Week In Washington: Elections and Regulations

November 9, 2018

Elections and Regulations

A few highlights on the results of the 2018 midterms:

National Outcomes

  • Democrats will take control of the House in January (picking up somewhere between 26 and 35 seats depending on the final tally)
  • Republicans will expand their control of the Senate.


  • There are minimal chances for any significant legislation over the next two years.
  • There will be an increase in hearings, especially on HHS policies and regulations, so that will likely be in the news.

State Outcomes

  • Democrats picked up at least 7 governorships (Alaska and Georgia outstanding at the time of writing this). They also made gains in a number of state legislatures (especially CO, IL, ME, NM, and NY).
  • Medicaid Expansion generally did well with Idaho, Nebraska, and Utah all voting to expand Medicaid. Maine and Kansas’ election of Democratic Governors will make implementation of expansion very likely for both (it’s estimated Medicaid could expand by about 300,000 people as a result of last night)
  • Montana did not approve funding for its Medicaid expansion program. If no source of funding is found soon, Montana will become the first state to halt its Medicaid expansion program.
  • If you are looking for other states that could expand Medicaid – the election made expansion more likely in North Carolina and Wisconsin.
  • California voted against capping dialysis profits.

Regulation Watch

The Trump Administration released a series of new regulations. Here’s a quick list of those released so far:

  • A new program integrity rule affecting the ACA Exchanges and QHP issuers. The rule increases oversight of Exchanges with a goal of keeping individuals being enrolled or eligible (depending on the circumstances) for other coverage from receiving subsidies. CMS also will begin to enforce the segregation of funds for abortion-covered services. QHPs that offer abortion services must collect a separate payment attributable to those services. There is risk of enrollment attrition given the requirement of two separate payments on the enrollee.
  • The Trump Administration also released a rule exempting employers from covering contraception. This rule is expected to be challenged.
  • CMS released an update to the Quality Payment Program. Changes included: expansion of practitioners eligible to participate in MIPS, change to the MIPS low volume threshold, revisions to MIPS final score weights and performance threshold, and other technical changes.
  • Medicaid Managed Care: CMS released a proposed rule for Medicaid and CHIP plan managed care
    • The rule proposed to increase flexibility for states including network-adequacy standards, access to telehealth, and what qualifies as a specialist.
    • The rules also would prevent states from retroactively changing the risk-sharing mechanism, which has been used to boost Federal dollars.
  • NEMT
    • According to Modern Healthcare, CMS is in the process of preparing a proposed rule that would make it easier for states to cut non-emergency medical transportation (NEMT) as a Medicaid benefit. The proposed rule is projected to be released in May 2019.

Odds and Ends

  • Idaho is pushing ahead with the introduction of non-ACA compliant state-based plans which require medical underwriting. A lawsuit is likely.