2024 Election Summary, Outlook for the Lame Duck Session & the New Congress

Election Day may have been all about Americans, but this year in every developed country in the world, the governing party facing election lost vote shares for the first time in history. The U.S. followed this global trend and displaced the party that led after the pandemic. Former President Donald J. Trump (R) won the 2024 presidential election by winning both the Electoral College and the popular vote by a significant margin.

Current Status of Congressional Races 

In Congress, the Republican party will serve as the majority party in the Senate. Republicans flipped the Senate from the Democrat majority by winning seats in red states against incumbent Democratic senators in Montana (Sen. Jon Tester) and Ohio (Sen. Sherrod Brown) and picking up a seat in West Virginia from retiring Sen. Joe Manchin (I-W. Va.). A close Senate race in Arizona is yet to be called, and in Pennsylvania, incumbent Sen. Bob Casey (D-Pa.) has yet to concede and votes are still being counted.

Republican candidates lead in the majority of outstanding House races, but 20 seats are still to be called. Other races may be subject to recounts or runoffs, and absentee and mail-in ballots have not yet been tallied. Current Speaker of the House Mike Johnson (R-La.) is expected to run for Speaker again if Republicans retain the majority. He would likely succeed in this bid for the top House position. The numbers should cement this week.

Lame Duck Session

The period between returning from the election and a long back-home recess and the end of the calendar year is referred to as a Lame Duck Congress. Congress is only expected to act on legislation that must be addressed before the 118th Congress formally adjourns. Following the election, Congress will hold leadership elections for the new Congress and begin to plan its agenda. With a likely Republican majority in the House and Senate and a Republican president, there will be a sense that the party has a mandate to lead initiatives and enact significant policy changes.

It is likely that President-Elect Trump will direct what legislation is passed in the remaining time this year if Republicans retain the House. This increases the likelihood that any end-of-year legislative package will be narrower than initially expected or hoped for before the election—if there is a legislative package at all. Funding for federal government agencies and programs is set to expire on Dec. 20, 2024, so at the very least Congress must agree to either an appropriations package or a continuing resolution (an extension of current funding levels); if they fail to do this, they risk a government shutdown.

The ACR’s top priority before the end of the year is to have Congress address the additional 2.83% cut to physicians in the final physician fee schedule for 2025. Since 2001, doctors have seen a cumulative pay cut of 29%, according to the AMA. These cuts come on top of the increasing costs of operating a practice, which went up 39% due to inflation. Congress must act before the end of the year to avoid the additional cuts and to have physician reimbursements updated to reflect inflationary pressures, the same way all other Medicare schedules are.

Another ACR priority for the lame duck is extending telemedicine flexibilities. One silver lining from the COVID-19 pandemic was expanded use of telemedicine. It is estimated that 74% of practices now provide telemedicine services, but without action from Congress, Medicare will go back to the far more restrictive use of these services seen before the pandemic. Although telemedicine is not a replacement for essential face-to-face assessments, nearly five years since the start of the pandemic, more and more patients are coming to rely on the flexibility and ease of telehealth services.

Unfortunately, the election results will make these priorities less likely than before as the House majority will be inclined to hold off on legislating until 2025, when they have a majority in the Senate and a friendlier White House to work with. For most of our priorities, this means starting over by reintroducing bills in the new Congress. Medicare reimbursement and telemedicine, however, have important deadlines at the end of 2024, so this Congress must act before the year ends.

Checks & Balances

Starting in 2025, there will be new rules as well as a new administration. For the last 40 years, agencies have interpreted statutes and promulgated rules knowing that they would be given deference by the courts known as “Chevron deference.” The Supreme Court’s decision in Loper Bright Enterprises v. Raimondo changed that. The Loper decision holds that courts must “exercise independent judgment in determining the meaning of statutory provisions” and may not defer to an agency’s interpretation of an ambiguous statute. This is a substantial curtailment of the authority of the executive branch. Because courts will assume a broader role in interpreting ambiguous statutes, it is reasonable to expect that the next administration will have to deal with a potentially unprecedented number of legal challenges to rule changes and statutory interpretation that could stall and delay policy changes.

Another limitation for the 119th Congress, the Senate’s legislative filibuster rule—requiring 60 votes to pass most legislation—is highly likely to remain in place, although President-Elect Trump has expressed exasperation with the rule. The Republican majority may attempt to use the budget reconciliation process to advance legislation. This legislative procedure allows legislation to pass with a simple majority (51 votes) if it is deemed “germane” to certain tax, spending and debt limit legislation. For example, this was the procedure used to enact the Affordable Care Act in 2010.

Looking Ahead

There is a lot we do not know about the incoming administration. Vice President-Elect J.D. Vance has cosponsored two telemedicine bills during his Senate tenure and could help to push forward a permanent telemedicine solution. We have reason to believe the administration may join us in prioritizing such things as reforming the role of pharmacy benefit managers in drug pricing, but it is also likely to revive a concerning proposal introduced during the current Congress to reorganize the National Institutes of Health.

A lot remains uncertain, but there is one thing you can depend on. No matter what, the ACR will continue to advocate for the needs of ACR/ARP members and their patients with returning champions and we will educate newly elected members on the policy priorities that matter most to you.

For final election results and more information, join us at ACR Convergence 2024 for the session Campaigning for Rheumatology: An Election Year Legislative and Policy Update, to be held Nov. 17 at 9 a.m. EST in room 152A.