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The US midterm elections: What they mean for the health of the nation

By Bette Browne - 25th Oct 2022

US midterm elections

As American politicians prepare to battle it out at the polls, healthcare may be the big loser. Bette Browne reports.

US President Joe Biden hopes that a landmark healthcare bill he signed into law will boost his Democratic party in the coming election battle for control of Congress. However, Republicans are playing down the urgency of healthcare reform in their quest to regain power. 

Democratic lawmakers, who have a slim majority in Congress and had been fighting for months for the legislation, were elated when President Biden signed their healthcare and climate change bill into law in August, seeing it as a major boost ahead of the 8 November congressional and state elections. 

Drug costs 

The legislation earmarked $64 billion (€65 billion) to help 13 million people to pay premiums over the next three years for private health insurance under the 2010 Affordable Care Act (ACA). It also caps prescription drug costs at $2,000 (€2,056) annually for recipients of the Medicare programme for older persons. In addition, they will pay no more than $35 (€36) monthly for insulin, which can cost hundreds of dollars in the US. 

“We pay more for prescription drugs than any other advanced nation in the world and there’s no good reason for it. For years, many of us have been trying to fix this problem, but for years Big Pharma has stood in the way. Not this year,” President Biden said. “This year, the American people won and Big Pharma lost.” 

In a long-sought goal to bring down the soaring cost of drugs in the US, the legislation would enable the Medicare programme to negotiate some prescription drug prices with pharmaceutical companies, which could save the federal government some $288 billion (€296 billion) over the 10-year budget window. 

The measure, which also includes a record $375 billion (€384 billion) over the decade to fight climate change, is a slimmed-down version of a more ambitious plan that President Biden and his party unveiled early last year. Their initial 10-year $3.5 trillion proposal also envisioned paid family and medical leave and expanded Medicare benefits. However, that failed when Democratic Senator Joe Manchin insisted it was too costly and went so far as to break off negotiations with the White House for a period. 

The Senator came on board later, however, and finally backed the slimmed-down version. Democrats were triumphant, hailing the legislation as a once-in-a-generation investment in the areas of healthcare and climate change. 

President Joe Biden 
Senator Chuck Schumer 
Senator Mitch McConnell

The House of Representatives, where the Democrats hold the majority, had earlier approved the measure on a party-line 220- 207 vote. It failed to get a single Republican vote in the Senate and passed only with Vice-President Kamala Harris breaking a 50- 50 tie in that chamber. During the debate, the Republican leader of the Senate, Mitch McConnell, characterised lowering the cost of prescription drugs as socialism. Democrats, he said, wanted “to put socialist price controls between American innovators and new cures for debilitating diseases”. 

In a speech in Philadelphia on 1 September, President Biden termed the Act as an historical achievement. Whatever about its historical significance, the President clearly saw it as a major political boost for his party facing into the elections. 

The legislation is paid for mainly through a new 15 per cent corporate minimum tax and stepped-up enforcement of tax rules on wealthy individuals. 

According to Democratic leader in the Senate, Chuck Schumer: “In normal times, getting these bills done would be a huge achievement. But to do it now, with only 50 Democratic votes in the Senate, over an intransigent Republican minority, is nothing short of amazing.” 

Roughly 77 per cent of Democrats and Democratic-leaning voters say healthcare is “very important” to their vote in the 2022 congressional election. By contrast, just 43 per cent of Republican and Republican-leaning voters agree. 

Democrats, however, will still have a major battle on their hands to translate any gains into ballot box votes next month. For a start, the party in power typically loses congressional seats during the first four-year term of a new president. 

In normal times, getting these bills done would be a huge achievement. But to do it now, with only 50 Democratic votes in the Senate, over an intransigent Republican minority, is nothing short of amazing 

So Republicans stand a strong chance of taking control of the House of Representatives, where they need to gain just four seats to assume the majority in the 435-member chamber. If that happens, it would be enough to derail most of the legislation President Biden and his fellow Democrats want to enact, including on healthcare. 

The battle for control of the Senate may be even easier for Republicans because there they need to gain just one seat to take control of the chamber. It is currently divided 50-50 with Vice-President Harris as the tie-breaking vote, as was the case in passing the Democratic healthcare legislation. 

Supreme Court abortion ruling 

Republicans are also hoping for a major turnout by their conservative base after the Supreme Court ruling in June that overturned the right to abortion, which became inevitable once President Trump’s three appointees swung the court to the right. 

