NADP Federal Election Wrap-up 2020

Presidential Election

After an extensive campaign spanning the COVID-19 pandemic and widescale protests on racial justice, former Vice President Joseph R. Biden, Jr. has been elected 46th President of the United States. As of publication of this article, approximately 78 million votes were cast for Biden and 73 million for Trump, the highest percentage turnout since 1964, when the voting age was 21.

Image Source: The New York Times



President-elect Biden was carried to victory by a reconstructed “blue wall” of Wisconsin, Michigan, and Pennsylvania, which all voted for President Trump in 2016, and by winning the Sun Belt states of Georgia and Arizona. Biden is the first Democratic presidential candidate to carry Georgia since 1992, and while his electoral map is diverse, increasingly both parties are geographically polarized. Republicans are winning by substantial margins in rural areas while Democrats do the same in urban areas, leaving suburbs as the main area of competition. In Georgia, an 11% swing towards Biden from 2016 among suburban voters near Atlanta combined with increased turnout in Democratic strongholds was decisive in winning Biden the state.

In the “blue wall” states of Wisconsin, Michigan, and Pennsylvania Democrats slightly improved margins with white non-college educated voters, who voted overwhelmingly for Trump in 2016, and improved margins in suburbs of cities like Detroit, Milwaukee, and Philadelphia while boosting turnout from urban areas. Biden also became the first nominee who did not win Ohio or Florida but carried the presidency since Bill Clinton in 1992, as Trump solidified Republican margins in both states. Moving forward, the electoral map will continue to shift as suburban voters slowly trend Democratic, while rural voters solidify their support for Republicans.

Image Source: Financial Times

Image Source: Hooper, Lundy & Bookman


On Dec. 14, the electors will meet in each state to cast their ballots for president and vice president.

House of Representatives

Democrats maintain control of the House of Representatives in the 117th Congress, by, contrary to expectations, a much narrower margin. With six races yet to be called as of Nov. 17, six-eight incoming Republicans will be from Congressional districts won by President-elect Biden, and the same number of incoming Democrats from districts won by President Trump.  Conversely, a number of Democrats who lost their seats held districts that were won by Donald Trump in 2016 and again in 2020, such as Kendra Horn (D-OK-05), Xochitl Torres Small (D-NM-02), and Max Rose (D-NY-11).

Current House Speaker Nancy Pelosi (D-CA-12), the Democratic leader since 2003, will serve what is expected to be her last two-year term as Speaker and House Majority Leader Steny Hoyer (D-MD-5) and Majority Whip Jim Clyburn (D-SC-6) will also likely continue in their roles. Republican Leaders Kevin McCarthy (CA-23), Steve Scalise (LA-1) and Liz Cheney (WY-at large) were re-elected to their respective positions.

Energy and Commerce Committee (E&C) Chairman Frank Pallone, D-NJ-6 and Committee on Ways and Means (W&M) Chairman Richard Neal, D-MA-1, leaders of the two committees with primary jurisdiction on health care matters, will remain in their positions in the next Congress. The E&C Committee will welcome new members after 10 current members, including ranking member Greg Walden (R-OR-2), retire at the end of this Congress. W&M will lose two members to retirements and two additional members’ reelections remain uncertain.

Image Source: The New York Times



Control of the Senate will not be determined until early January. Senate Republicans fared better than expected, losing only Arizona and Colorado to Democratic challengers, and flipping the Alabama seat. Notably, Susan Collins (R-Maine) and Joni Ernst (R-Iowa) survived tough re-election campaigns with polls repeatedly showing them behind their Democratic challengers.

Georgia, where state law requires the winning candidate to earn at least 50 percent of the vote, will hold two runoff races January 5: Republican Sen. Kelly Loeffler will face Democrat Raphael Warnock and Republican Sen. David Perdue will face Democrat Jon Ossoff.

If Democrats win both Georgia seats the Senate will split 50-50 giving Democrats an operating majority with Vice-President Elect Kamala Harris casting the tie-breaking vote. In this scenario, Democrats will control both chambers of Congress and the Executive Branch and significant healthcare legislation becomes more likely.

Senate health care committees will be under new leadership with retirement of Health, Education, Labor, and Pensions (HELP) Chairman Lamar Alexander (R-TN), and term limits requiring Sen. Charles Grassley (R-IA) to relinquish the Republican helm of the Finance Committee. Finance Republican leadership will likely go to Sen. Mike Crapo (R-ID) with Sen. Ron Wyden (D-OR) remaining to lead the Democrats. Patty Murray (D-WA) will continue to lead the Senate HELP Committee Democrats, with Sen. Richard Burr (R-NC) most likely leading the Committee for the Republicans.

Image Source: The New York Times


What’s Next

The transition process is underway within the Biden camp and a formal process will likely begin soon. President-elect Biden has announced a coronavirus taskforce and is preparing a series of Executive Orders and other Day-one actions which could include announcing a “national supply chain commander” and establishing a “pandemic testing board” according to media reports. President-elect Biden also released a list of health policy advisors that will be guiding his transition team as they search for personnel to staff his administration. Biden has named longtime aide and Obama Administration “Ebola Czar” Ronald Klain as his chief of staff. Biden is expected to name his nominee for Health and Human Services Secretary earlier than usual, possibly by the end of the month.

Under the Presidential Transition Act, the General Services Administration (GSA) is charged with providing administrative support to the President and Vice-President Elect and begin the transition process. The head of the GSA has yet to make the call to begin the transition.

