The NCSL Blog


By Haley Nicholson

Congress’ focus on health care over the past few years has ranged from attempts to revamp the Affordable Care Act (ACA) to reauthorizing critical programs like the Children’s Health Insurance Program.

A doctor examines a Medicaid patient at a clinic in Sacramento, Calif. The state is one of at least 10 exploring whether to allow residents to pay premiums to "buy in" to Medicaid. Rich Pedroncelli/The Associated PressWith the 116th Congress back in full swing and the chambers divided between a Democratic majority in the House and a Republican majority in the Senate, what are the expectations for health policy?

Prescription drugs and health care costs continue to be among the highest ranked issues and have already seen movement in the 116th session. These two stand out among the few health-related issues where parties in both chambers and the administration could come to an agreement.

House Oversight Committee Chairman Elijah Cummings (D-Md.) said he intends early to address the rising costs of prescriptions drugs. The committee has already held a hearing to gain insight from pharmaceutical companies on pricing practices. Senate Finance Committee Chairman Chuck Grassley (R-Iowa) expressed similar interests and kicked off what will be a series of hearings looking at prescription drug prices and rebates.

Continuing from the last Congress, the overall costs of health care services and billing remains a front-burner issue. Recently the Senate Health Education Labor and Pensions Committee, chaired by Senator Lamar Alexander (R-Tenn.) held a hearing to examine what can be done to address costs and outcomes in primary health care settings. A bipartisan group of senators has also continued discussions to re-introduce legislation addressing surprise medical billing.

Several other issues that could share the spotlight include:

The future of Medicare: Federal policymakers have shown interest in changing Medicare payment systems, combining Medicare Parts A and B, and addressing Medicare fraud.

Pre-existing Conditions: Among the more popular aspects of the ACA, the issue has moved from highly discussed on the campaign trail last year to the halls of Congress this year.

Legal challenges to the ACA: After a Texas judge ruled the ACA is unconstitutional without the individual mandate requirement, 20 state attorney generals and the District of Columbia have filed an appeal. House Democrats also introduced a resolution in January that would intervene in the ACA lawsuit.

Medicare-for-All and Medicaid Buy-In: Medicare-for-All, a policy proposal that would create a single-payer health system where everyone gets health insurance from the government, has already been the topic of legislation introduced in the 116th Congress and has been a focal point for the slew of Senate Democrats announcing their bids for president in 2020. While Medicaid Buy-in received attention in the 115th Congress, it could also prove to be a popular option this year. Medicaid Buy-In is an option some states use for individuals that don’t qualify under certain state or federal Medicaid requirements, but can pay into the program to receive some of its services.

This list does not include the reauthorization of the Older Americans Act, health-related appropriations, and ongoing attempts to support states in the opioid crisis. Whatever health policies rise to the level of regular congressional order and above political chatter remains to be seen.

Haley Nicholson is a policy director-health, in NCSL’s State-Federal Affairs Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.