Ken PerezIn the wake of the 2018 midterm elections, in which health care emerged as the top issue for voters, the United States was left with a divided government, with the Republicans controlling the executive branch as well as the Senate, and the Democrats controlling the House of Representatives. 

Not to be overlooked, in December, the judicial branch also appeared to enter the partisan fray, with two highly controversial rulings by federal district courts. On Dec. 14, a conservative judge in the federal district court in Texas declared the entire Affordable Care Act (ACA) unconstitutional. Then on Dec. 27, a liberal judge in the federal district court in Washington, D.C. struck down the U.S. Department of Health and Human Services’ payment reduction to the 340B Drug Pricing Program, dealing a blow to the Trump administration’s efforts to reduce drug prices. While these court decisions undoubtedly will be appealed, they clearly added fuel to the fire of polarization and divisiveness that has engulfed the nation.

Given a divided government, are there any healthcare-related areas where common ground exists between Republicans and Democrats? 

The day after the 2018 midterm elections, Senate Majority Leader Mitch McConnell (R-Ky.) voiced his support for protecting people with pre-existing conditions, addressing the problems with the ACA (presumably including continued high healthcare costs), and tackling high prescription drug prices. Similarly, on Jan. 3, in her first address as Speaker of the House, Nancy Pelosi (D-Calif.) indicated that a prominent part of the mission of the House of Representatives would be “to lower healthcare costs and prescription drug prices, and protect people with pre-existing conditions.”  

Thus, at least between the highest-ranking leaders of both parties, there is shared concern about these three issues. There is also tacit understanding that polar extremes are infeasible, as McConnell has conceded that a complete repeal of the ACA is off the table, and Pelosi has been careful not to endorse Medicare for All. 

Of course, although conservatives and liberals may share concerns about healthcare costs and prescription drug prices, as well as the opioid crisis, when it comes to actual passed legislation, the devil is in the details. Hopefully, the art of bipartisanship can be rekindled. 

However, even if Congress is able to produce and pass compromise legislation, there is the specter, especially with the Trump administration, of the presidential veto. As illustrated in the current acrimonious debate over funding of a border wall, which has led to an ongoing government shutdown, the real conflict often is arguably over political power—not the particulars of policy. 

The 2018 midterm elections made it clear that the American populace cares a lot about health care, so the message to Washington is to keep seeking common ground and generating bipartisan solutions. 


Ken Perez is vice president of healthcare policy, Omnicell, Inc., Mountain View, Calif., and a member of HFMA’s Northern California Chapter.

Publication Date: Friday, January 18, 2019