Impact of a Divided Congress on Healthcare & Health Policy in 2023

The midterm election cycle has come and gone. The Democrats retained control of the Senate, but Republicans will control the House, albeit by a slim majority, putting the GOP in position to set the agenda for committee leadership and the full House. What does this mean for healthcare and health policy in 2023?

What to Expect Regarding Health Policy

A divided government means that it is highly unlikely that Congress, and specifically the House, will pass any monumental policies that would face defeat in the senate or a veto from the Executive Branch. Since the signing of the Affordable Care Act (ACA) in 2010, Republicans have pledged to “repeal and replace” the law. They have challenged pieces of the ACA in state and federal courts, with some successes but also some defeats. The law still stands, and Republicans seem to have resigned themselves to its existence.

With the ACA off the table, however, there is bipartisan support for action on several healthcare issues. Among the possibilities:

  • Mental health
  • Opioid crisis treatment programs
  • Price transparency (especially drug pricing)
  • Telehealth and new technologies
  • Enabling & supporting enhancement of patient-provider relationship
  • Data collection, sharing, and usage, including issues related to information security and interoperability

Prioritizing Healthcare Information Sharing and Management

There is broad consensus that health data and health information will be the key commonality across all these issues. It could be argued that healthcare has turned into an information brokerage business. Health data is being collected in increasing volumes, formats, and velocity. Driving this is the ever-increasing prevalence of chronic disease and the emergence of new technologies, such as wearable devices, that are starting to inject additional key clinical data into the system at real-time speed. Finally, advanced diagnostics such as genetic profiling and pharmacogenetic testing are also augmenting existing clinical data sets.

Events on the immediate horizon will also impact health data collection and management. The COVID Public Health Emergency (PHE) designation will sunset. Large numbers of people will fall off Medicaid rolls that were expanded under the PHE. Linking and tracking the data for these individuals will present a challenge. And Medicare Advantage expansion will likely create a similar data challenge.

With the growing wealth of clinical data, the challenge has always been to aggregate and curate health data to make it actionable for payers, providers, patients and others. This challenge will only become more difficult. Pressure will be on the health data management and information sharing industry to enhance their solutions and create a data platform that provides a complete, accurate, and actionable longitudinal record at a person level and data that can be shared through interoperable systems.

The industry must consider:

  • Data collection, aggregation, and curation:
    • Ability to collect data from multiple sources
    • Track a person across multiple health plans and health delivery systems
    • Curate and normalize data at speed
  • Decision support:
    • Supporting personalized medicine and treatment with augmented intelligence
    • Enabling and supporting the patient-provider relationship
    • Incorporating new advanced diagnostics
  • Technology:
    • Supporting the emerging telehealth and remote patient monitoring environment
    • Ingesting data and analyzing data from new sources such as wearable devices
  • Financial:
    • Enabling systems to do more with less money and fewer resources
    • Developing new analytics to support more accurate pricing and price transparency
    • Improving efficiency of payers and health systems

Interoperability, personal data access, support for mental health and substance use disorders and price control and transparency are all issues that are likely to receive focus in 2023. Implementing these programs will require relevant health information and data governance policies. Understanding their impact will require them to be underpinned by high-quality clinical and administrative data.