THE 2016 ELECTION AND HEALTHCARE POLICY OUTLOOK

THE 2016 ELECTION AND HEALTHCARE POLICY OUTLOOK

PRESIDENTIAL ELECTION: THE RESULTS Though Trump won in the Electoral College, Clinton now has a much wider margin of victory in the popular vote than Al Gore did in 2000 (By some estimates, Clinton has almost a 2 million vote lead, compared to Gore s lead of 546,398 votes) 2012 332 EV s for Obama, 206 for Romney 2016 306 EV s for Trump, 232 for Clinton Turnout was roughly the same as 2012, but was lower than projected 2008 61.6% Turnout (the highest since 1996) 2012 58.2% Turnout 2016 58.2% Turnout Third Party votes, however, surpassed 2012 levels by 4.5 million votes (for a total of 6.9 million votes) The Electorate was younger, better educated and less white, however Clinton was not 1 able to transfer these demographic advantages into votes

DEMOGRAPHICS Young voters (18-29) maintained a 19 percent share of the electorate, but voted for Clinton in smaller margins than they did for Obama Latinos increased their share of the vote from 10 to 11 percent, but the myth that they would vote overwhelmingly for Clinton turned out to be false In 2012, Hispanics voted for Obama by a margin of 44 points, compared to Clinton s margin of 36 points In Florida, half of Cubans broke with the larger Hispanic voting bloc this year to support Trump Black voters share of the electorate declined slightly, and Clinton s margin also shrunk among these voters Obama won the black vote by 87 points in 2012 (93% to 6%), while Clinton s margin narrowed to 80 points (88% to 8%) 2

DEMOGRAPHICS CONTINUED Independents Clinton 42, Trump 48 White College Graduates Clinton 45, Trump 49 High School Education Clinton 45, Trump 51 Some College Clinton 43, Trump 52 3

PRESIDENTIAL ELECTION: WHITE VOTERS White voters without college degrees have overwhelming jumped the Democratic ship to join the GOP, while the gap between whites with and without college degrees is at its largest ever 35 points Trump won white voters at a near-identical rate to Romney in 2012 White non-hispanic voters chose Trump over Clinton by 21 points: 58% to 37% That same group chose Romney over Obama in 2012 by 20 points: 59% to 39% White voters without a college degree preferred Trump by a margin of 39% White voters with a college degree voted for Trump by a margin of 4% 4

THE BLUE WALL Democrats solid coalition of blue-collar white voters, who have served as the base of the Blue Wall, crumbled Trump won 3 states that went blue in the last 6 presidential elections Wisconsin, Pennsylvania, and Michigan. Wisconsin: 52.8% Obama in 2012 (+6.9), 47.9% Trump in 2016 (+1) Pennsylvania: 52.0% Obama in 2012 (+5.7), 48.8% Trump (+1.2) Michigan: 54.2% Obama in 2012 (+9.5), 47.6% Trump (+0.3) Florida: 50.0% Obama in 2012 (+0.9), 49.1% Trump (+1.3) 5

WHY TRUMP WON Trump was the candidate of change in 2016 (much like Obama in 2008) - Change was the candidate quality that mattered most to voters (39%) and Trump won those voters by a margin of 69% He was favored on key issues Economy +4, Jobs +6, Defense +1, Terrorism, +4. ACA very unpopular - 58% of voters wanted it repealed while only 36% wanted it kept in place Unified his Party - 90% of Republicans voted for him 93% voted for Romney in 2012 Ran against the: Establishments Leaders of both parties Washington, DC: Drain the swamp Political Correctness Media Trust in the media is at its lowest point since records for have been kept. (14% for Republicans and 30% for Independents) 6

WHY CLINTON LOST: PART I Sanders framed her Being a woman Changing positions on trade policy (TPP) Paid speeches Arrogance/entitlement Failure to put adequate resources into key states: Florida, Michigan, Pennsylvania, Wisconsin 7

WHY CLINTON LOST: PART II Didn t hold the Obama Coalition together Underperformed in key demographic groups that were central to Obamas 2012 victory. Millennials 5%, African Americans 5%, Latinos 6%, Asian Americans 8% 30 years of political baggage and negative branding: Benghazi, emails, Clinton Foundation Parties rarely win three consecutive terms in office. Since 1950, only Reagan has won a third term for his party. Third Party vote cost her in key states MI and WI 5.1% voted third party in Michigan 5.2% voted third party in Wisconsin Did not have a clear, positive economic and reform message. 8

THE POLLS Key Dates FBI announces no indictment: July 5 Republican Convention: July 18-21 Democratic Convention: July 25-28 First Debate: Sept. 26 Second Debate: Oct. 9 Third Debate: Oct. 19 Comey Letter to Congress: Oct. 28 9

THE MONEY Total amounts raised by candidates: $1.3 billion Total raised by super PACs supporting them: $594 million 10

THE 115 th CONGRESS: BY THE NUMBERS SENATE Democratic Independent Republican TBD 46 (+2 from the previous Congress) 2 51 (-3 from the previous Congress) 1* *The Louisiana election was sent into a runoff, to take place on December 10, 2016. The final seat will be decided then, although this will not affect the majority. HOUSE Democratic Republican TBD 194 (+6 from the previous Congress) 240 (-7 from the previous Congress) 1* *Two Louisiana districts were sent into a runoff, to take place on December 10, 2016. One of the runoffs is between two Republicans and will not affect the House composition; the other runoff is between a Democrat and Republican. 11

THE 115 th CONGRESS Must Pass Legislative Vehicles: December 9: Continuing Budget Resolution Spring 17: A new budget agreement March 17: An increase in the debt ceiling Fall 17: A package of expiring Medicare provisions and extension of Children s Health Insurance September 17: PDUFA VI First 100 Days: Regulatory Changes, ACA Repeal & Replace, Infrastructure, Tax Reform, Nominations (SCOTUS) 12

OUTLOOK FOR THE AFFORDABLE CARE ACT When we win on November 8 th and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare. - Donald Trump What does he mean by immediately? Is the ACA really getting repealed? What does the GOP replacement plan look like? What does it all mean for CAPG? 13

THE MOVE FROM VOLUME TO VALUE Our first goal is for 30% of all Medicare provider payments to be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide and to do it by 2016. Our goal would then be to get to 50% by 2018. - HHS Secretary Burwell What does the election mean for delivery system reform? What about MACRA and changing how we pay physicians Will the Innovation Center survive? Who will be in charge at HHS/CMS 14

QUESTIONS? 15