Last week’s general election brought clarity for the Texas Hospital Association on what kind of legislative environment THA and other hospital advocates will be navigating both in Austin and in Washington, D.C. – even as the dust continues to disperse in the latter, with some congressional winners still unknown as votes are counted.
Here’s a look at what the election results in the Texas Legislature, Congress and the presidency may mean for hospitals’ advocacy at the state and federal levels.
The Texas Legislature: New Faces, New Opportunity
Key results – House of Representatives: Republicans win 88 House seats, Democrats win 62; Senate: Republicans will control 20 seats, Democrats 11.
Impact – On the surface, the makeup of the Legislature might look like a near-carbon copy of the 2023 version. Republicans modestly increased their already-strong majority in each chamber, flipping two Democratic House seats as well as this cycle’s only tightly contested Senate seat. Those 88-62 and 20-11 advantages, by themselves, don’t present a new state of play for THA.
However, beneath those top-level numbers lies an important factor: More than 30 members will be new to the House. And with such a large crop of freshmen, Carrie Kroll, THA’s senior vice president of advocacy and public policy, sees an opportunity to reach and teach the newbies on health care issues and mold their understanding of the hospital perspective.
“I think that it actually works out well that we have so many new people we have to educate,” Kroll said. “Because ultimately, it gives us time to let the House figure out what [it] is going to do in terms of the speaker, gives us time to hear from the lieutenant governor and governor in terms of their priorities, and allows us to create strategies on all of our issues.”
THA’s state policy priorities for the 2025 session features an ambitious list that includes pushing for stability in hospital Medicaid funding, strengthening the continuum of care in behavioral health and continuing to address the stubborn bottleneck in the state’s nursing workforce. Kroll knows that THA’s path to informing the new legislators on these hospital issues won’t come without inherent resistance; industries with competing interests, such as the health insurance lobby, will be trying to offer the freshman lawmakers their own points of view.
At a high level, THA’s educational effort will focus on “really explaining to them [about] the hospital industry being the business machine that it is in communities,” Kroll said. “A lot of members are aware of this; some of the new members may or may not be. But the idea that hospitals are usually a first- or second-[largest] employer in most communities – that we are big businesses, we’re highly regulated, that we are very similar to other businesses in terms of how we are there to help contribute to the economy. But we have the added benefit of being a place of healing.”
For health care as much as any other issue, the Speaker of the House race will bear watching during the next month-plus. The reelection last week of incumbent Speaker Dade Phelan (R-Beaumont) was a formality after Phelan’s real fight came last spring in a tight primary runoff victory. But Phelan, who survived that runoff in the face of heavy opposition from party leadership, is facing several challengers for the speaker’s gavel.
Congress and the Presidency: More ACA Scrutiny Possible
Key results – President-elect: Donald Trump; House of Representatives: Party control TBD (leaning Republican); Senate: Republicans 52 seats, Democrats 46 (1 independent caucuses with Democrats); one seat too close to call.
Impact – “What’s past is prologue,” William Shakespeare famously wrote in The Tempest. It now remains to be seen whether a second Trump administration may have similar implications for health care as Trump’s first stint in the White House from 2017-2021.
As he did for the first two years of his first term, it increasingly appears President-elect Trump will have his party controlling both chambers of Congress. The Republicans have clinched control of the U.S. Senate with 52 seats and are leading the count in a close outstanding race in Pennsylvania. Control of the U.S. House of Representatives is still to be determined, but the GOP appears to have the inside track to retaining that chamber. As of early Wednesday afternoon, Republicans had clinched 216 House seats, according to CNN’s House election page. That left the GOP needing just two seats to seal up the majority with 11 races still outstanding.
Although some of the names in the Texas congressional delegation have changed, the party breakdown of Texans in Congress remains the same: 25 Republicans and 13 Democrats in the House, plus the GOP still holding both Senate seats following Sen. Ted Cruz’s reelection win over Rep. Colin Allred. Some of the new members of the delegation will be proven hospital champions. Current state Rep. Julie Johnson (D-Farmers Branch) won the race for Rep. Allred’s Dallas-area seat, and fellow state lawmaker Rep. Craig Goldman (R-Fort Worth) will also move on to Washington after winning the retiring Kay Granger’s seat in Congressional District 12. Both were endorsed by HOSPAC, THA’s bipartisan political action committee.
THA federal lobbyist Cameron Krier Massey, J.D., MPH, says with President-elect Trump’s return to the White House, one thing to watch closely are subsidies tied to the Affordable Care Act, which the first Trump administration unsuccessfully attempted to repeal outright.
“It remains to be seen how a new Congress may or may not extend those,” Massey said. “I would expect to see some scrutiny on Medicaid spending – the advancement of work requirements at the state level, changes to how states are funded.” During Trump’s first term, a Republican-led effort to turn Medicaid into a block-grant program was also defeated.
Massey also notes that the first Trump administration placed a large amount of scrutiny on supplemental payments and introduced the Medicaid Fiscal Accountability Rule, the since-withdrawn regulation that attempted to restrict how states could use certain supplemental payments. Massey believes that scrutiny – which has continued through the Biden administration, resulting in a court challenge from the State of Texas – could continue.
“We could see restrictions around physician-owned hospitals removed,” Massey added. “We could see freestanding emergency centers become Medicare providers, a flexibility they had during the COVID-19 pandemic. I would absolutely expect to see site-neutral [payment] proposals advanced.”
On Wednesday, Sen. John Thune (R-S.D.) won the Senate GOP election to become the majority leader in the new Congress, defeating Sen. John Cornyn in the final round of voting and scuttling the prospect of a Texan leading the chamber.
In the short term, before the new Congress is sworn in in January, the current one will be examining a slew of hospital issues in the “lame-duck” session that gaveled in this week. Those issues include pending Medicaid Disproportionate Share Hospital cuts in fiscal years 2025-27 – which would levy a $2.3 billion hit to Texas safety-net hospitals if not delayed or repealed. THA is also looking for an extension or permanence for several federal programs and flexibilities that will expire at the end of the year: two key rural add-on payment programs, Medicare telehealth flexibilities that began during the pandemic, and the federal hospital-at-home program.
All of those issues and many more will be in the mix as a Dec. 20 deadline looms for Congress to reach a deal to continue funding the government. Massey says a short-term funding-and-extenders package is possible that would “kick the can” into the new year. That would allow the new administration and Congress, including the Republican-led Senate, to get settled before having to make more permanent spending and policy decisions.
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