The Senate and House are now in session to complete work for the year. They face a Dec. 11 deadline for funding the government and addressing expiring Medicare, Medicaid and public health provisions. Congress is also considering additional pandemic relief/stimulus measures but continue to grapple with competing priorities. Finally, the Trump Administration is expected to release a plethora of rules and regulations in the remaining weeks before Biden is inaugurated, addressing prescription drug prices and state Medicaid and Affordable Care Act (ACA) waivers.

Looking ahead, President-elect Biden has repeatedly noted that an economic stimulus package and public health action around COVID-19 will be his top priorities. While the legislative outlook is still unclear because of the Senate runoffs in Georgia, there are several rulemaking and administrative actions that Biden could take. First, it is widely expected that Biden will extend the Public Health Emergency, revisit actions taken by the Trump administration on funding for ACA marketplace navigators and marketing, and reverse the public charge rule that created barriers for immigrants to enroll in public programs.

Biden’s team has also indicated that they could review changes to enforcement of Section 1557 of the ACA, focused specifically on restoring nondiscrimination rules protecting transgender individuals. The new administration may also revisit Medicaid and exchange waivers granted to states during the end of the Trump administration, such as those for Medicaid work requirements or eligibility adjustments. Some observers have stated it is likely that Biden will issue an administrative “rule freeze” at the beginning of his term to stop any Trump administration rules still under review from being finalized.

If Congress is under unified Democratic control, the Administration will be more able to pass their agenda, including a broader relief package, technical changes to the ACA with subsidy expansions, and reversing late Trump administration rules through the Congressional Review Act. Without unified control, options for large COVID relief become more limited, and ACA changes will be unlikely, as will the inclusion of dental benefits in Medicare.

Other issues that may emerge during the 117th Congress include continued scrutiny of insurance carriers’ business practices during the COVID-19 crisis, recently-revived attempts to advance federal non-covered services legislation, efforts to include dental in all-payer claims databases, and a movement to repeal the more than 60-year-old McCarran-Ferguson Act, which clarifies that the states, rather than the federal government, have regulatory authority over insurance. 

NADP will be hosting a members-only webinar with health care consultants from Faegre Drinker on Nov. 30. The webinar will delve further into details on the election’s impact on the dental benefits industry and provide insight into NADP advocacy strategy for 2021 and beyond. Registration for the event is free.


NADP State Election Report 2020

GOVERNORS: Prior to the election, there were 24 Democratic governors and 26 Republican governors. Gubernatorial elections were held in only 11 states this year: Washington; Montana North Dakota; Utah; Missouri; Indiana; West Virginia; North Carolina, Delaware, Vermont; and New Hampshire. All incumbent governors won their races, and the only change in party control was in Montana, where the Republican candidate won after the Democratic governor chose not to run for re-election. This results in a net gain of one for Republicans and a projected breakdown of 23 Democratic governors to 27 Republican governors.

STATE LEGISLATURES: Democrats have not held a majority of seats in the nation’s legislatures since the 2010 election, when Republicans flipped 24 chambers. Prior to the election, Republicans controlled 59 chambers and Democrats controlled 39. One chamber (Alaska House) was under a power sharing agreement. The 2020 election did little to disrupt the status quo.

Eighty-six of 99 chambers held elections on Nov. 3. Republicans took control of both chambers in New Hampshire and will likely take control of the Alaska House. Democrats did not gain control of any legislative chambers. Overall, this represents a very minor shift—in fact, this election represents the smallest change in party control of legislative chambers since the 1940s.

For more details, please access the National Conference of State Legislatures’ (NCSL) 2020 State & Legislative Partisan Composition chart <here>.

Chamber control is a key metric in analyzing state legislatures. The majority party in any chamber sets the agenda. In 49 states it takes two chambers to pass a law, Nebraska being the exception with its one-chamber legislature that is elected on a nonpartisan basis. Both pre-election and post-election, Minnesota has the only split in the nation, with the Senate held by Republicans and the House by Democrats. Following the 2020 elections Republicans hold control of both chambers in 29 states and Democrats hold control of both chambers in 18 states. (See map below)

Image Source: National Conference of State Legislatures


Another element of political analysis at the state level is considering where the legislature and governorship are controlled by the same party (the “trifecta”). Prior to the 2020 election Republicans held trifectas in 21 states and Democrats had 15. On Nov. 3, Republicans took control of the New Hampshire legislature and Montana governorship, creating trifectas in those states, and bringing their total trifectas to 23. Democrats will continue to have trifectas in 15 states, and the remaining 12 states have divided governments (different parties controlling the legislature and governor’s office).

INSURANCE COMMISSIONERS: Only 11 states have elected insurance commissioners, with the remainder being appointed. Of those 11 states, four held elections in 2020: Delaware; North Carolina; North Dakota; and Washington. Incumbents won their re-elections in all of these states. In Montana, the open race for state auditor, a role which includes insurance commissioner and securities regulator duties, was won by a Republican. 

BALLOT INITIATIVES: In 2018 Medicaid expansion was on the ballot in three states: Idaho, Nebraska, and Utah, and was adopted in all. While no such ballot initiatives were part of the 2020 general election, voters in two states (Missouri, Oklahoma) voted to expand Medicaid earlier this year, bringing the total number of states having done so to 38.

For more on results of statewide ballot measures, refer to the NCSL Ballot Measures. Database:

Please contact Owen Urech with questions about state election results.

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