2016 political outlook: 6 things healthcare leaders need to know

Though it has long been an integral part of political discussion, healthcare has taken on an even bigger role in politics since the implementation of the Patient Protection and Affordable Care Act, according to political analyst Stuart Rothenberg, PhD, editor, publisher of Rothenberg Political Report and columnist with Roll Call.

Dr. Rothenberg made his remarks at the American College of Healthcare Executives at the 2015 Congress on Healthcare Leadership Monday, outlining the political environment on Capitol Hill, noting what trends and forces will be at work over the next few months and next couple years going into the 2016 presidential election. A day later, House Republicans revealed their budget proposal with provisions to repeal the PPACA and make major changes to Medicare and Medicaid.

Here are six key takeaways healthcare leaders should know from Dr. Rothenberg's discussion about the national political atmosphere.

1. Midterm elections put Washington in political gridlock. In the midterm elections last November, Republicans gained 13 House seats and nine Senate seats, giving the GOP more power than it has had since the 1920s, according to Dr. Rothenberg.

Both of the last two midterm elections have resulted in victories for Republicans, which may be a reflection of public sentiment regarding the larger political environment. By voting Republican, voters were essentially rejecting President Obama and his agenda, Dr. Rothenberg says. "Midterm elections, when voters are unhappy, are about the president. They just are."

This has created two main sentiments: Republicans feel the voters gave them a mandate to check the President, while Democrats are dismissing the results.  

The American left claims the midterm elections were more about individual candidates in each state, rather than President Obama or the Democratic Party. The map in 2014 was not in favor of the Democrats — seven Democratic senators went up for reelection in states that voted for Mitt Romney in 2012, so they didn't have a chance, according to Democrats.

Plus, as Dr. Rothenberg notes, the demographic of the electorate for midterm elections is much different than that of the electorate for presidential elections. The fall off is among Hispanic voters and young voters, both groups that tend to vote Democratic, according to Dr. Rothenberg.

While the Democratic justifications seemed dismissive, President Obama is not the type of president that needs validation from the American public, according to Dr. Rothenberg. President Obama knows where he wants the country to go and is unlikely to change course, Dr. Rothenberg says.

These two opposing forces, between President Obama and the growing Republican power, mean gridlock is likely to continue in the next few months, especially over the big issues like healthcare, tax reform and immigration.

2. Deepening political divisions mean gridlock is likely here to stay. Washington, D.C., is in a confrontational period. Republicans want to do away with the PPACA, as evidenced by their budget proposal revealed Tuesday, but their party is deeply divided, making it difficult to move forward. The same divisions that plague the Republicans are beginning to percolate in the Democratic Party as well, according to Dr. Rothenberg. While things are unlikely to change in the Democratic Party under President Obama, it is possible the party could become more divided under future leaders.

"I'm not saying nothing can get done in Washington. Stuff can get done as long as it's not ideologically polarizing, as long as it's not partisan and as long as it doesn't require big compromises by groups," he says.

This means we're unlikely to see major headway on big issues like tax reform and immigration any time soon.

3. 2016 will be a good year for Democrats. It will potentially be a really good democratic year, at least Congressionally, Dr. Rothenberg says. Down the road, however, things could change.

In the next Senate class, 24 Republicans and 10 Democrats will be up for reelection. No Democrats will be up for reelection in states that voted for Romney in 2012, and seven Republicans will be up for reelection in states that voted for Obama.

During presidential elections, white voters are a decreasing majority of the electorate, Dr. Rothenberg says, and could hit a low of 70 percent in the next election. This means a higher portion of the electorate will be made up of minority and younger voters. While not all minority or young voters are Democrats, the groups typically vote more liberally, positioning 2016 to be a great chance for Democrats to take back the Senate, Dr. Rothenberg says.

4. Hillary Clinton will likely be the front-runner in 2016 for the Democratic Party. "Democratic voters would rather vote for Elizabeth Warren," says Dr. Rothenberg. He believes the heart and soul of the Democratic Party is with Ms. Warren, but it doesn't show up in polls because it is unclear if she is running or not.

Over the past four or five weeks, Ms. Clinton has appeared sloppy, in terms of her performance at press conferences and other events, Dr. Rothenberg says. Nonetheless, Ms. Clinton has built a loyal following for years. She was a "vision of change" in 2008, until President Obama trumped that vision. In 2016, Ms. Warren likely will not be able to trump Ms. Clinton in the upcoming election, Dr. Rothenberg says.

5. The Republican race is completely fractured. It is so fractured, in fact, that Dr. Rothenberg compared it to a swimming pool, with candidates swimming in parallel lanes.

Jeb Bush is swimming in the "establishment" lane, according to Dr. Rothenberg.

"Chris Christie thinks he's in the [establishment] lane, but I think he jumped in and all the water went out of the pool."

Mr. Bush is serious, thoughtful and likely to have millions in campaign funding, but many Republicans feel he is wrong on issues like Common Core and immigration, Dr. Rothenberg says.

Rand Paul is in the libertarian, Tea Party lane. He's also thoughtful, serious and able to raise campaign funds, but he doesn't support muscular American foreign policy and national security, unlike most Republicans, according to Dr. Rothenberg.

In the third lane, Dr. Rothenberg places the conservative evangelical candidates that tend to do well in Iowa Caucuses, such as Mike Huckabee, Rick Santorum and Ben Carson, MD.

The last lane is mostly Midwestern governors who are conservative, but have the potential to appeal to both the "establishment" Republicans and the Tea Party ones. Gov. Scott Walker of Wisconsin is swimming in this lane, and sharing it with Sen. Marco Rubio of Florida, Gov. John Kasich of Ohio and Gov. Mike Pence of Indiana.

"The thing to remember with the Republican race is that it is wide open; this never happens," says Dr. Rothenberg. "There is no old white guy in line now. That's the problem."

This means there is a narrow advantage for the Democrats, but, as Dr. Rothenberg notes, it is rare for one party to take office three terms in a row.

6. The fractured political environment calls for more individual involvement. Republicans likely won't get off the issue of healthcare, Dr. Rothenberg says. However, he also predicts nothing big will happen in the next couple years as Washington works through this period of division.

"I think healthcare will continue to be a big issue, with other issues like taxes and immigration and increasingly, increasingly foreign policy and national security."

The best news?

"We always seem to figure out a way to stumble ahead," Dr. Rothenberg says. The best way to get issues to move forward is to talk to Congressional members and work with professional healthcare groups and associations to promote the issues and put them on the top of politicians' agendas, he says.

"At some point, we will bust through the gridlock."

 

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