Welcome to the home stretch! Margins are razor thin as the presidential election is just days away. Most national polls have former president Donald Trump and Vice President Kamala Harris in a near tie as early voting is in full swing across the country. Notably, polling numbers in the seven swing states (Arizona, Georgia, Michigan, Nevada, North Carolina, Pennsylvania, and Wisconsin) that will ultimately decide the election show the candidates separated by fractions of a percentage point. Interestingly, these margins have essentially been unchanged for most of the campaign between Vice President Harris and former president Trump.

This election is likely to be one of the closest—and perhaps most contentious—elections in American history. It is likely that the American public will not know the results until days (or even weeks) after the final polling center closes next Tuesday evening.

While the presidential race commands much of the attention, the legislative powers needed to advance most health policies ultimately lie with Congress. Control of both Chambers of Congress remains as close as the presidential race.

The Senate is widely predicted to shift from Democrat to Republican, but several races have tightened in recent weeks. Currently, Cook Political Report has nine Senate seats labeled as a “Toss Up” or slightly leaning Republican or Democrat. Five of the nine are in presidential swing states, which could improve voter turnout in these states.

With the House being much larger, it is more difficult to pin control down to just a select few races, especially since all 435 House members are reelected every two years. Currently, there are 220 Republicans, 212 Democrats, and three vacancies. For comparison, while Cook Political Report identified nine “competitive races” in the Senate, it predicts 43 are competitive in the House—it truly is anyone’s game.

As these Congressional races will dictate which party controls each chamber of Congress, the outcomes are pivotal for shaping the legislative agenda. Understanding the resulting scenarios is essential, as they will determine how effectively and efficiently legislation can progress in the next Congress.

Here are the situations we are watching out for:

Unified Government

If either party controls the presidency, Senate, and House, they will have a “unified government.” In theory, a unified government will have an easier time advancing a policy agenda than a divided government.

Divided Government

A divided government means one party does not control the White House, Senate, and House. This scenario makes it more challenging to pass legislation since it will require bipartisan collaboration for legislation to advance.

It is particularly advantageous for the president’s party to control the Senate for the sake of confirming cabinet positions and judicial nominations.

An important caveat across these scenarios is that for most legislation the Senate needs 60 votes to invoke cloture and proceed to a final vote. This threshold means that even with a unified government, passing significant legislation remains difficult without bipartisan support in the Senate. It is highly unlikely that either party will control 60 votes in the next Congress.

We will be keeping a close eye on races across the country and will issue a special edition of Capitol Insights next Wednesday, November 6^th with updates on key races and what this could mean for the future of health policy.

On Tuesday, a bipartisan group of lawmakers introduced a bill that would mitigate Medicare physician payment cuts set to take effect at the end of the year. The bill would increase Medicare payments to physicians for 2025 in two ways. First, it would offset the 2.8% increase Congress passed for 2024 that expires at the year’s end. Second, it would provide an additional increase equal to half of the Medicare Economic Index (MEI), which is used to measure medical inflation. These two provisions would result in a 4.73% increase to the 2025 Physician Fee Schedule (PFS) Conversion Factor (CF).

An NPR article on racial and ethnic inequities in healthcare access and treatment highlighted the disconnect between policymakers and minority populations, which contributes to higher rates of chronic illnesses among Black, Latinx, and low-income communities.

Senate Finance Chair Ron Wyden (D-OR), House Energy & Commerce Ranking Member Frank Pallone (D-NJ-6), and Representative Richard Neal (D-MA-1) have drafted a letter to CMS, criticizing the declining value and quality of care in Medicare Advantage plans. The letter highlights problematic strategies such as the excessive use of prior authorizations and aggressive, misleading marketing tactics.

Lastly, MedPAC released the updated 2024 Medicare Payment Basics series.