The November 4 elections saw the Republican party win control of the U.S. Senate, increase its majority in the House of Representatives, and increase its majority of governorships.

The leadership of Senate committees with jurisdiction over health policy issues will change substantially. Senator Orrin Hatch (R-UT) will take over the chairmanship of the Finance Committee, and he is expected to focus on health care. Current Chairman Ron Wyden (D-OR) is expected to become the ranking Democrat. On the Health, Education, Labor and Pensions Committee, Senator Lamar Alexander (R-TN) will take over from retiring Chairman Tom Harkin (D-IA). Senator Patty Murray (D-WA) is expected to become the ranking Democrat on the Committee.

In all, Senate Republicans gained seven seats to give them a 52-44 majority (not including two Independents who traditionally caucus with the Democrats). Two more races have yet to be decided, potentially yielding a pickup of nine seats and increasing their majority to 54-44. Louisiana will hold a December 6 runoff election, and Alaska is in the process of counting all remaining ballots, a process that could take until November 18.

In the House, Republicans picked up a net total of 12 seats, with five races in Arizona, California, and New York remaining too close to call, and two in Louisiana heading to a runoff on December 6. Republicans increased their majority to at least 244, their largest since 1928.

Congressman Fred Upton (R-MI) will continue as Chairman of the Energy and Commerce Committee. Energy and Commerce Committee Democrats will lose retiring Representatives John Dingell (D-MI) and Henry Waxman (D-CA) and will choose a new ranking Democrat, either Anna Eshoo (D-CA) or Frank Pallone (D-NJ). The Ways and Means Committee will select a new chairman to replace retiring Representative Dave Camp (R-MI), with Paul Ryan (R-WI) and Kevin Brady (R-TX) vying for the top slot. Ranking Member Sander Levin (D-MI) will remain as the ranking Democrat.

While we anticipate an early congressional vote to repeal the Affordable Care Act (ACA), there are not sufficient Republican majorities to override a veto by President Obama. There may be new opportunities to amend selected portions of the ACA, such as repealing the medical device tax or addressing the 30-hour work week that triggers employer coverage.

Republicans increased their current majority of governorships, adding four states for a total of 31 Republican and 17 Democratic governors, with two races undecided. The outcome of the gubernatorial races this year will likely result in a slowing of Medicaid expansion. Each of the Republican governors from the non-Medicaid expansion states of Maine, Florida, Kansas, Wisconsin, and Georgia won reelection. In Arkansas, Republican Asa Hutchinson was elected to replace Democratic Governor Mike Beebe, a champion of that state’s “private option” Medicaid expansion. Because this “private option” must be reauthorized by a 75 percent majority of the Arkansas legislature each year, this expansion may be curtailed.