Healthcare Is Local: Channeling Tip O’Neill in the 2018 Midterm Election Results

As Tip O’Neill’s mantra goes, “All politics is local.” In the U.S. 2018 midterm elections, healthcare voting seems to have translated as a local issue, falling into O’Neill’s axiom.

In this election, healthcare was the most important voting issue for consumers, PwC found, ranking above the economy, national security, and education.

On this morning after 2018 midterm election results are (mostly) out, it looks like healthcare was a local and state issue for U.S. 2018 midterm voters. The Democrats flipped more than 23 seats in the U.S. House of Representatives to gain control of that chamber. The Senate is up to 54 seats today, with a runoff to happen in Mississippi, adding to the GOP’s control in that part of the legislative branch.

While we have a divided government via split legislature, one winner in the 2018 midterm outcome is Medicaid.

As I wrote about yesterday (about learning from Governor Kasich), people keen on healthcare should pay attention to the states, which are laboratories for health reform. Governors have health-coverage missions along with managing their portfolios of services for education, infrastructure, and other objectives for state residents. In these midterms, governors flipped from Republican to Democrat in Kansas, Maine and Wisconsin, all of whom promised to expand Medicaid through the Affordable Care Act. Idaho, Nebraska, and Utah voters also opted into Medicaid expansion.

Another healthcare issue that should get traction in this legislative environment is prescription drug pricing. Expect strange bedfellow’ing between House Speaker Nancy Pelosi (D-CA) and President Trump, who has made Rx costs a top priority at least in his healthcare portfolio. Democrats have been committed to the concept of the government negotiating drug prices directly with pharmaceutical companies the way other developed countries do. [Ironically, it’s through those negotiations conducted by other countries on which President Trump and Alex Azar would base their latest proposal to base U.S. pharma costs on reference pricing]. “We want to give President Trump what he said he wanted in the campaign,” Rep. Lloyd Doggett (D-TX) said to the Washington Examiner. Rep. Doggett has been drafting legislation to allow the government such authority for drugs covered by Medicare Part D.

Health Populi’s Hot Points:  How might healthcare play out locally in the next 1-3 years? In the private sector, we’ve been seeing the evolution of retail health beyond the pharmacy, as pharmacy chains and retailers expand services that provide primary and self-care on-ramps to people who want to be active in their own and their families’ healthcare. Walmart announced plans to develop a new town center store concept, and CVS, whose merger with Aetna is expected to be completed by the American Thanksgiving holiday, launched the CarePass loyalty and delivery program (presumably to more effectively compete with Amazon and PillPack), and plans to offer more services in stores in 2019 post-acquisition.

Of course, Amazon continues its march into healthcare, as the company grows into private-label medical devices, private label products (in and outside of healthcare), leverage the PillPack acquisition, and consider its role in primary care services with the hires of staff and thought leaders in the space.

Employers, too, will be nudging insured workers to lower-cost sites of care in 2019, from virtual care via telehealth platforms to retail clinics for flu shots and less-acute care providers.

PwC’s research also learned that consumers would be open to earning rewards and discounts in exchange for accessing services through these new front doors for care, shown in the third chart. Just as consumers’ taste for subscription meal-kits and pet care grow, so might peoples’ interest in bundling services by novel healthcare entrants.

In her post-midterm election public remarks this morning at a press conference, Nancy Pelosi referred to Tip O’Neill’s “all politics is local” creed. She then did a riff on that sentiment, stating that, “All health care is personal.”

For Americans who voted in 2018, health care was top-of-mind on the basis of both access and cost to the family budget. In 2018 and beyond, patients-as-consumers are looking for health care that’s quality and cost-effective. In fact, costs and financial health were actually bundled into the top 3 issues on voters’ minds, cited in the PwC survey above: healthcare, Social Security and Medicare, and the economy, together.

Welcome to the 2020 Presidential campaign season, all 726 left of it.

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