2016 is an important transition year for the debate over health reform in America. By the time a new president takes office in January 2017, it will have been nearly seven years since the enactment of the Affordable Care Act (ACA). What comes next—whether we build on the law or dismantle it—will largely depend on who sits in the oval office. Republicans finally got an ACA repeal bill through both chambers in late 2015, though it was promptly vetoed by President Obama.
Retaining the majority in both chambers will be important for Republicans who hope the new president will sign their repeal bill. It remains to be seen whether Republicans would still support legislation taking away insurance from more than 16 million people without the guarantee of a veto preventing these cuts from going into effect. Even so, the shape and outcome of this debate will turn largely on which party controls Congress.
Will Democrats win control of Congress in 2016?
The House
The answer in the U.S. House of Representatives is easy. No, the math is just too daunting for Democrats to have any hope of reclaiming control. Republicans currently have 247 seats, meaning that Democrats would need a net gain of 30 to reach the magic number of 218. This would not be an unprecedented change, but is rare and highly unlikely in 2016.
The House has only changed hands three times since Eisenhower was president in the 1950s. The Gingrich revolution gave Republicans a net gain of 54 seats in 1994. Democrats retook control with a net gain of 31 in 2006, only to lose control in the Tea Party wave of 2010 in which Republicans had a net gain of 63 seats.
None of these major swings took place during a presidential election year and in all three cases the resurgent party had uniquely strong momentum. Republican wins in 1994 and 2010 came two years into a new Democratic president's first term. The Democrats' victory in 2006 was a repudiation of President George W. Bush and the Iraq War.
Democrats have no such momentum in 2016. Political forecasters project that at least 207 seats are solidly Republican compared to 170 that will almost definitely go to the Democrats. In other words, gerrymandering and other forces are such that there are only 58 somewhat contested seats in the House. Republicans only need to win 11 of these to retain control. Only about 20 districts are considered true toss-ups. Republicans could lose all of these and would still have enough seats to be in the majority.
The bottom line is that Democrats have almost no chance of regaining the House and are likely to end up with a net gain of not much more than three to five seats.
The Senate
Prospects are a little better for Democrats in the Senate. Republicans currently hold 54 seats. Democrats have 44, plus two independents that caucus and typically vote with them (including a certain socialist from Vermont). Fans of House of Cards will know that the net gain required by Democrats to recapture the Senate depends on who wins the presidency since the Vice President holds the 101st vote in the event of a tie. To be safe, Democrats should assume they need a net gain of five seats to win the Senate.
Republicans begin the election cycle with a strong advantage — they currently control 24 of the 34 seats being contested. Only three Republicans are retiring, meaning that there is a Republican incumbent running in nearly two-thirds of the seats up for election this year. This is a very strong starting point given that Senate incumbents have a re-election rate of well over 80 percent in the last three decades. Democrats also have three retirements, but this represents a much higher percentage of the 10 seats they are defending.
Five races are considered true toss-ups by The Cook Political Report: Florida, Illinois, New Hampshire, Nevada, and Wisconsin. Democrats have a realistic chance of winning three or four of these. Marco Rubio would most likely have won re-election in Florida, but decided he would not seek to return to the Senate if his bid for the presidency failed. This was a gift to Democrats, particularly in a presidential election year when turnout will be higher and not driven as much by Tea Party forces. The only toss-up seat currently controlled by Democrats is in Nevada where Senate Minority Leader Harry Reid is retiring. Republicans have targeted Nevada for a long time but have been unable to run a strong enough candidate to beat Reid. Now the seat is open.
Democrats will need to retain Colorado and have strong showings in North Carolina, Ohio, and Pennsylvania if they are to have a chance of gaining control of the Senate. Three of the most interesting races involve an incumbent Republican senator being challenged by a Democrat who has previously won statewide office. Former Senator Russ Feingold is hoping to oust first-term senator Ron Johnson. Outgoing governor Maggie Hassan is the Democrat's best chance at defeating first-term Senator Kelly Ayotte. Similarly, Democrats in Ohio hope that former Governor Ted Strickland will be able to defeat incumbent Rob Portman.
The bottom line is that Democrats will likely pick up two to three seats but will fall short of winning control of the Senate.
Looking Forward
Democrats will likely make gains in 2016, but it won't be enough to take control of either the House or the Senate. This will shape the debate about what comes next in many ways. Hillary Clinton and Bernie Sanders are both talking about health reform on the campaign trail. Hillary wants to build on the ACA to further expand insurance coverage and increase access to care for the newly insured. Bernie wants to push for single payer. Neither will be possible without substantial majorities in Congress.
On the other side, many Republicans say they want to repeal the ACA. This will require winning the presidency and maintaining control of both chambers of Congress. The biggest question going into the 115th Congress will not be who is in charge, but whether House Speaker Paul Ryan will be able to manage his majority. Will he have a governing coalition or a fractured division leading to more gridlock?
Kentucky offers a lesson about the challenge a Republican-controlled Congress would face delivering on the promise of repealing Obamacare, particularly if a Republican is elected president. Republican governor Matt Bevin campaigned on rejecting the ACA. Now that he is in office he is following through with dismantling KYnect—the state's name for its exchange—but has backed off of repealing the Medicaid expansion. Although there are arguably some benefits to an exchange being run at the state level, this is mostly symbolic since no consumers are losing access to government tax credits to help them buy insurance.
Paul Ryan's challenge with respect to health reform will be to unify congressional Republicans around a substitute for Obamacare that would continue to provide benefits to most of those who receive them under the ACA. The best he can likely hope for is a similarly symbolic reform that satisfies the far right of his caucus but does not upset constituents who have been helped by the reform. Either would be a tall order.
from Health Affairs Blog http://ift.tt/1PSv9Cj
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