Democratic hopes on health care rest with Georgia Senate races

Democrats are hinging their hopes of fulfilling Joe Biden’s health care agenda on runoff elections in Georgia, where voters are expected to decide next month if they want to send two Democrats to the Senate and give the party unified control of the government. 

It’s an uphill climb, as Democrats in both races will be seen as slight underdogs in the race, though the party’s hopes have been lifted by what they believe will be a win in the state for Biden’s presidential campaign.

The stakes are high, and Democrats plan to partly frame the races as a referendum on health care. Without a Democratic majority in the Senate, Biden’s health care agenda would be severely limited to administrative action and bipartisan legislation which has become increasingly hard to pass in a gridlocked Washington. 

Democrats think if they can make health care the focus of the election in Georgia — one of the few states that hasn’t expanded Medicaid to low-income adults under ObamaCare — they have a decent shot at victory. Black people in Georgia has also been disproportionately dying of COVID-19, partly due to a lack of access to health care. Meanwhile, the Supreme Court will hear arguments in a case that will determine the future of the law Tuesday. 

“Health care has always been a big issue, but now that you’ve got ObamaCare going to the Supreme Court, and it’s such an important problem for so many people, especially given COVID. I think it’s absolutely resonating in Georgia,” said Stefan Turkheimer, a Democratic strategist in the state.

While Democrats have a bad history with runoffs in Georgia, Turkheimer, who worked for a Senate campaign that lost a runoff in 2008, said this time is different, because the national party is pouring more money and attention to the race, and voters feel more motivated than ever. 

“There is a not-so-great history of Georgia runoffs… It created a narrative that Democrats in Georgia don’t show up for runoffs. That’s been the conventional wisdom. I think that’s going to change now.”  

Democrats are currently projected to hold 48 seats in January, while Republicans are expected to have 50 if Sen. Thom Tillis (R) wins in North Carolina, where he’s had a small but steady lead. 

Sen. Dan Sullivan (R) also appears to be cruising to reelection in Alaska, but the state hasn’t yet been called.  

Winning both Georgia races would make the Senate split 50-50, with Democrats controlling the majority because a Vice President Kamala Harris could break a tie.  

“It may be the slimmest of majorities, but it would make a very, very big difference to the ability of a President Biden to build on the ACA and follow through on the affordability and coverage pieces of his agenda,” said Maura Calsyn, managing director of health policy at the Center for American Progress.

If Democrats do win a narrow Senate majority, they could accomplish health care reform through reconciliation, an obscure but powerful tool that gets around the filibuster as a means to kill legislation. Republicans unsuccessfully used it to try to repeal the law in 2017, but didn’t get enough support from their own party. 

“If Democrats are able to take the Senate majority, budget reconciliation would loom large as a strategy to push forward a health care agenda,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation.

He said more ambitious parts of Biden’s agenda, like a public option, would be met with vehement opposition from the health care industry and unlikely to pass, but “expanding ACA premium subsidies to the middle-class would likely have smoother sailing.”

House Speaker Nancy Pelosi (D) has already committed to using reconciliation to bolster ObamaCare and address the pandemic.

“We most certainly will be passing a reconciliation bill, not only for the Affordable Care Act, but for what we may want to do further on the pandemic, and some other issues that relate to the well-being of the American people,” Pelosi said in a call with reporters this week.

A bill passed by the House earlier this summer would expand the ACA by expanding eligibility for subsidies to people with higher incomes who have increasingly been priced out of marketplace plans. 

It would also pressure the 14 states that have not expanded Medicaid to more low-income adults to do, and restore funding for ObamaCare enrollment marketing and outreach that had been cut by the Trump administration. Under the bill, the federal government would be instructed to negotiate the cost of drugs under Medicare, a long-time wish-list item for Democrats.

The Supreme Court is also poised to rule on a lawsuit filed by Republican attorneys general that argues ObamaCare is unconstitutional after Congress repealed the fine for not having insurance.

A Democratic-controlled Congress could kneecap that argument but adding a modest fine back into the law, experts say. 

“I would think one of the first orders of business for a Democratic majority would be making the Supreme Court case to overturn the ACA moot,” Levitt said. 

If one or both of Georgia’s incumbent Republican senators keep their seats, however, the GOP would keep the Senate majority,  and the reforms to Obamacare that Democrats have been pushing to make for ten years would be unlikely to pass.

Instead, a divided Congress may be able to address surprise billing or pass something on drug prices. A President Biden is also sure to reverse many of the agency actions taken by the Trump administration that were aimed at weakening the law. 

Biden’s administration could roll back rules that allows the sale of short-term plans that are cheaper than ObamaCare, but offer fewer benefits. Democrats have worried that consumers have been tricked into buying those plans, and not having the coverage they need when they get sick. Biden could also shore up marketing and outreach for ObamaCare enrollment and increase the length of time people can sign up for plans. He’s expected to roll back the Trump administration’s approval of Medicaid work requirements and rescind a rule that led to fewer providers participating in the federal family planning program, which pays for health care services for low-income women and men. 

“There are tools within existing law that could really be used to unwind a lot of the harm the Trump administration did,” Calsyn said.