Although the US midterm elections have not fully concluded, it is now known who has control of each chamber of the US Congress. The media leading up to the mid-term elections had been predicting a ‘red wave’: both the US Senate and House of Representatives would be taken control by the Republicans, weakening President Joe Biden’s Democrat government. However, the election results reveal that the Democrats will retain control of the Senate and the Republicans secured only a narrow victory of the House. These results have important implications for the pharmaceutical industry and US healthcare sector over the next two years.

When Democrats had control of the Senate and House, they were able to push through legislation, including drug price reforms by passing the Inflation Reduction Act this summer. All Republicans voted against the government drug price negotiation and the pharmaceutical industry had been fiercely against the Inflation Reduction Act, which allows government negotiation on drug prices for the first time. Now, with Congress divided, Democrats will find it difficult to pass any new legislation through both chambers of Congress, and it will be hard for the Biden administration to build on any agenda from the last two years. With a slim Republican majority, the Democrats will have to persuade some House Republicans to support any new policies.

With Democrats taking control of the Senate, Biden can fill the federal courts with his nominees and staff the way his administration sees fit. This is notable when it comes to states attempting to repeal restrictive abortion laws, which some have enacted after the US Supreme Court overturned the Roe vs Wade decision earlier this year, and abortion rights will be easier to defend at a state level, where most of the legal battles will take place. With a Republican majority in the House, that body will likely focus more on oversight activities and bipartisan bargaining. Additionally, Republicans can subpoena officials and set the agenda for key committees. It is likely that Republicans will criticise Biden’s response to the Covid-19 pandemic and the spending which occurred in response to the public health emergency. Other health officials, like Anthony Fauci, Xavier Becerra and Chiquita Brooks-LaSure, could also face criticism from the House in oversight hearings.

After the mid-term election results, former President Donald Trump also announced his intention to run for re-election in the 2024 presidential election. If he is re-elected, his second term could bring back the healthcare policies and agendas seen in his first term, such as reduced spending for both Medicare and Medicaid. However, due to the controversies surrounding Trump and his popularity waning in recent years, it may be less likely for him to win the election than in 2016.

Healthcare policy could also be influenced by the probable appointment of Bernie Sanders as the new head of the Senate Health, Education, Labour and Pensions (HELP) committee, replacing Patty Murray, who will now head the Senate Appropriations committee. If appointed to the role, Sanders will focus on universal healthcare and influencing the costs of prescription drugs. Sanders has campaigned to bring down the cost of drugs for years and has voiced strong opinions against the pharma industry. He also supported the drug price reforms in the Inflation Reduction Act and expressed support for further drug pricing measures, something the Department of Health and Human Services (HHS) Secretary Xavier Becerra has noted the US Government plans to explore. As the new leader of the Senate HELP committee, Sanders could push the committee meetings and legislative markups harder to the left than his predecessor had.

Overall, Republicans taking control of the House means Biden will have greater difficulty pushing his policies into law, as approval is needed from both the upper and lower chambers of Congress. As a result, no new major healthcare legislation is likely to be passed. However, Democrats will be relieved to lose only one chamber of Congress to the Republicans, and even then, the Republican Party will only have a slim majority in the House. Therefore, the Democrats may not be discouraged and still try to push legislation through both the Senate and House if they can rally House Republican support behind any proposed bills.

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For the pharmaceutical industry, many hopes have been dampened on any attempt to reverse the drug price control provisions that were approved in the Inflation Reduction Act. The pharma industry had hoped for a full Republican-controlled Congress. Instead, a divided Congress means that any policy change is unlikely to happen. Had there been a Republican majority in both the Senate and the House, then some attempts may be made on the Inflation Reduction Act, though a complete repeal of the Inflation Reduction Act would unlikely occur. Regardless, with little probable success, the Republicans will still likely push to weaken drug pricing reforms.