WASHINGTON — The midterm elections this year are centered on weighty topics: the economy looms large, as does the existential future of democracy. But there are plenty of health and science priorities on the ballot, too, as Tuesday’s votes will chart the course for the future of health care access, affordability, and public health writ large.
While President Biden and Democrats spent the 2020 election promising to trust science, the script is flipped entirely this year. Republicans’ rhetoric has prominently featured attacks on science and public health officials. They’ve villainized Anthony Fauci and criticized public health measures like mask mandates and economic lockdowns that were employed to contain the Covid-19 pandemic.
Control of Congress will also have major consequences for how money flows to federal health agencies, and could cause headaches for Biden administration officials if Republicans choose to investigate federal health agencies’ decisions.
There are also a number of notable ballot measures, from a first-of-its-kind proposal to legalize psychedelic mushrooms in Colorado to another in Arizona that would curb patients’ medical debt.
Read on for the races, ballot measures, and health care stakes we’re watching as votes roll in on Tuesday.
Abortion at the ballot box, like never before
There may be no bigger health care issue on voters’ minds heading into the 2022 elections than abortion. The Supreme Court’s June ruling overturning Roe v. Wade’s federal protections for abortions triggered immediate limits or outright bans in 13 states and kicked off a frenzy of legislation and ballot measures nationwide.
There are a record five abortion-related measures on state ballots this Tuesday, plus an August ballot measure in Kansas that voters ultimately rejected. Measures in California, Michigan, and Vermont would make abortion a constitutional right, shielding the states from future anti-abortion legislation and setting them up as potential safe havens for pregnant people from abortion-restrictive states.
Kentucky voters, like those in Kansas, will decide on a measure that effectively would do the opposite — ensuring abortion is not considered a constitutional right. Finally, Montana’s ballot measure mirrors “born alive” laws in 18 other states that require doctors to provide care for a fetus that is born prematurely or survives abortion. Opponents of the measure say it is medically unnecessary and is being used to rally anti-abortion support.
Outside of state votes, Democratic congressional candidates are hopeful that the wave of abortion rights advocacy will buoy them into office. Polls show some momentum in that direction but likely not quite enough to protect their majorities in the House and Senate.
Meanwhile, while many Republicans have distanced themselves from harsh anti-abortion measures, others have made federal restrictions, such as those proposed by Sen. Lindsey Graham (R-S.C.), a campaign promise. Still, they’re walking a line with voters: Arizona Republican candidate for Senate Blake Masters, for example, has sought in recent weeks to paint a more nuanced picture of his stance since calling abortion “demonic” in summer campaign events.
— Sarah Owermohle
Anti-science, anti-Covid, and anti-Fauci campaigning
The pandemic Biden pledged to end still lingers. Death rates have plateaued at over 2,000 people a week, new vaccinations have stagnated, and public health officials are warning that a winter variant could bring a new case surge.
Republicans have seized on that public fatigue to hammer federal health officials on mask and vaccines requirements, remote schooling, and economic lockdowns, while Democrats blast their attacks as anti-science misinformation.
GOP lawmakers poised to take committee leadership have promised probes into the origins of Covid-19, the Biden administration’s pandemic response funding, and top health officials such as NIAID Director Anthony Fauci.
The outcomes of the midterm elections — particularly if Republicans take the House and the Senate — set up for a splintered and divisive national response to public health and pandemic preparedness.
— Sarah Owermohle
Relative silence on drug pricing
Despite the fact that Democrats accomplished the most significant reforms to prescription drug prices in two decades, the law hasn’t been Democrats’ top health care message in the home stretch, outshined by messaging on the GOP’s plans to scale back Medicare and on abortion rights.
It’s cropped up in a few races, though, in part due to a couple Senate Republicans’ decision to release a bill that would repeal the entirety of Democrats’ drug pricing reforms, including caps on how much seniors have to pay for drugs each year. Sen. Marco Rubio, who is a Republican defending his seat in his home state of Florida, has drawn the most flak for his position, which gained national attention.
This summer, Democrats had hoped to hammer Republicans on a vote to strip insulin cost protections for patients with private insurance from their domestic spending bill, but Senate Majority Leader Chuck Schumer (D-N.Y.) ultimately backed off promises to force Republicans to vote on the policy, so the issue has faded from mind for many candidates. The insulin cost cap bill was formally led by Sen. Raphael Warnock, a Georgia Democrat facing one of the most competitive races in the country.
Another race to watch is Rep. Peter Welch (D-Vt.), who is poised for more power and a bigger platform this cycle as he runs for Senate in Vermont. Welch was a key advocate for drug pricing reform in the House as a member of Democratic leadership.
— Rachel Cohrs
A return to congressional dysfunction
Despite plenty of fireworks among Democrats over the direction of the party’s domestic agenda, Congress actually passed quite a bit of legislation during its period of Democratic trifecta, including bipartisan packages on gun reform and semiconductor manufacturing, emergency funding for Ukraine, reforms to veterans’ health care benefits, and two large party-line bills packed with longtime domestic policy priorities.
If Republicans take control of one or both chambers of Congress, prepare for gridlock. With several moderate Republicans in the Senate set to retire, getting votes for every nominee, and every funding cycle, will be harder over the next two years.
That has big implications for health care. Despite its agreements this session, lawmakers still haven’t provided the Biden administration more money to help fight the Covid-19 pandemic, or address emerging threats like monkeypox. Biden still hasn’t picked a director to lead the National Institutes of Health. And Congress’ premier pandemic preparedness legislation is up for a reauthorization next year, and would need bipartisan buy-in.
