How will the midterms affect health care, women’s health, and climate change?

Three Penn experts explain the influence voters could have on these health-related topics in the coming election.

Elephant and donkey stand on american flag and peer across a stethoscope and pills at one another to indicate the prevalance of healtchare in the midterm election
The 2018 midterm elections will impact key health-related issues.

Next week’s midterm elections will affect health-related issues. Three Penn experts weigh in with their opinions on how the results may change health care in general, women’s health, and environmental policy.

Health care
If Republicans retain a majority in the House and the Senate after the midterm elections, they might make another push for repeal and replacement of the Affordable Care Act (ACA), says Janet Weiner, co-director for health policy at the Leonard Davis Institute of Health Economics. However, it is unclear whether they could muster enough votes with a presidential election on the horizon. If Republicans maintain control of the Senate but lose the House, she says, the ensuing gridlock would leave little chance for major health care reform legislation in the next two years.

One aspect of the ACA has dominated campaigns across the country, Weiner adds.

“People are very concerned about pre-existing conditions,” she says. “There’s widespread agreement across parties that people shouldn’t be turned down [for having a pre-existing illness], but some policies might have that effect. People are concerned about prices in general, but neither party has a magic bullet for that.”

In August, Republicans had set forth legislation that they said would protect those with pre-existing conditions, but the bill would have allowed insurers to deny treatment and services for certain conditions. In light of that proposal and in an effort to retain Senate seats in states like West Virginia and Florida, which Donald Trump won in 2016, many Democrats have honed their focus, saying they will continue to protect those with pre-existing illnesses from being denied insurance. 

“We need a discussion about health care that’s taken out of the political realm, which is hard, but solutions come from finding agreement across parties,” Weiner says. “For now, people will vote for whoever they think will protect pre-existing conditions and the ability to see a doctor without going into debt.”

Women’s health
Twenty-three women are running for seats in the Senate, 239 women are competing for seats in the House, and 16 women are gubernatorial candidates. Those are record numbers, says Wendy Grube of Penn Nursing, who serves as interim director of the Center for Global Women’s Health. “This shows that women’s issues, especially women’s health, will be front and center [during the elections].”

According to a Kaiser Family Foundation Poll, three in 10 women voters say that health care is “the most important issue” when considering candidates, with gun policy and the economy following closely behind. “Additionally, 88 percent of women believe that funding for reproductive services is important or somewhat important in this election,” Grube says. “This means more than just birth control; this is access to cancer screenings, health education, and more.”

But few women’s health topics divide women across party lines more than abortion. Almost three-quarters of women who identify as Democrat or Democratic-leaning support access to these services, and 58 percent of women who identify as Republican or Republican-leaning favor restricting it. Republican women are also split down the middle on whether the Roe v. Wade Supreme Court decision should be overturned. 

Add to this the surge of the #MeToo movement and the appointment of Justice Brett Kavanaugh to the Supreme Court, and one of the most common challenges of midterm elections—apathy from voters, particularly young voters—vanishes. 

“We’re witnessing a set of circumstances that is galvanizing, along with women candidates, women voters, and in particular younger women voters,” Grube says. “We can see this reflected in activities right here on campus. They’re canvassing, registering people to vote, and have been very vocal on the importance of voting. These young women see themselves as part of a change for the future.”

Climate change
Following the October report from the Intergovernmental Panel on Climate Change, which asserts the world must limit global warming to 1.5º C—not the previous 2º C max—climate change should be at the forefront of political discussion, says Christina Simeone, director of policy and external affairs at the Kleinman Center for Energy Policy. However, the report seems unlikely to influence long-term climate deniers. 

“With the current administration, the potential to have meaningful climate change legislation passed will be zero, and the chance of a change in this administration’s executive agenda is slim to none,” Simeone says. This changes slightly, however, if Democrats win a majority in the House. They could then practice more oversight of the executive branch’s activities around climate change, environmental deregulation, and expansion of fossil fuel production. 

In the interim, leadership will happen at the state level. Simeone says voters should keep an eye on two interesting ballot initiatives, one in Washington state, the other in Colorado. 

Voters in Washington will vote to decide whether to implement a carbon fee, which would require polluters to pay for greenhouse gases emissions. Ballot Initiative 63 will test the waters as to whether states can implement climate policy as the Trump administration rolls it back.

In Colorado, voters will decide whether to establish Proposition 112, which would increase limits on new oil and gas drilling in the state. If passed, this would require 2,500 feet between wells and all buildings, unlike current limits, which require 1,000 feet from schools and 500 feet from homes. This could deal a major blow to the oil and gas industry, Simeone says.

A close House race in Florida’s 26th district, in the state’s southernmost part, could indicate how this topic will impact elections in states directly threatened by climate change. Incumbent Republican Carlos Curbelo and Democrat Debbie Mucarsel-Powell both recognize the danger that a changing climate poses to their state, which Simeone says is a step toward bipartisan agreement. On the other hand, in the state’s Senate race, climate change-denier and Republican candidate Rick Scott appears to have just a 30 percent chance of beating incumbent Democrat Bill Nelson. As climate change begins to reshape the state’s coastline, Simeone says she expects voters will reshape politicians’ stances on it too.

“We’ve already started seeing more extreme weather events, as climate scientists predicted,” she says. “Scientists have warned a changing climate could have significant health impacts: heat-related deaths in the summer, flooding, drought, and increases in vector-borne diseases. Sadly, these terrible outcomes may be the only thing able to create the political will needed to make change.”