Studies conducted over the past several years have found the polarization is increasing in American society.a And not surprisingly, the 2022 midterm elections reflected the deep divisions.
Two fiercely contested Senate seats in this past election are emblematic. Democrat John Fetterman won Pennsylvania’s hotly contested Senate race over Republican Mehmet Oz, MD, taking over the seat formerly held by retiring Republican Sen. Pat Toomey. Then in a Dec. 6 Georgia runoff election, incumbent Democratic Sen. Raphael Warnock edged Republican challenger Herschel Walker by less than 100,000 votes out of the more than 3.5 million cast. Ultimately, the Democrats held onto 14 seats, the Republicans held onto 20, and the Democratic win in Pennsylvania allowed the Democrats to add one seat to their slim Senate majority.
In the House, the Republicans gained nine seats and regained control, 222-213, although it took 15 rounds of voting for the fractious GOP to elect Kevin McCarthy (R-Calif.) house speaker.
With the Republican majority in the House, the United States will have a divided government for the next two years, as it has had throughout 10 of 17 full congressional sessions since 1989.b The message from pundits regarding this latest occurrence of divided government is pessimistic.
Steven Smith, a professor at Washington University in St. Louis, predicted that the next two years in American politics will be marked by unavoidable gridlock and vetoes, noting that President Joe Biden’s goals will be far more limited in the new Congress than previously.c
Anthony Zurcher of BBC News was more blunt: “For the next two years, legislative gridlock will be the name of game.”d
Olive branches in short supply
When the party in the White House holding majorities in both the House and Senate loses majority control of one or both chambers of Congress, the president, not wanting to appear oblivious to the message delivered by a majority of the electorate, usually makes some statement indicating a desire to find common ground with the opposition party. For example, after President Barack Obama suffered what he famously called “a shellacking” in the 2010 midterms, he pronounced himself humbled and pledged to negotiate with Republicans on a much less aggressive agenda.
Similarly, two days after the recent elections, President Biden said, “I’m prepared to work with Republicans, but the American people have made it clear they expect Republicans to work with me as well.”e
Common ground and bipartisanship
Working with the other party means finding common ground to garner the bipartisan support in Congress necessary to pass legislation. Yet today’s polarization makes such a prospect elusive. The question will be how to get there.
There are different paths to bipartisanship. One path may be described as “something for everybody,” or perhaps more appropriately, “something for both political parties.” The latest omnibus spending bill, The Consolidated Appropriations Act of 2023, is a good example. It was passed by the Senate by a 68-29 vote on Dec. 22, 2022. Then the following day, the House passed the bill by a 225-201 vote, with one abstention. Both votes were bipartisan, and Biden signed the $1.7 trillion spending bill into law on Dec. 29, while on vacation in the U.S. Virgin Islands, avoiding a government shutdown and funding the federal government through September. The legislation provides $858 billion for defense spending, which Republicans supported, and $773 billion for non-defense discretionary spending, which pleased the Democrats. Consequently, after the bill was signed into law, both parties claimed victory.
Another path to bipartisanship is the traditional common-ground approach. Some political scientists, such as Smith, think that the Democrats’ strategy will be to press for votes on popular legislation to get Republicans to go on record against those measures. Avoiding the default of the U.S. government by raising the federal government’s debt ceiling is one such measure, and accordingly, McCarthy expressed in February a desire to find common ground with Biden on that issue.
What it all means for health policy
Although Biden has already declared that undoing the Inflation Reduction Act’s prescription drug pricing reforms is off limits, certain less-controversial health policy changes, which truly constitute common ground, could gain passage during this new Congress.
A prime example is pharmacist provider status, which would add pharmacists to the list of providers whose patient care services are covered by Medicare Part B, when delivered in medically underserved areas. The Pharmacy and Medically Underserved Areas Enhancement Act was introduced during the last Congress for this purpose, in response to the nation’s serious shortage of primary care physicians.
There were 14,193 primary care residents training in the 2021-22 school year versus annual demand of over 17,000 such residents.f Meanwhile, the nation’s shortage of primary care physicians is projected to increase to nearly 48,000 by 2034.g Further, rural areas feel the brunt of the growing shortage. While only 14% of Americans live in rural areas, rural communities represent nearly two-thirds of the nation’s primary care health professional shortage areas.h
Unfortunately, the bill died in committee, despite having significant groups of cosponsors from both parties in both chambers of Congress.
Pharmacist provider status is one of those legislative initiatives that appeal to both parties, because it would help promote greater health equity, a Biden administration priority, and it would especially assist rural areas, where congressional preferences have become more Republican since 2006.
What Americans want
Today’s divided government mirrors our sharply divided populace. But that division does not mean that a majority of voters will be content with intractable, grinding gridlock over the next two years. Rather, most Americans would prefer that Congress and the President follow a different, more productive path, finding common ground and pursuing bipartisanship.
a. See, for example, Dimock, M., and Wike, R., “America is exceptional in its political divide,” Pew, Trust Magazine, March 29, 2021.
b. See history.house.gov, “Party government since 1857.”
c. Savat, S., “WashU Expert: Next two years will be marked by gridlock, vetoes,” Washington University in St. Louis, Jan. 13, 2023.
d. Zurcher, A., “US election results: Where do midterm elections leave Biden?” BBC News, Nov. 10, 2022.
e. Sabes, A., “Biden vows to work with Republicans who have ‘good’ ideas, but not on some issues,” Fox News,
Nov. 10, 2022.
f. Kacik, A., “Data shows mental health, primary-care physician shortage,” Modern Healthcare, Jan. 17, 2023.
g. Association of American Medical Colleges, “AAMC report reinforces mounting physician shortage,” Press release, June 11, 2021.
h. Waldrop, T., and Gee, E., “How states can expand health care access in rural communities,” Center for American Progress, Feb. 9, 2022.