The Battle for the House: The Last Piece of the Political Puzzle

With Donald Trump securing the presidency and Republicans taking control of the Senate, all eyes are now on the House of Representatives—the final undetermined piece of federal power. Control of the House remains too close to call, with over 100 races yet to be decided.¹

The outcome will have major implications for health care policy. A Republican House majority, combined with GOP control of the Senate and White House, could revive efforts to repeal and replace the Affordable Care Act (ACA)—something Trump has already promised to pursue.² However, a Democratic House majority could protect the ACA and other health care programs, including the Medicare drug price negotiations that began under the Biden-Harris administration.²

If Republicans win the House, it will give the GOP unified control of Washington and a clear path to implement their favored agenda. However, Democrats still have a chance to maintain a foothold in federal government by flipping just 4 Republican seats while holding their own.¹

Early results show an extremely tight race. Democrats have found some success in New York, flipping 2 seats, including Josh Riley's victory over Republican Rep. Mark Molinaro in a district spanning the center of the state.¹ However, Republicans have also secured important wins, such as Tom Barrett flipping Michigan's 7th district, previously held by Democrat Elissa Slotkin.¹

California, with 6 of the 15 districts rated as toss-ups by analysts, could prove decisive. However, the state's vote-counting process is notoriously slow, with mail-in ballots accepted up to 7 days after Election Day if postmarked by November 5.¹ This means some crucial races might not be decided until around Thanksgiving.

What's becoming increasingly clear is that regardless of which party prevails, we're likely looking at one of the smallest House majorities in recent history. This razor-thin margin could have significant implications for governing, potentially giving outsized influence to small groups of members who could make or break any party-line vote—particularly crucial for complex health care legislation.

For now, the waiting game continues. As vote counting proceeds in key battlegrounds like California, Washington, and Oregon—states with substantial mail-in voting—Americans may need to exercise patience before knowing which party will control the House in the 119th Congress.

Join me on Wednesdays as I highlight key court decisions, review notable health policies, and analyze what's behind the bill in health care.

References

1. The Associated Press. Congressional elections live updates: Republicans win Senate majority, House control still up for grabs. AP News. November 6, 2024. Accessed November 6, 2024. https://apnews.com/live/senate-house-election-updates-11-5-2024

2. Levitt L. The Politics of Health Care and the 2024 Election. KFF. September 4, 2024. Accessed November 6, 2024. https://www.kff.org/health-policy-101-the-politics-of-health-care-and-the-2024-election/