Capsule: Democrats’ 2020 Test, Blows to Abortion, & Medicaid Wins

By Jacquie Lee

Welcome to Capsule—your weekly dose of health-care news, where we give you a recap of this week’s highs and lows for key players in the health-care industry. You can expect us every Friday morning as a bookend for your week.

So you thought you’d finally escaped midterm coverage, did you? Sorry to say, there’s still a lot to unpack from the elections Nov. 6—whether it’s the ballot initiatives that passed or which health policy initiatives are now front and center in Congress. Let’s take a look.

Here’s who ended the week on a high note:

  • Democrats wrested control of the House from Republicans in the midterms. That’s clearly a pretty good week for Democrats—but especially for female candidates, who saw a record-breaking amount of election wins, Mark Niquette and John McCormick from Bloomberg News report.
  • The victory also means Democrats will take over the top committee positions and be able to drive policy decisions. For example, the House Ways and Means Committee, which includes a health subcommittee, currently has 24 Republicans and 16 Democrats, a picture that will flip in the 116th Congress with Democrats having the majority of members, Kaustuv Basu and Shira Stein report.
  • Some ballots from this week’s election haven’t even been counted yet, but Democrats are already looking forward to what 2020 holds. Health care will likely stay on voters’ priority lists, which means the left needs to refine its health-care message moving forward, Shira Stein writes.
  • After all, not all policies play out the same way. Candidates who won in contentious races—like Lauren Underwood (D-Ill.), Sean Casten (D-Ill.), or Colin Allred (D-Texas)—were more likely to be elected because of their support for insurance coverage of pre-exisiting conditions rather than backing Medicare for All, Stein notes.
Medicaid Expansion
  • Voters in Idaho, Nebraska, and Utah voiced their support at the ballot boxes Nov. 6 for expansion of the federal health program, Medicaid. That now makes 37 states that have decided to offer Medicaid coverage to more low-income adults, Victoria Pelham and Adrianne Appel report.
  • The sweep of Medicaid wins in GOP states is a sea change for Obamacare’s expansion that faced years of intense conservative opposition, including from the Trump administration. It’s also a sign that the program’s growth could be here to stay.
  • States will now have to figure out how to fund those newly covered people, although the feds pick up the tab for roughly 90 percent of the cost of expansions. It’s unclear how Nebraska and Idaho will fund their share, although Nebraska might consider a cigarette tax. Nebraska Republicans might also look to impose work requirements, which could reduce the number of people eligible for the program.
Dialysis Companies
  • The country’s largest dialysis companies, DaVita and Fresenius Medical Care North America, dodged a bullet this week in California when voters rejected a statewide cap on dialysis providers’ profits, Joyce Cutler and Adrianne Appel report.
  • Dialysis is a process that removes excess toxins, water, or solutes from someone’s blood, which is typically the duty of one’s kidneys. The procedure can be a strain on patients’ pocketbooks, so a California initiative, called Proposition 8, aimed to penalize companies that exceeded a state-set limit on how much they can charge consumers for their services.
  • Organized labor coughed up $20.37 million to support the failed initiative and says it will return in two years and expand its effort.

It was a bleak week for others. Here’s whose Thursday closed on a downswing:

Drugmakers’ Future Coffers
  • Political scourge aimed at drug companies and their high profit margins will only get more attention after Democrats take over the House. Future leaders of the House Oversight and Government Reform Committee say drug pricing is their top concern and they plan to ramp up investigations, James Swann and Cheryl Bolen report. Those investigations will likely include drug companies.
  • Drug pricing is also one of the rare policy areas where Democrats and Trump can find common ground, Shira Stein and Alex Ruoff write. They’ll have to strike a deal though, and it’s not yet clear whether Democrats will agree to work with Trump and risk giving him a political victory going into 2020.
  • Meanwhile America’s largest drug makers, dispensaries, and pharmacies are still battling over litigation that could cost them billions, Alex Ebert reports. CVS, Walgreens, and Walmart are among the companies trying to fight claims that they should be liable for the nation’s opioid crisis.
Abortion Supporters
  • Alabama and West Virginia voted to tighten restrictions on abortion access this week, Ayanna Alexander writes. It means those states won’t protect the right to abortion and won’t require public funding of abortion. It’s the latest blow to the U.S. Supreme Court’s Roe v. Wade ruling, which prohibits states from banning abortion entirely.
  • The federal Medicare agency also published a proposed rule that would require health insurers to bill separately for the portion of Affordable Care Act premiums that cover abortion services, Sara Hansard reports. It means consumers will get two bills, which opponents of the rule say will create confusion.
  • The agency is also exempting churches, nonprofit groups, for-profit entities, higher-education institutions, and individuals from providing birth control if they have “sincerely held religious beliefs” or non-religious “moral convictions” against contraceptive services, Fawn Johnson writes.
Obamacare Subsidies
  • If you’re using federal subsidies to cover your Obamacare premiums, be wary of screwing up your paperwork or using them inappropriately. The federal Medicare agency is tightening requirements to ensure that people who get Obamacare subsidies are entitled to them, Sarah Hansard writes.
  • “Maintaining a high level of program integrity on the Exchange is essential, including ensuring that premium tax credits only go to those who are eligible for them,” Seema Verma, head of the Centers for Medicare and Medicaid Services, said. The state-based exchanges would have to provide annual reports showing their compliance with eligibility and enrollment processes, and they would be subjected to “various auditing vehicles,” the agency said.
  • The Trump administration says that the move will help ensure that applicants are eligible for the ACA subsidies they receive. But ACA supporters told Hansard it also could make it harder for consumers to get the subsidies they are eligible for.

Thanks for joining us this week and have a great weekend. I’m all ears when it comes to your two cents, tips, critiques, or coordinating exclusive interviews. Send them my way at