Where substance is lacking, rhetoric attacking the Biden administration will be at a fever pitch if Republicans take control of either or both the House and Senate. Lawmakers who have promised accountability for public health officials, including Sen. Rand Paul (R-Ky.) and Rep. Cathy McMorris Rodgers (R-Wash.), are poised for power. The topics of inquiry could include health care issues like federal officials’ response to the Covid-19 pandemic, demands for documents from health officials, and studies conducted by federally funded researchers.
— Rachel Cohrs
A new focus on fentanyl
The U.S. addiction and overdose crisis has been a stump-speech mainstay for years, and with drug deaths hovering at an all-time high, addiction is only gaining ground as a political issue.
In 2022, it’s mostly Republican congressional candidates who’ve made the drug crisis a focus of their campaigns. But they’re not zeroing in on overdose deaths or a lack of addiction treatment options. Instead, GOP candidates across the country have seized on the influx of the ultra-potent opioid fentanyl, using it to bolster their arguments about law enforcement, crime, and border security.
Fentanyl is a highly powerful synthetic opioid that, in recent years, has permeated the U.S. drug supply, leading to a dramatic rise in overdoses. It’s not just present in heroin, however. In many cases, people have overdosed and even died after consuming the substance entirely by accident, via cocaine or counterfeit opioid pills that most users would never suspect contained fentanyl.
In Kansas, Colorado, Arizona, Pennsylvania, and dozens of other states, Republican candidates for national, statewide, and local office have pledged to stop traffickers from bringing fentanyl into the U.S. by imposing stiffer sentences and providing more funding to law enforcement. In many cases, GOP candidates — including Mehmet Oz, the celebrity doctor running for Senate in Pennsylvania — have attacked their Democratic opponents for supporting drug decriminalization or shorter sentences for nonviolent drug offenses.
Some Democrats are even employing a similar strategy: namely Rep. Tim Ryan (D-Ohio), who’s running against Republican J.D. Vance for the state’s open Senate seat. Earlier this year, Ryan even introduced a House resolution in favor of classifying fentanyl as a weapon of mass destruction.
— Lev Facher
Another state looks to expand Medicaid
Medicaid expansion has been on a roll at the ballot box in recent years. After some state governments resisted expanding the program under the Affordable Care Act, voters in places including Utah, Idaho, and Missouri forced their leaders’ hands and passed measures to extend health coverage to more low-income adults.
Still, there are about a dozen states — mostly controlled by Republicans — that have held out. Another state could join the expansion club this Election Day, when South Dakota will vote on a measure called Amendment D. Polls have indicated voters are leaning toward passing it.
But South Dakota is seen as perhaps the last state where voters could greenlight Medicaid expansion, at least for the near future. Some of the remaining holdout states don’t allow for such ballot measures, while in others, there aren’t campaigns moving to put Medicaid expansion on the ballot, or it would seemingly be a long shot.
Gubernatorial races in states including Florida, Georgia, and Texas could also influence the fate of Medicaid expansion in those places.
— Andrew Joseph
A very expensive fight over the future of vaping
Amid growing anger over youth vaping rates, voters in California will decide whether to ban all flavored products in the state. California wouldn’t be the first state to enact such a ban — Massachusetts, Rhode Island, and New Jersey have all enacted similar — but California’s flavor fight has been particularly protracted, nasty, and expensive.
The California legislature first passed its flavor ban more than two years ago. And while the bill was promptly signed by Democratic Gov. Gavin Newsom, opponents of the policy gathered enough signatures to put the fate of the policy up to a referendum. The main driver of the petition initiative was the California Coalition for Fairness, which received more than $21 million in funding from the tobacco industry.
Now, moneyed proponents of the flavor ban are throwing their own cash into the referendum fight. Philanthropist Michael Bloomberg alone has spent more than $15 million supporting the initiative — nearly 90% of the funding the initiative has raised overall.
California’s flavor ban isn’t just worth paying attention to if you’re interested in the intersection of electoral politics, public health, and big money. If passed, the ban will also be one of the biggest experiments to date testing whether banning flavored vaping products actually improves public health. For years, there’s been a contentious debate raging over whether such bans keep these products out of the hands of young people — who overwhelmingly prefer flavored products — or drive people toward smoking more dangerous cigarettes.
— Nicholas Florko
Other odds and ends
There are a few other health-related ballot measures worth watching:
- A new ballot measure in Arizona, backed by a progressive California health care union, looks to reduce the pressure of crushing medical debt. It would cap the interest creditors can charge on outstanding medical bills from 10% to 3%, as well as the amount of a person’s wages collectors can garnish for medical debt to 10%, or 5% for “extreme economic hardship.”
- In what would be a first for a state in this country, Massachusetts might soon require dental insurers to spend a certain percentage of premiums on patient care. Question 2 on the state ballot looks to limit the portion of consumers’ dental insurance premium dollars that goes to administrative costs and profits, such as overhead and salaries. If passed, the ballot initiative would fix that “medical loss ratio” at 17%. (While the Affordable Care Act already sets this medical loss ratio for medical insurance, dental insurers in the U.S. have been generally unregulated.)
- In what would be another first, Oregon might amend its constitution to guarantee all residents have “access to cost-effective, clinically appropriate and affordable health care.” No other state has inscribed this right into its constitution. It’s intentionally vague, which opponents argue would create too many opportunities for lawsuits against the state. But senators who led the charge say it’s clear the measure doesn’t do anything too radical.
— Ambar Castillo