Every election is consequential, but the 2020 election turned out to be consequential in ways that were not expected going into Election Day. Turnout eclipsed all-time highs in raw vote totals and may be the highest turnout percentage since the election of 1900. However, the end result of all those ballots largely maintains the status quo for 2021, with the exception of President-Elect Joe Biden. Minimal power shifts—near historic lows across almost every level of government—hold implications for the ACR’s advocacy agenda moving forward.
The Congressional Landscape
There will be many new faces in Congress, including at least seven new members of the Senate and close to 60 new members in the House. Educating the freshman crop of legislators about the issues facing rheumatology providers and patients will be extremely important to achieve ACR legislative goals. Additionally, given the Republican gains in the House and the narrow Senate margins (regardless of the election outcomes in Georgia), every vote will be incredibly important to move legislation through either chamber.
The Democratic majority in the House narrowed its vote lead, but maintained leadership. This lends itself to smooth reintroduction of many priorities from the 116th Congress to the 117th. Popular legislation, such as prior authorization reform under Medicare and limits to step therapy use, as well as policies supporting growth in the medical workforce, can get a headstart with early reintroduction by sponsors who are continuing to serve in the House.
The Senate is harder to predict due to its tighter margins and possible flip, where we won’t know who the majority leaders will be until January. If Senate Majority Leader Mitch McConnell (R-KY) maintains his position, we can expect he will continue to be incredibly selective about what legislation passed by the House that he allows to be considered in the Senate. The tighter majority margin means any legislation taken up will have to appeal to at least centrist Republicans to have a chance of passing. If Sen. Chuck Schumer (D-N.Y.) becomes majority leader after the Georgia runoffs, we are likely to see a smoother pipeline of legislation from the House to the Senate and a higher likelihood of passage. However, even if both chambers are led by one party, the small margins in the Senate mean that any legislation from the House will have to be further moderated to get through the Senate.
We expect 2021 and the new Congress and administration to bring a fresh perspective on our current issues. A more comprehensive response to COVID-19 and the pandemic’s medical and financial demands will be top of mind. In this process, we are likely to see renewed discussion of major healthcare overhauls, which would not pass through a McConnell-led Senate and would need to be carefully worded to get through a narrow Schumer-led Senate. It is more likely that popular measures from the 116th Congress, such as utilization management policies and workforce support, will be taken up, while the larger picture continues to be negotiated by elected officials and stakeholders.