However, as the restrictive impact of the ruling on women’s healthcare became clearer to many in the Republican party, its leaders became nervous. 

Within weeks of the ruling, many in America were shocked when news emerged that a 10-year-old girl, who had been raped, was blocked from having an abortion in her native Ohio and had to travel over 270km to neighbouring Indiana to access a termination. 

A poll by the Pew Research Centre found that a majority of the American public disapproved of the Supreme Court’s decision. Fifty-seven per cent of adults disapproved of the court’s decision, including 43 per cent who strongly disapproved. Forty-one per cent of adults approved of the ruling, while 25 per cent strongly approved. The survey also found that 62 per cent of Americans believe abortion should be legal in all or most cases. 

Republican worries deepened on 6 August when voters in a referendum in the usually reliable Republican state of Kansas decisively backed keeping abortion protections in the state’s constitution. 

Since then, there have been a number of delays in passing abortion bills across the country, some of which would have banned abortion even in the case of rape or incest. Many women are increasingly questioning the impact on their healthcare. They worry, for example, about whether a woman would have access to an abortion if she was faced with a life-threatening ectopic pregnancy or an incomplete miscarriage. 

Doctors say the abortion ban will imperil their ability to safeguard the health and lives of their patients. Many expressed concerns about the impact in cases including miscarriage and in vitro fertilisation. The practice of medicine will be reshaped or even contradicted “by laws not founded in science or based on evidence”, the American College of Obstetricians and Gynaecologists stated after the Supreme Court ruling. 

When Democrats in Congress tried and failed to codify the 1973 Roe v Wade abortion rights decision, they asserted that the solution would be a vote for the party in the November elections. The President referred to this in a press briefing in July. “We need two additional pro-choice senators and a pro-choice House to codify Roe as federal law,” he said. “Your vote can make that a reality.” 

He predicted that anger over the loss of abortion access would motivate women to turn out in record numbers. “I don’t think the court or for that matter the Republicans who for decades have pushed this extreme agenda have a clue about the power of American women,” he said, “but they’re about to find out.” 

In the meantime, he signed an executive order that will help women travel out of state to receive abortions, and ensure healthcare providers comply with federal law. 

Another executive order he signed will safeguard access to abortion care and contraceptives and protect patient privacy. Executive orders have limited power, however, since they can be overturned by Congress. 

Such congressional action is what anti-abortion groups are hoping for if Republicans triumph in November. “We are committed to exposing Democrats’ abortion extremism to voters across key battleground states so this extreme agenda can be soundly rejected at the ballot box,” declared Ms Marjorie Dannenfelser, the President of SBA Pro-Life America group, welcoming the Supreme Court decision. 

But the Republican party’s nomination of a raft of candidates to run in the November elections, characterised as ‘hard-line’ by many, has unsettled some voters. In a special election in August, voters in the usually Republican state of Alaska sent a Democrat to Congress for the first time in nearly half a century when they rejected Sarah Palin, a strong pro-Trump ally. 

At a Northern Kentucky Chamber of Commerce luncheon on 18 August, he expressed concern about the “quality” of some candidates who have embraced Trump’s false assertion that he and not Biden won the 2020 election. 

Still, Trump’s influence over voters was evident in races where Republican members of Congress who voted last year to impeach him were seeking renomination in the November race. Of the six who sought re-election this year, only two survived. In one of the most notable races, Republican Congresswoman Liz Cheney, one of Trump’s most vociferous critics, lost in a landslide to a candidate endorsed by the former president. 

If the US economy continues to suffer the fallout from Russia’s war on Ukraine, Republicans could have a strong chance of taking control of the House of Representatives, if not the Senate. 

Affordable Care Act 

Although most Republicans have continued to oppose President Barack Obama’s 2010 Affordable Care Act, which made health insurance affordable for millions of Americans, the party has become far less vocal about it as the elections approach. 

The reason is that they failed with a concerted campaign for over a decade to repeal the Act in Congress or block it in legal challenges. They increasingly realised that the Act is now popular with most Americans. Therefore, it is unlikely there will many fresh efforts at seeking its repeal if they win power. 

Polling by the Kaiser Family Foundation showed the Affordable Care Act had a 55 per cent approval rating, one of the highest ratings on the law since it was implemented. However, Senate Republican hopeful Mehmet Oz, a retired cardiothoracic surgeon, has said he would expand access to private short-term health plans that former President Trump championed as an alternative to the ACA. 

