2016 Election Outcomes and Implications

November 28, 2016

Author: Daniel Landon, Senior Vice President of Governmental Relations

The 2016 election resulted in Republicans retaining control of the Missouri and U.S. House of Representatives and Senate, and winning the Missouri governorship and U.S. presidency.

The Missouri congressional delegation will have the same seven Republicans and three Democrats. Overall, Republicans have 241 seats in the U.S. House and Democrats have 194. In the U.S. Senate, Republicans have 52 seats and Democrats 46 seats, with two Independents who caucus with the Democrats.

Partisan control of the Missouri General Assembly essentially stayed the same, with 117 Republicans and 46 Democrats in the House of Representatives, and 25 Republicans and nine Democrats in the 34-member Senate. A Republican senator was elected Lieutenant Governor; his reliably Republican seat will become vacant and be filled by a special election.

The election of Republican Eric Greitens as Missouri’s next governor enhances the likelihood that Republican legislative priorities will be signed into law. They include “right to work” legislation to prohibit mandatory participation in a labor union and tort reform legislation to revise standards for liability lawsuits. The General Assembly previously enacted these bills, but they were vetoed by Democratic Gov. Jay Nixon and the General Assembly failed to override the vetoes. The alignment of a Republican state legislature and governor also is expected to favor new laws to revamp executive branch regulatory powers.

The new federal and Missouri political landscape means that an expansion of Missouri Medicaid eligibility as authorized by the federal Patient Protection and Affordable Care Act of 2010 is improbable. Already disinclined to support Medicaid expansion, Missouri Republican politicians know President-elect Donald Trump is expressing support for legislation to repeal significant components of the ACA. With a supportive president, a congressional enactment to repeal all or much of the ACA will be signed into law. There were, and are, insufficient votes in Congress to override a presidential veto of an ACA repeal. The November election makes a partial repeal of the ACA very likely, if not a certainty.

Missouri Republicans will watch carefully to see how Congress and the new president reshape the health policy landscape. The mantra of those supporting repeal of the ACA has been “repeal and replace.” However, at present it is unclear what will be put forward as a replacement. President-elect Trump’s website describing the transition to his inauguration includes brief references promoting high-risk health insurance pools, health savings accounts coupled with health insurance coverage, new regulatory standards for interstate sale of health insurance, and modernization of Medicare.

The details of legislation to define the Republicans’ health policy landscape likely will be crafted by Congress in consultation with the White House. For example, U.S. House Speaker Paul Ryan previously developed a Medicare reform proposal based on a premium support model.

The prospect of federal Medicaid financing being converted to state “block grants” is being discussed, with few details of design or implementation. In general, Medicaid block grants would award each state a capped amount of federal funding, with greater flexibility to design and implement its Medicaid program.

It is unclear how Congress will revamp the Medicaid program, but all indications point to a concerted effort to do so. However, passing the federal laws to accomplish the change will require some bipartisan engagement. Current U.S. Senate procedures dictate that complex or controversial legislation must receive 60 affirmative votes at key points in the legislative process. The Senate is expected to retain those procedures.

If significant portions of the ACA are repealed and replaced with new laws and programs, MHA will be working to ensure that Missouri is treated equitably and in a way that recognizes the state’s innovative approach to financing its Medicaid program.