Over 110 million of the voting-eligible population (almost 50%) participated in the 2018 midterm election. Some states, such as Colorado and Oregon, exceeded 60% registered voter turnout.1 In Washington State, 71.83% of registered voters returned a ballot, just missing the midterm record of 71.85% set in 1970.2

The 2018 midterm election resulted in Democrats securing control of the US House of Representatives while Republicans gained several seats in the Senate to increase its margin of control.3 Changes also occurred in state legislative races. Although there are more republican than democratic governors and state legislatures, democrats did have modest success.4 Many ballot measures decided several important health-related issues. For example, in Nebraska, Utah, and Idaho, voters approved adoption of the Medicaid expansion authorized by the 2010 Patient Protection and Affordable Care Act (ACA), which had been blocked by these states' legislatures.4

How the midterm elections may affect healthcare legislation

Republican efforts to dismantle the ACA were unsuccessful during the 2017-2018 115th Congress; democratic control of the US House of Representatives ensures Congress will not repeal the ACA.5 House democrats will likely seek to reign in pharmaceutical drug prices; strengthen the ACA's provisions, which prevents insurance from excluding coverage for preexisting conditions; provide additional funding for a response to the opioid epidemic; and eliminate "surprise" charges related to a hospital visit.5

How the midterm elections affect NP-related healthcare issues

When the 116th Congress convened in January 2019, any legislation that did not pass in the prior session will need to be reintroduced for consideration. Priority legislation in the 116th Congress to promote NP practice includes the Home Health Care Planning Improvement Act, Promoting Access to Diabetic Shoes Act, and the Accountable Care Organization Assignment Improvement Act. Each bill needs cosponsors in both the House and the Senate.6 The Nursing Workforce Development programs that provide support to NP students who will work in primary care and with underserved populations require sufficient funding to meet the demand.6

Regulatory issues

Regulatory issues also affect the ability of NPs to deliver care. Access to contraception may be limited to women whose employers invoke rules issued on November 7, 2018, by the Departments of Health and Human Services, Treasury, and Labor. The rules provide an exemption for employers with religious or moral objections from an ACA mandate for their sponsored health plans to include contraceptive methods.7 Congress has the option to overturn the rules with legislation.

Another example of a proposed regulatory change relates to the prevention of the improper influence over Medicare and Medicaid patient choice of providers, hospitals, and prescription drugs. The administration has requested information to revise the antikickback statute and/or the beneficiary inducements civil monetary penalty-both of which may impede care coordination or value-based care.8 The rules currently prohibit kickbacks and other payments for referral of Medicare and Medicaid patients and prohibit a provider's ability to refer patients to a medical business in which they have a financial interest.9

State legislation will affect NPs

The changes in composition of the executive and legislative branches of state government may provide opportunities for NPs to advocate for laws that enhance NP practice. Bills that do not pass in this year's legislative sessions will either carry forward or will need to be reintroduced. These bills affect a wide variety of issues, such as full practice authority, controlled substance prescribing, loan repayment, global signature authority, changes to state law to allow NPs to prescribe buprenorphine for medication-assisted treatment of opioid use disorder, adoption of the APRN consensus model, and medical marijuana.10

NP advocacy in 2019

NPs can advocate for legislation by contacting their members of Congress and state legislature to secure their sponsorship of bills that promote NP practice, support access to care, and rein in cost. Join your state's NP legislative committee. Serve as a citizen lobbyist to provide legislators with information about proposed legislation. Although legislators' support for bills is typically what you lobby for, there may be bills you want them to oppose. Write letters, send emails, and testify at committee hearings. Analyze and comment on proposed federal and state regulations. Comments on federal regulations can be made at http://www.regulations.gov. Speak up, reach out, and make a difference.

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