What the Midterm Election Results Mean for Health Policy in 2019
“Is the purpose of free elections to allow the most clever and vicious person to aggregate power, or is the purpose of free elections to enable the American people to have a serious conversation about their country’s future and try to find both a policy and a personality that they think will carry to them that better future?”
Election results may appear to be seismic shifts, jarring the foundations of the American political system to its core as voters stare in disbelief, attempting to translate the meaning of the public’s intent. But is that really the case?
U.S. Election Process
The 2018 midterm elections brought few unexpected results as the tumultuous preceding two years culminated in a slight change of power in half of one branch of government. By all inside-the-beltway political analysis, what Americans wanted—and got from the November returns—was for both parties to work together and solve serious problems. Keeping the separate branches of government under different control forces the extremes to work in tandem (https://fivethirtyeight.com/features/yes-it-was-a-blue-wave). Some elections were too close to call, others required a recount, and still others were forced into a runoff. Such is the fate of an imperfect system.
Direct election of the people’s choice is a uniquely American exercise. For 242 years, eligible citizens have selected candidates to represent them in Washington, DC. The idea of the social contract (https://www.britannica.com/topic/social-contract), an understanding between rulers and the ruled as to how people should be treated, is relatively new: the people can overturn leadership if dissatisfied. The United States routinely, and almost singularly, changes political leadership without a military intervention. Although it seems natural to people who’ve lived in the United States all their lives, it’s still not the norm in most countries today. In fact, U.S. state and federal laws regarding election procedures continues to evolve to protect free-decision making, as President Abraham Lincoln said, “of the people, by the people, and for the people.”
Several iterations have advanced in election law, including who, where, how, and under what circumstances people can vote. Although we think of the United States as a country that freely and directly elects representatives, it wasn’t until the 17th amendment was ratified (https://www.archives.gov/legislative/features/17th-amendment) in May 1913 that the direct election of U.S. senators was complete, and it’s still not the case for the office of the president. In 2016, Maine enacted a law (http://legislature.maine.gov/lawlibrary/ranked-choice-voting-in-maine/9509) that allowed for “ranked-choice voting for statewide elections of governor, state legislature, and Congress.” This actually had an impact on the result of the very close election for one of the state’s U.S. House representatives in the midterms.
Participatory democracy is just that: a requirement to take an active role in the process. Repealing personal political authority is when tyranny begins (https://doi.org/10.7202/1005132ar). Citizens must keep their government in check, and, when necessary, replace those leaders through free elections.
Health Policy in the New Congress
As we enter 2019 and the pomp and circumstances of the new 116th Congress begin, all eyes will be focused on translating the promises of the previous campaign. By most accounts, health care topped the list for domestic issues (https://www.kff.org/health-reform/poll-finding/kff-election-tracking-poll-health-care-in-the-2018-midterms). Pre-existing conditions, Medicaid expansion, and drug pricing are now immediate concerns for most Americans, and the new political elite are going to have to coalesce around the idea that real results to help provide affordable and accessible health care is a national priority.
Once each party celebrates their election wins, all of the photo ops are complete, the receptions have wound down, and the office space overlooking the Capitol is selected, the real work begins. Briefing books, policy papers, and detailed memos must be written, read, and analyzed (https://www.rollcall.com/news/politics/new-member-orientation-2018).
Constitutionally, members of Congress jobs’ entail (http://www.congressfoundation.org/storage/documents/CMF_Pubs/cmf-member-job-description.pdf):
- Making laws
- Raising revenue, authorizing and appropriating federal funds, and managing the federal debt
- Providing for the common defense
- Providing for the general welfare
- Regulating commerce among the states and with foreign nations
- Establishing the federal court system and defining federal crimes
- Declaring war and maintaining and regulating the military
- Directing a census every 10 years
- Impeaching federal officers, including the president (House only)
- Trying impeachments (Senate only)
- Advising and consenting to treaties and appointments of judges and federal officials (Senate only)
Through the collective conscious of voters, chosen leaders are supposed to find solutions to problems making the lives of their constituents better. Although the wheel keeps rolling, the beauty of the American government is that to some degree, every two years offers an opportunity to begin again. This election cycle is no different. And the work of advocates—nurses in particular—is to be engaged with their representatives.
Be a reliable resource, join ONS’s efforts (https://www.ons.org/courses/advocacy-101-making-difference), both at home and in the U.S. capital, and help make a real difference in health policy.