The midterms will have a big impact on healthcare at both the national and state levels. Here's what to keep your eye on for election day.
The 2018 midterm elections on Tuesday will determine the direction of US politics for at least the next two years.
Depending on which political party wins a majority in the House of Representatives and the Senate, it will set the tone for the healthcare debate for the remainder of the Trump administration's first term.
Healthcare and pharmaceutical analysts said leading up to the election that they anticipate Democrats winning the House of Representatives and Republicans keeping hold of the Senate. That's in line with polling and forecasts. Should that happen, Washington deadlock should prevent any big policy changes.
"We expect that the anticipated mixed GOP-controlled Senate/Democratic House make-up of Congress will maintain the political stalemate status quo, making further implementation of Trump’s drug pricing blueprint more challenging, and this would be net positive for the sector," RBC Capital Markets biotech analyst Brian Abrahams wrote in a note Monday.
Also likely off the table in that scenario: repeal of the Affordable Care Act or big cuts to Medicaid, which were narrowly defeated in the Senate last year.
Still, in some states, major changes to the way healthcare is paid for and administered are on the table. Here's what to keep your eye on for election day.
Three states are considering expanding Medicaid.
Residents of Idaho, Nebraska and Utah will vote on whether to broaden access to their state Medicaid programs to more low-income people, in line with actions taken by 34 other states and Washington, DC under the Affordable Care Act.
If voters in all three states choose to expand eligibility for Medicaid, roughly 325,000 more people could gain access to the health program, according to Avalere.
The measures' chance of success is unclear. There's been little polling in Nebraska (Initiative 427) or in Idaho, though Idaho's outgoing Republican governor has endorsed the state's Medicaid expansion measure, known as Proposition 2. In Utah, a poll showed Medicaid expansion (Proposition 3) had support from 59% of voters.
In Montana, voters will decided whether to raise taxes on tobacco products and make Medicaid expansion permanent (I-185). Otherwise, the state's Medicaid expansion would expire next year.
California's Proposition 8 would limit payments to dialysis providers.
One of the biggest fights in healthcare is going down in California, where there's a proposition on the ballot that would limit the amount of money dialysis providers make.
Dialysis helps patients whose kidneys aren't working properly filter impurities out of the blood (healthy kidneys would remove those impurities).
The process can be expensive — Medicare nationally spends $34 billion a year on the treatment.
As such, the dialysis industry is keen to defeat it. So far, $111 million has been raised to defeat the bill, the Washington Examiner reports. Of that, DaVita contributed $66 million while rival Fresenius has contributed $33 million.
A Massachusetts ballot measure would limit the number of patients assigned to nurses in hospitals.
Massachusetts voters on Tuesday will consider Question 1, which asks if the state should place limits on the number of patients nurses are assigned in the hospital. The idea is that by limiting the number of patients, it could keep nurses from getting overwhelmed and improve care.
Vermont Senator Bernie Sanders endorsed the measure. "Question 1 would set a safe maximum on the number of patients nurses can treat, so that patients can receive the quality care they deserve," Sanders said in a statement.
Hospitals oppose the measure, arguing that the limit would lead to increased medical costs and less flexibility, in part because they'd need to hire more nurses.
Maine could increases taxes to care for seniors.
Maine has a measure on the ballot that would increase taxes to fund care for elderly people in their homes. Maine's Question 1 would create a 3.8 percent tax on income above $128,400. The money would be used to pay for in-home care for all people 65 and over who need it in the state.
The measure could raise taxes on about 10 percent of Maine residents, and generate about $310 million a year, according to the Portland Press Herald.
Abortion is up for a vote in Alabama, West Virginia, and Oregon.
Alabama (Amendment 2) and West Virginia (Amendment 1) will vote on measures to explicitly ban abortion in their state constitutions. Both already have abortion bans in state law as well, according to Governing.com, though the bans can't be enforced because of the Supreme Court's Roe v. Wade decision.
In Oregon, Measure 106 would prohibit the use of public funds for abortion, except in cases where a doctor determines that the procedure is necessary, or in cases where federal law requires the state to pay for an abortion. If the measure passes, it would stop the state's Medicaid program from covering abortions for low-income women.
Oklahoma, Georgia, and Nevada also have healthcare issues on the ballot.
Around the country, the midterm elections will give voters in some states the opportunity to weigh in on different healthcare initiatives.
Oklahoma, for instance, is considering letting places like Walmart and Costco give eye exams — something 47 other states allow.
Georgia is considering a ballot referendum that would help nonprofits in the state provide housing for those living with mental illnesses.
And Nevada is considering a measure that would make medical equipment — like oxygen tanks and wheelchairs — exempt from taxation.