Today is Election Day, with control of Congress up for grabs and a number of health care-related measures on the ballot across the country. Here's how the health care industry could be affected by the 2022 Midterms.

Who will control Congress?

As it stands, which party will control Congress remains uncertain, the Washington Post reports. According to the Post, there are at least eight Senate races whose polling averages put them within five percentage points.

If Republicans win a majority in Congress, experts say they expect a greater degree of congressional oversight than before. "Whenever you have one party in control of Congress, and a different party in the administration, the oversight cranks up," said JC Scott, president and CEO of the Pharmaceutical Care Management Association.

Scott said he anticipates a Republican majority will focus on oversight of how federal agencies carry out the provisions of the Inflation Reduction Act. The Washington Post also notes that Republicans would likely investigate the Biden administration's pandemic response, including how pandemic relief dollars have been spent, as well as the origins of Covid-19.

"There could be a lot of hearings, a lot of testimony by leadership from HHS and CMS, and a desire to understand the sausage-making process by getting the administration to come on-the-record and talk about what they're doing, and what their objectives are," Scott said. "That becomes an opportunity on a political basis for them to relitigate the substance of a bill that many Republicans didn't like because it was passed under a partisan reconciliation process."

According to Tara Straw, senior advisor at Manatt Health, if Democrats lose the House, Senate, or both, "you can foresee a lot of investigations of administrative actions that could hum up the works on legislation." These investigations would look at "administrative actions, administrative rules, do they have the legal authority to [issue] a particular rule, or looking into the guts or process of a rule," Straw said.

Joseph Antos, senior fellow and Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, said if Republicans take control of either the House or Senate, "they will be more vigorous about making proposals and advancing proposals to trim back what Democrats have done in the past two years—rather than initiating truly new initiatives."

However, if Democrats retain control of Congress, they could attempt to pass several of the health care priorities that were left out of the Inflation Reduction Act, according to Chris Jennings, founder and president of Jennings Healthcare Strategies.

That could include closing the Medicaid coverage gap, adding funding for Medicaid home- and community-based services, and passing maternal and child health policies, including a permanent authorization of the Children's Health Insurance Program, as well as mandatory 12 months of postpartum Medicaid coverage, Jennifer Taylor, senior director of federal relations at Families USA, said.

In addition, many states also have citizen-led petitions on the ballot, including:

• Abortion ballot measures in California, Kentucky, Michigan, Montana, and Vermont
• A vote to expand Medicaid to around 42,000 residents in South Dakota
• Ballot measures legalizing marijuana in Arkansas, Maryland, Missouri, North Dakota, and South Dakota
• A ballot measure cracking down on medical debt in Arizona
• A vote to tighten regulations for dialysis clinics in California
• A ballot measure in Oregon to declare health care as a human right

The importance of health care issues to voters

According to a poll conducted by Pew Research from Oct. 10-16, health care is one of the five most important issues influencing voters in the 2022 Midterms.

When asked what topics were "very important" to their vote this year:

• 79% of voters said the economy
• 70% of voters said "the future of democracy in the country"
• 64% of voters said education
• 63% of voters said health care
• 61% of voters said energy policy
• 61% of voters said violent crime

In addition, 56% of voters said abortion was very important to their vote this year, a number largely driven by Democratic voters, as 75% of Democrats cited abortion as very important to their vote compared to just 39% of Republicans.

Meanwhile, just 23% of voters said the coronavirus outbreak was very important to their vote, down from around a third of respondents who said the same in March.

In a separate poll of 1,534 U.S. adults conducted by the Kaiser Family Foundation from Sept. 15-26, half of voters said the overturning of Roe v. Wade has made them more motivated to vote in the midterms, a trend largely driven by Democratic voters.

(Roubein, "The Health 202," Washington Post, 11/7; Christ et al., Modern Healthcare, 10/18; Frieden, MedPage Today, 11/4; Schaeffer/Van Green, Pew Research Center, 11/3; Lopes et. al., Kaiser Family Foundation poll, 10/12; Selsky, Associated Press, 10/27)