As of this writing, control of the U.S. House of Representatives after the midterm elections is unclear but leans Republican. The Senate will remain under Democratic leadership. But no matter the exact outcome, both chambers of Congress will be about as closely divided as is mathematically possible, making bill movement a highwire act of negotiation. What does this mean for health and health IT policy in the United States?

Before the new Congress is sworn in, what might happen in the 2022 lame duck session?

Congress returns this week for a lame duck session to finish up the work of the 117^th Congress.  First, there is enormous pressure for them to act through a budget vehicle to reverse the nearly 4.5% physician payment decrease that was included in CMS’ recent 2023 Medicare Physician Fee Schedule. Additionally, some of the popular telehealth and virtual care waivers granted during the COVID-19 Public Health Emergency are set to expire, but the Senate could vote on a bill already passed by the House to extend them for an additional year.

What would a GOP-led House of Representatives focus on?

If Republicans do regain control of the House, they will conduct in-depth oversight on the Biden Administration’s efforts related to the COVID-19 response, and they will focus on different priorities related to healthcare policy than the Democrats have. Throughout this year, some current members of the House GOP convened stakeholders in an effort they call the “Healthy Future Task Force,” which identified five priority areas of focus for their healthcare platform in 2023: Health Security, Affordability, Treatment, Doctor-Patient Relationship and Technology Modernization. I had an opportunity to provide input on this initiative.

While I have a good idea what the GOP will want to do in healthcare and health IT if they win a House majority, it’s important to note that such a scenario does not mean an easy pathway for these priorities. In fact, many of the ideas in the House would likely face opposition even from GOP Senators, given that both parties in the Senate tend to take more deliberative approaches to legislation.

Administrative action versus legislative inaction?

In 2023, it is likely the White House will more frequently use the power of executive order (EO) to affect health policy and circumvent the Congressional logjam. Anticipating the idea that Republicans might control part of Congress, the President already began to pivot to this strategy pre-election, such as with his efforts to lower prescription drug costs for Americans, and it is all but certain that he will use his EO authority to create new federal programs to support his priorities.

Because there is little mention in GOP platforms related to social determinants of health and health equity, this is an area where the administration will likely use EOs and regulations to accelerate efforts.  While significant policy steps from the administration have remained in the planning phase so far, I anticipate that CMS, HHS more broadly, and the White House will make these issues a priority in the next two years.

Though I don’t believe EOs will be issued specific to health IT-related policy, President Biden is well-versed in the industry’s main challenges, including focusing personally on interoperability and patients’ access to their data when he was Vice President. I attended a meeting at the White House on health IT and data exchange in 2017, and I expect his administration to keep the pressure on software developers and providers alike, as efforts continue to increase data liquidity in healthcare.

Conclusion

Altera has built bipartisan relationships with Congressional offices that work on healthcare and health IT, as well as every recent administration. No matter who (temporarily) controls Congress, we are in a good position to advocate for reasonable healthcare and health information technology policy that works for both Altera and our clients.