Published 1/1/2019
Catherine Hayes, Stacie Monroe

Big Battles, Small Change Ahead in Divided Congress

With Democrats in control of the House in the 116th Congress, they are expected to introduce legislation that aligns with their campaign goals. Americans also can expect some disagreement over Medicaid: Republicans will want to put the program on a “sustainable path,” whereas Democrats favor expansion. A “Medicare for All” alternative, or added public option, to the Affordable Care Act (ACA) becomes more likely with a Democratic-led House. Recent polling has shown that 70 percent of Americans—and more than half of Democratic candidates in the House—support giving all citizens access to Medicare coverage.

Lawmakers may find themselves addressing a court ruling overturning the popular mandate that health insurance cover preexisting conditions. Democrats also are expected to hold many oversight hearings in all policy areas, including health care. However, with Republicans maintaining control of the White House and the Senate, more controversial and partisan ideas are not likely to be signed into law. Instead, many of the ideas introduced in the 116th Congress will end up as blueprints for future Congresses.

Although Republicans and Democrats may agree on many key healthcare issues, their different approaches could mean that incremental changes stand a better chance than enactment of any major bill. This includes finding solutions to combat the rising cost of prescription drugs, empowering law enforcement to reduce the flow of opioids and other illegal drugs, and addressing the increasing premiums for individual health plans. Whatever the issue, it likely will be politicized ahead of the upcoming 2020 presidential election.

The makeup of key committees in the 116th Congress will change significantly, especially in the House. Not only do the current ranking members assume the chairmanships, but in total, the House Committee on Energy and Commerce will lose seven current members, and the House Committee on Ways and Means will lose 12, most from the Republican side. Because the makeup of the House committees depends on the ratio of Republicans to Democrats in office, not all vacant Republican seats will be filled. It is possible, therefore, that Republicans could add very few to no additional members to the committee, whereas Democrats are expected to add 10–12. Additionally, because Rep. Peter Roskam (R-Ill.) lost his election, there will be a fight for the new ranking member position for chairman of the House Ways and Means Subcommittee on Health.

AAOS is ready for the new Congress; the Orthopaedic Political Action Committee (PAC) had a record-breaking cycle. At this point in the two-year election cycle (calendar-based), the Orthopaedic PAC is positioned to hit $4 million dollars—a near $200,000 increase from its record-setting cycle in 2010 during the ACA debate. This is a whopping $500,000 increase and 14 percent jump from last cycle.

Given this ongoing success, the Orthopaedic PAC remains the nation’s largest provider PAC; it was able help many friends in the House and Senate and invested in candidates vying for the substantial number of open seats. The only requirement for the Orthopaedic PAC’s support is that the candidates champion orthopaedic causes. The Orthopaedic PAC is nonpartisan and does not base its donations on a candidate’s party affiliation.

Orthopaedic PAC midterm recap

Supported more than 320 candidates and members, including:

  • 75 percent of House Appropriation members
  • 89 percent of Energy and Commerce members
  • 100 percent of Ways and Means members
  • 56 females
  • 44 minorities
  • eight challengers

Invested in:

  • 25 open seats
  • 20 doctors

Had an overall general win rate of:

  • 90 percent in the House
  • 86 percent in the Senate

The Orthopaedic PAC is very pleased with its win rates, especially given the historic number of congressional retirements. In 2018, the Republican party saw the most retirements since 1930. Although AAOS did lose some congressional allies, the Orthopaedic PAC remains well positioned to tackle its priorities and educate new members of Congress on issues important to orthopaedics. AAOS will continue to update members via AAOS Now and Advocacy Now.

Catherine Hayes is the senior manager of government relations in the AAOS Office of Government Relations (OGR).

Stacie Monroe is the senior manager of political affairs in the AAOS OGR.