“Republicans have been talking about healthcare for the last decade almost exclusively around repeal and replace (of the Affordable Care Act). We found out the hard way that it’s not a winning issue anymore and backed off of that entirely,” Republican strategist Mr Brendan Buck told the Axios news site. “It’s not bias against healthcare. But, if it’s not inflation, gas prices, then it’s not a front burner issue.” 

The difficulty has been coming up with a distinctly Republican policy on healthcare, according to Mr Larry Levitt, Executive Vice-President of the Kaiser Family Foundation. “When Republican candidates have talked about healthcare, it’s generally in opposition to Democratic plans,” Mr Levitt told Axios. “That leaves Republicans in a bit of a box in this campaign since the ACA is now as popular as ever.” 


Democrats’ expectations that a swift economic recovery from the Covid pandemic would boost their election prospects have not been realised. Nevertheless, their efforts to protect Americans from the pandemic are continuing. 

In early September, the White House asked Congress for more than $22 billion (€22.7 billion) to address what it described as “critical” needs to finance its response to the disease, including funds to procure more vaccines, offer free community testing, bolster research, and other measures. 

However, comments by President Biden just a few weeks later that “the pandemic is over” had the effect of undermining the request in Congress, especially among Republicans. “We still have a problem with Covid. We’re still doing a lot of work on it… but the pandemic is over,” President Biden said on the CBS network on 18 September. Figures suggest otherwise, however, showing that while the number of deaths is decreasing they were still averaging about 400 deaths daily in October. 

If Republicans win in November they can be expected to hold congressional hearings on the origins of Covid and the Biden administration’s response. But for the moment they are vague on health policy. 

When the House of Representatives Republican Leader Kevin McCarthy unveiled his campaign agenda on 22 September – called a “Commitment to America” – it pointed to broad issues like price transparency and competition. Instead of a specific plan for the future of health reform, the document referred to commitments to provide cheaper and higher quality options, lower prices through transparency and competition, creating “lifesaving” cures and boosting access to telemedicine, plus protecting “the lives of unborn children and their mothers”. 

The findings signal a looming crisis for the healthcare industry and an impact on patients’ health and wallet that no-one can afford 

Meantime, as both parties swipe at each other with increasing ferocity, the health of democracy rather than the health of the nation may become the biggest concern for American voters. 

On 25 August, for example, President Biden used the term “semi-fascism” when he took aim at Trump and his supporters in the Republican party. “What we’re seeing now is either the beginning or the death knell of an extreme MAGA [Make America Great Again] philosophy,” he told a group of Democratic donors. “It’s not just Trump, it’s the entire philosophy that underpins (it)… it’s like semi-fascism.” 

In the September speech in Philadelphia, he charged Trump’s Republican allies of undermining the country’s democracy and urged voters to reject “extremism” in the November elections. 

Trump lashed back two days later at a rally, also in Pennsylvania, calling Biden “an enemy of the state”. He also branded the FBI and the Department of Justice as “vicious monsters”. 

His speech came at a time when the former President faces unprecedented legal jeopardy after the FBI raid on his Mar-a- Lago estate in Florida on 8 August as part of a wide-raging probe. 

He is also facing an ongoing investigation into the events of 6 January 2021, and whether he may have encouraged his supporters to invade the halls of Congress in an attempted coup to try to stop formal confirmation of Biden’s election as president. 

Voters want whichever party wins congressional power to dial down the bickering and focus on solutions to improve the country’s healthcare system, as evidenced by a representative poll in early October. 

Nearly half (44 per cent) gave poor (30 per cent) or failing (14 per cent) grades to the healthcare system, percentages that rose when it came to affordability and health equity, according to the poll of more than 5,500 Americans by the West Health group and polling organisation Gallup. 

Nothing earned more failing grades than affordability, which for three-quarters deserved no higher than a D (41 per cent) or F (33 per cent). The negative feelings about healthcare affordability were similar across gender, age, race, household income, and political persuasion. 

Nearly one-in-five Americans said they or a family member had a health problem worsen after being unable to pay for care and an estimated 70 million people (27 per cent) reported that if they needed quality care today, they would not be able to afford it. 

Health inequities account for approximately $320 billion in annual healthcare spending in the US, and if unaddressed, this figure could grow to $1 trillion or more by 2040, an analysis by Deloitte has found. Such a projected rise in healthcare spending could cost the average American at least $3,000 annually, up from $1,000 per year. “The findings signal a looming crisis for the healthcare industry and an impact on patients’ health and wallet that no-one can afford,” Deloitte stated. 

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