As I sit here writing, I’ve seen exactly 5 political ads in one commercial break. Five! Granted, Colorado is a huge swing state for the House, Senate, and Gubernatorial races, but still. And of course, all these commercials are filled with mudslinging and misinformation to sway voters one way or another. Almost everyone I’ve talked to about the upcoming elections seems so jaded about the entire political process, and many hold out little hope that anything beneficial will actually get done. Honestly, I can’t blame them. The past few years, Congress has been so polarized that they intentionally fight over every bill to the point that nothing gets done.
Can we really expect things to change after this year’s elections? The best response is one that we hear all the time in PT school: it depends. With the House currently controlled by Republicans, and the Senate controlled by Democrats, many bills easily pass one chamber just to get shot down by the next. The Affordable Care Act is still a hotly debated topic in Congress, despite being passed as law AND approved by the Supreme Court. Still, House Republicans have voted numerous times to either repeal, change, or add more oversight to the ACA. Some have passed, but many more have failed in the Senate. Each legislator’s stance on the ACA has had a huge impact in their current campaigns for election/re-election.
Republicans are gunning to retake the Senate this November. They would then have the majority in both chambers of Congress, making it much easier to pass laws through without as much bipartisan support. In all likelihood, Republicans are going to retake the Senate. With Republicans actively trying to change or tweak the ACA, we might see more limitations put in place, or laws that would reel in Medicaid expansion across the country. The issue of Medicaid expansion is one specific issue that Republicans and Democrats bitterly oppose each other. Democrats wish to expand Medicaid coverage to millions more people under the federal poverty line, allowing more access to healthcare for the underserved population. Meanwhile, Republicans are mostly opposing expansion, because that would mean the government would have to pay more in healthcare for these people, ultimately causing more national debt.
Obviously, changes to Medicaid would have a big impact for physical therapy, particularly for those working in acute care and inpatient settings. With more people covered by Medicaid, there will be more patients admitted, requiring physical therapists to appropriately discharge these patients quickly, as the hospital receives a lump sum for that patient, regardless of their length of stay. This may lead to higher productivity requirements for inpatient PTs, and reimbursement for rehabilitation departments can be significantly impacted by lower productivity measures.
Even if Congress sways to Republicans, will there be sweeping changes to healthcare right away? I don’t think so. For one, Democrats will still have some authority, as they would still be able to filibuster more controversial bills. Second, Medicaid expansion has historically been performed on a state level. That means this would be dependent on gubernatorial elections, rather than Congressional. Perhaps the biggest barrier to large changes is the fact that Republicans are trying to gain more favor for their future presidential candidates in 2016. If they were to pass controversial healthcare changes next year, this could potentially lead moderate voters away from Republican candidates, particularly the more left-leaning voters.
The original Medicaid expansion plan
Molly Ball, a writer for The Atlantic, wrote an interesting piece on this possibility. Her take in a recent article is that we won’t likely see huge changes in day-to-day operations. However, if the Senate were to flip, Sen. Mitch McConnell (below)
would become the Majority Leader. He has always taken a hard stance against President Obama and his attempts to pass more liberal legislation. If he does become Majority Leader, he would have the authority to determine what bills get considered in the Senate. With Congress already so polarized and gridlocked, this seems like the status quo for the next two years. This is actually a very interesting perspective, as the Senate Committees and sub-committees will also change hands. As you may remember from one of my prior posts, this is where many bills are either killed outright or passed on with amendments. If any healthcare changes were to occur, this would be a critical choke-point in order to pass.
“One possibility is that nothing will really change. After all, we have divided government now, and we will still have divided government if Republicans go from 45 senators to 51.” – Molly Ball, The Atlantic, 10/27/14
Ultimately, we’re not really sure what will happen next week. My belief is that with each party so entrenched and opposed to each other, it will be difficult to suddenly break that mindset with new leadership. We can always hope to see beneficial changes, but both parties must learn to work together for that to happen. Can we expect that to suddenly happen? Make sure to watch the elections November 4 to find out! Also, DON’T FORGET TO VOTE! It’s the biggest thing we as citizens can do to change the future and direction of our country.
What do YOU think will happen after the midterm elections? Comment below, or find me on Twitter @tylerspt!
an exercise in politics 