Post-Election Policy Update

from CRD Associates

Election Update

• Donald Trump won the presidency with 312 electoral votes, with Vice President Kamala Harris receiving 226 electoral votes.
• Senate
  • Republicans flipped the Senate and will have the majority in the 119^th Congress. Senators Sherrod Brown (D-OH), Jon Tester (D-MT), and Bob Casey (D-PA) lost their re-election bids. As of this morning, the races for the Senate seats in Nevada and Arizona are too close to call.
  • For the 119^th Congress, the chair of the Senate Health, Education, Labor and Pensions (HELP) Committee will be Senator Bill Cassidy (R-LA) and the chair of the Senate Finance Committee will be Senator Mike Crapo (R-ID).
  • Leadership elections will be held on November 13 as Senator Mitch McConnell (R-KY) has announced that he will not run for leadership. Senators John Thune (R-SD), John Cornyn (R-TX) and Rick Scott (R-FL) have all announced their intention to run to be the party leader.  It is expected that Senator Chuck Schumer (D-NY) will continue to lead Democrats.
• House
  • As of this morning, the majority of the House has not yet been decided. Republicans are currently expected to maintain the majority, with the current count at 214 R – 205 D.  It is being predicted that Republicans will control between 221 and 223 seats.
  • House Republicans are planning to have leadership elections tomorrow.  Rep. Mike Johnson (R-LA) will likely retain the Speaker gavel.
  • Minority Leader Hakeem Jeffries (D-NY) is expected to continue to lead House Democrats.

CRD will continue to monitor the House election results and any changes to relevant committees of jurisdiction. We will also provide analysis of the implications of the election on health policy for the 119^th Congress and will continue to work with our clients to support policy priorities with the new administration and Congress.

Implications for Health Policy

• The Department of Health and Human Services
  • The Trump administration will likely make major changes in agency leadership and set a new agenda for health care. The incoming administration will face immediate challenges, including managing cybersecurity threats, navigating legal disputes over the Affordable Care Act’s preventive care mandates, and implementing Medicare drug pricing reforms under the Inflation Reduction Act (IRA), which faces opposition from pharmaceutical companies and congressional Republicans. The department will also play a pivotal role in combating the opioid crisis, with new Medicaid requirements aimed at expanding access to treatment.
  • Robert F. Kennedy Jr. (RFK) is expected have a leading role in health care, although it is not clear in what capacity, and Paul Mango, who was the previous Trump administration HHS deputy chief of staff is on the short list for leading HHS.
  • Additionally, uncertainties loom over the department’s budget, which Congress has yet to finalize for FY 2025, potentially affecting programs related to public health, climate change, and gun violence prevention.
• NIH
  • With Republicans poised to control the White House, Senate, and potentially the House, they plan to reform the NIH’s structure and priorities. Senator Bill Cassidy, the likely chair of the Senate HELP Committee, laid out his plans for NIH in a white paper, which includes focusing more on early-stage, basic research without immediate applications for patients, as well as restructuring the NIH review process. In the House, Energy & Commerce (E&C) Committee Chair Cathy McMorris Rodgers (R-WA) is retiring, but had laid out a framework for NIH reform that included consolidating the 27 I/Cs into 15 new I/Cs, five-year term limits for I/C directors, and integrating ARPA-H into the NIH. Both Reps. Bob Latta (R-OH) and Richard Hudson (R-NC) who are running to lead the E&C Committee have expressed support for the ideas in the framework; Rep. Brett Guthrie (R-KY), the current chair of the E&C Health Subcommittee, has not spoken on his plans for NIH reform.
  • RFK Jr. has voiced his potential restructuring plans, which could impact the NIH’s $47 billion budget that supports critical biomedical research. RFK’s “Make America Healthy Again” platform would include directing NIH funds toward preventive, alternative, and holistic approaches to health, while also addressing conflicts of interest within NIH-funded projects.
  • While some experts agree that streamlining operations and introducing term limits could enhance efficiency, they are wary of proposals that could diminish NIH’s focus on essential biomedical research, especially given RFK’s controversial views on vaccines and chronic disease management.
• FDA
  • RFK has openly stated plans to overhaul the FDA’s staff, particularly in the food division. His comments have reportedly created anxiety among career staff, increasing the risk of departures.
  • Republican members of Congress are also calling to pull back the stricter FDA regulations on laboratory-developed tests, implemented under the Biden administration to ensure test accuracy. With any moves unlikely in the lame duck session, under Trump, FDA oversight could be scaled back, shifting toward less restrictive policies.
• Drug Pricing
  • The incoming Trump administration, with unified control in Washington, could potentially target Medicare’s newly granted power to negotiate drug prices, a key provision of the IRA. Some members of Congress such as Sen. Mike Lee (R-UT) and Sen. Marco Rubio (R-FL) have called to repeal drug price negotiations; however, senior Republican members have shown support for the spending caps.
  • While Vice President-elect JD Vance has voiced interest in drug negotiations, President-elect Trump’s agenda on the matter is still unclear. The prior Trump administration did focus on reducing drug costs, although they took a different approach than what is in the IRA.
  • Senator Bob Casey (D-PA), a long-standing member of the Senate Finance and HELP committee, has lost his seat to former hedge fund CEO Dave McCormick. Sen. Casey has been a significant advocate for important health reforms including the IRA and pushing for expanded insulin cost caps across all insurance plans. His departure could shift the balance on health policy decisions, particularly concerning drug pricing and Medicare reforms.
• Appropriations
  • Senator Tammy Baldwin (D-WI), who chairs the Senate Labor-HHS Appropriations Subcommittee won her re-election bid, as did Senator Deb Fischer (R-NE), a senior member of the Appropriations Committee. As noted above, Senator Jon Tester (D-MT) lost his re-election bid and is likely to be replaced in the top spot of the Defense Appropriations Subcommittee by Senator Brian Schatz (D-HI). There is speculation that Senator Mitch McConnell will be the chair of the Defense Appropriations Subcommittee, as he will no longer be the party leader.
  • Several House Appropriations Committee members are in tight races that have yet to be called. Reps. David Valadao (R-CA) is all leading his challenger but counting votes in California is expected to continue for another few weeks. Races for Rep. Marcy Kaptur (D-OH) and Josh Harder (D-CA) have yet to be decided.  Reps. Matt Cartwright (D-PA) and Mike Garcia (R-CA) lost their re-election bids.

Lame Duck Session

• Lawmakers are set to come back today to start the lame-duck session. Congress faces a December 20 deadline to fund the government. While some Republicans might prefer to pass the FY25 appropriations bills to give Trump a clean start in January, others could push to postpone, allowing for deeper spending cuts in negotiations with Democrats under a GOP controlled government. Given the magnitude of Trump’s win, congressional Republicans are likely to defer to his preferences on how to handle pending legislation. As of this morning, Republican leaders expect to fund the government into March.
• We expect Congress to prioritize passage of the National Defense Authorization Act (NDAA) during the lame duck session. Other health provisions that could be addressed include telehealth extensions, health care extenders, and physician payment issues.
• Congress also needs to pass at least a short-term extension of the Farm Bill, with a full authorization likely to be delayed until the 119^th Congress.
• Senate Democrats also have a closing window to confirm nominated judges. With Republicans set to take control in January, Senate Majority Leader Chuck Schumer (D-NY) would need to push through as many confirmations as possible before they lose the majority.