When the Pendulum Swings: What the Midterms Mean for Healthcare

History tells a pretty consistent story here. Since 1902, the party occupying the White House has lost seats in the midterms all but four times. On average? Roughly 20 seats between the House and Senate slip away. Sometimes the losses are catastrophic. George W. Bush called his 2006 drubbing a “thumping” after dropping 31 seats. Obama famously described 2010 as a “shellacking” when 63 seats evaporated. And Trump’s first midterm in 2018 cost him more than 40.

So the pattern held. What surprised a lot of us, though, was the scope. While we’re still waiting on final numbers for both chambers, the pendulum has moved significantly providing the largest majority of seats to a single party since 1997.

 

The Math That Matters

Let’s talk about what actually can and can’t be done with the new majorities.

The Senate wins didn’t hit 60. That means the filibuster stays alive and well, and any ambitious legislation, drug pricing reform, Medicaid expansion carrots, ACA tweaks, will need Republican buy-in to clear the chamber. The House wins, meanwhile, don’t come close to the two-thirds needed to override a presidential veto.

Translation: gridlock. Expect a lot of it.

For the pharmaceutical industry, this has real implications. The current Administration’s posture on prescription drug pricing is essentially frozen in amber for the next two years. Don’t expect sweeping new federal initiatives or a dramatic reversals of existing policy

 

The Governors Tell a Different Story

For the first time in 16 years, Democrats control the majority and a handful of states are going to look fundamentally different by this time next year:

• Georgia, Iowa, Texas, Ohio, and Nevada are all staring down major changes to their Medicaid departments and Insurance Commissioner offices
• Florida, even though it stayed in the same party column, is heading into significant upheaval at the agency level, and the Senate and House Rs lost their supermajorities which means the Ds will be able stop legislation in its tracks.
• Transition teams are forming as we speak, and policy priorities will start leaking within the week

Manufacturers who built relationships with outgoing teams are starting from scratch in multiple states simultaneously.

 

The Trifecta Factor

Democrats are on track to secure governing trifectas, Governor plus both state legislative chambers, in Pennsylvania, Michigan, Wisconsin, Minnesota, and Nevada. Arizona and Alaska are also in play. What does that mean practically?

Aggressive policy changes. Prescription Drug Affordability Boards gain momentum in states that previously stalled them. 340B expansion debates get louder. Medicaid managed care contracts come up for renegotiation with different priorities baked in. State-level importation proposals, stalled for years in some of these capitals, suddenly have a path.

 

The Real Question: What Happens Next?

As political leadership changes, so will the people, priorities, and policies shaping healthcare access across the country. Petauri brings together policy, market access, Medicaid, reimbursement, and strategic expertise to help clients separate political noise from changes that could materially affect their business.

Connect with our team to understand the evolving landscape, anticipate what is coming, and prepare your access strategy for what comes next.

 

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About the Author

Michael Garner is the Vice President of Policy & Strategy for Artia Solutions, Powered by Petauri. He has worked as an advocate and analyst on health, environmental, and educational policy issues for both the private and public sectors since 1992.

Previously, Michael was the CEO of The Garner Group. While managing The Garner Group, Michael and his team developed ground-breaking coverage policies around prescription digital therapeutics (PDTs), conducted nationwide surveys and analyses of gaps in state policies and programs for the treatment of Substance Use Disorder/Opioid Use Disorder, and assisted clients by providing state engagement advocacy plans to create awareness and educate policymakers on ultra rare conditions and diseases. Immediately before transitioning into his new role in Artia Solutions, Michael led an internal Public Policy Workgroup tracking and analyzing the progress of President Trump’s “One Big Beautiful Bill Act,” one of the most comprehensive domestic policy bills in over a decade. Finally, Michael provided policy support across all three companies on issues ranging from the removal of the AMP CAP to helping clients understand the major differences between Medicaid and CHIP.

Before starting The Garner Group, Michael retired as the Senior Director of Government Relations for Anthem Inc. and its affiliates in Florida.Prior to Anthem, Michael served for many years as the President and CEO of the Florida Association of Health Plans (FAHP), the state trade association for health plans in Florida.

Michael has worked for the Mayo Clinic in Jacksonville establishing a Medicare outpatient reimbursement system; Blue Cross and Blue Shield of Florida (BCBSFL) as a Senior Policy Analyst and advocate focusing on state and federal health policies including health coverage mandates, mental health parity, civil remedy for HMO liability, and the implementation of the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996; and started his career in a nonprofit health planning council conducting community healthcare needs assessments and implementing community programs providing prenatal screening and perinatal services for pregnant women and infants.