In Depth: Unpacking 3 Potential Scenarios in a Toss-up Election

October 14, 2024

By Jake Felker, director, political engagement

Election Day is now less the three weeks away.

The race for president is a toss-up but the top-of-the-ticket is driving voter turnout and spending that will affect every race down-ballot. No matter what happens on November 5, party control and majorities will be narrow in Washington and Harrisburg. Here’s a look at what some of those scenarios mean for hospitals.

Federal

• Democratic sweep:  This would mean a victory for Kamala Harris, giving Vice President Walz the tie-breaking Senate vote if Democrats can hold every seat. Expect reconciliation bills to avoid the 60-vote filibuster; expansion of Biden-era programs, like the Inflation Reduction Act and federal subsidies; and policy focuses like health equity, access, transparency, mental health, and substance use disorder treatment.
• Republican sweep:  Expect reconciliation bills to avoid the 60-vote filibuster, increased focus on health care price transparency, avenues around Affordable Care Act mandates, and renewed focus on Trump-era tax cut extensions requiring stricter limits to regulations and spending, including physician payment reform, 340B, site-neutral payments, and federal Medicaid subsidies.
• Divided legislature:  Bipartisan negotiations would be necessary but not expected for America Rescue Plan, Tax Cuts and Jobs Act, and spending as part of debt ceiling increases. Expect short-term policy extensions, continued oversight of consolidation, and reforms to pharmacy benefit managers, physician payment, and Medicare Advantage.   

State

• Democratic sweep:  This would mean Democrats have retaken the State Senate for the first time since 1993, though only likely with a tie-breaking vote from Lieutenant Governor Austin Davis. Expect a continued press of varied legislation from the House with a new opportunity of Senate support including health equity, mental health access, labor union initiatives, nurse ratios, and consolidation oversight.
• Republican sweep:  Expect a new battle for House leadership, which could determine the pace and direction of legislation. There would be looks to limit taxes, spending, and regulations as the new majority attempts to deliver tougher votes to the governor’s desk, as well as a renewed push on health care price transparency initiatives, cuts to Medicaid and social welfare programs, and rural health care access.
• Divided legislature:  Expect more of the same as party margins likely narrow as bipartisan agreements are a must to get anything to the governor’s desk. Extended budget battles are possible, leaving more time for renewed legislative pushes. Issues like health care price transparency initiatives, consolidation oversight, and nurse ratios will see a renewed push.

Whichever of these scenarios plays out, strong advocacy and relationship-building will be critical to advancing hospital priorities and defending against or mitigating harmful policies. The Pennsylvania hospital political action committee, HAPAC, plays a vital role in our advocacy and political influence by supporting hospital champions. Please consider contributing online using the passcode HAPAC and running a HAPAC campaign within your organization. The HAP team stands ready to support you. Contact me or Heidi Ryan, HAP’s political action manager, to learn more.

With more than 267,000 employees, Pennsylvania’s hospital community is an important voice in every election. HAP has created an election website to serve as a non-partisan resource for hospital teams and the community and an election toolkit with CEO resources to engage your employees and communities in voting.