election scheduled for December 6. Republicans did flip control of the House of Representatives, but at press time, they have won 220 seats, enough to claim the majority, with two races still outstanding. Regardless of the outcomes in those races, Republican leadership will have little margin for error when trying to pass legislation without Democratic support.

The 118th Congress is unlikely to be one that adopts sweeping policy changes. Neither party will be able to advance partisan policies. Instead, this Congress will only be able to make considerable progress in areas with strong bipartisan agreement; telehealth and mental health policy may be examples of where progress can be made. Another area where we may see significant legislative change is Medicare physician payment as Representatives Ami Bera (D-CA) and Larry Bucshon (R-IN) solicited a bipartisan request for feedback on the topic this fall, and Congress is tired of passing costly physician payment updates each year.

Despite some meaningful health policy areas that could be addressed in the new Congress, we anticipate Republicans and Democrats will disagree on more policies than they agree…some with significant consequences. Once area where Republicans can exert their newfound leverage is on raising the debt ceiling. The $31.4 trillion debt limit will need to be raised before the end of 2023. Influential Republicans have described the debt limit as a tool they will use to extract major spending cuts, despite the risk of crashing the economy.

Republicans will also be able to meaningfully influence the fiscal year 2024 appropriations bills by controlling the House Appropriations Committee. This will allow them to include their priorities in the House’s spending bills, placing them in a stronger negotiations position as Democrats will only control the Senate Appropriations Committee. Republicans will likely argue for greater increases in defense spending while Democrats typically make larger investments in non-defense discretionary programs, including health programs. Ultimately, divided control of Congress may deliver a return to parity between defense and non-defense spending allocations.

While Republicans will not be able to enact significant legislative changes, expect them to advance their agenda through a robust oversight agenda in the House. Leaders have already discussed several topics for oversights, including the COVID-19 pandemic, the Biden administration’s immigration policy, and President Joe Biden himself and his family.

For questions, please contact Katie Martino, SGO’s Manager of Governance and Clinical Practice.