Public Health Experts Make Sense of the Midterms

The day after the midterm elections, the Columbia Mailman community came together for a nonpartisan discussion about the implications of the outcome on public health. According to exit polls, healthcare was the number-one issue for voters, ahead of the economy and immigration.

The community discussion was moderated by Professor Robert Fullilove and featured remarks by Dean Linda P. Fried and Ross Frommer, Vice President of Government and Community Affairs at Columbia University Irving Medical Center. Insights on several key issues were provided by a Columbia Mailman faculty panel with Merlin Chowkwanyun, John W. Rowe, Goleen Samari, and Carolyn Westhoff.

After record voter turnout for midterm elections, Democrats retook the majority in the U.S. House of Representatives while Republicans gained ground in the Senate. Frommer said these results were in line with historical averages but featured several important firsts, including the first Muslim women and the first Native American women in Congress. House Democrats from New York are in line to oversee several powerful committees. Nita Lowey from New York’s 17th District will lead Appropriations, setting policy on federal spending for programs like the National Institutes of Health and the Centers for Disease Control and Prevention. Yet, according to Frommer, her expanded influence will be constrained by new budget rules. “We are hoping for a large piece of the pie, but the pie could get smaller.”

Another power shift took place as voters elected a record number of women to the House. Carolyn Westoff, a professor of Epidemiology and Population and Family Health, said these gains in female representation could favor legislation that benefits reproductive health. However, she cautioned, abortion access will increasingly be decided state by state. “It looks like Roe is going to fall, and that is going to send everything back to the states,” Westhoff said. The election highlighted stark regional differences. Voters in Alabama and West Virginia approved ballot initiatives aimed at limiting abortion rights. On the other hand, Michigan and New York State are newly positioned to pass greater protections for abortion services.

In a clear victory for public health, voters in Utah, Nebraska, and Idaho approved ballot initiatives to expand Medicaid eligibility, extending health insurance to as many as 300,000 low-income Americans. With Democrats elected to governor in Kansas, Maine, and Michigan, expansion will likely proceed in those states too. However, on Tuesday, Montana voters rejected an expansion initiative tied to a cigarette tax. John Rowe, professor of Health Policy and Management, said the tactic was ill-conceived. “It created a well-funded enemy that blew them out of the water,” he said. In the U.S. House of Representatives, Rowe said Democrats will likely focus on strengthening the Affordable Care Act, controlling drug costs, and protecting Medicare and Medicaid. Other issues could include gun control and single payer healthcare.

Goleen Samari, assistant professor of Population and Family Health, spoke about what the midterm results might mean for immigration. She said House Democrats will likely push for legal status for migrants protected under the Deferred Action on Childhood Arrivals (DACA) program. A compromise bill with the Senate could involve concessions on border enforcement. Elijah Cummings of Maryland who is set to chair the House Oversight committee is interested in addressing the zero-tolerance policy and the detention of migrant children at the border, as well as the citizenship question which conservatives want to add to the 2020 census. Democrats are also poised to fight a Republican effort to limit legal immigrants’ access to social services to deter migration. “Removing public benefits as an incentive is very threatening to people’s health,” says Samari. Going forward, she said it is important that the public health community collect data and measure the effect of these policies on health and work with advocates and media to raise awareness on their effect on families and communities.

Of all the midterm results, a single ballot measure in Florida could remake the political map and tilt the outcome of the 2020 election to Democrats. By a 65 to 35 margin, Floridians granted voting rights to ex-felons. Merlin Chowkwanyun, assistant professor of Sociomedical Sciences, said this outcome would have been all but impossible as recently as 10 years ago. “Something has definitely changed,” he said. More than the result of a single election campaign, he said the result reflects a growing consensus around the need for criminal justice reform. Scholarship by Columbia Mailman faculty and others on mass incarceration alongside activism by the Black Lives Matter movement brought new urgency to criminal justice issues. “Elections are the culmination of larger social transformations,” said Chowkwanyun. “Election work is crucially important and so is all the work we do before it and after it.”

In closing remarks, Fullilove called the conversation fruitful but admitted it had barely scratched the surface of the midterm elections. He called for continued attention to the many and complex ways the outcome could have on public health, including on issues like drug policy, gun control, and climate change. “This forum today is only the beginning.”