The U.S. elections on November 8 confounded predictions and delivered surprising outcomes that will shape domestic politics until the general election in 2024. For many in the United States and beyond, these elections restored faith in American democracy. This moment was much needed given the violent attempt to prevent the peaceful transfer of power after the 2020 election and two years of orchestrated attempts to destroy the legitimacy of that election and damage the democratic process for the 2022 vote.
That restorative effect also has domestic and foreign policy significance. The turmoil in American democracy threatened President Joe Biden's desire to strengthen democracy against authoritarianism and raised questions about the credibility and durability of U.S. international commitments. Combined with the Joe Biden administration's resolute response to Russian aggression against Ukraine, the midterm elections fortify President Biden's claim that America is, indeed, back.
The turmoil in American democracy threatened President Joe Biden's desire to strengthen democracy against authoritarianism
Concerning public health, the domestic political impact and foreign policy importance of the midterm elections create a complicated, less uplifting picture. In this robust display of American democracy, the need to strengthen domestic public health in the wake of a devastating pandemic played no apparent role in political campaigns or when ballots were cast. Similarly, foreign policy issues—whether on supporting Ukraine or improving global health security—mattered little, if at all, to politicians on the hustings and citizens in the voting booth. However, the midterm elections have produced political conditions that create both benefits and threats to policy progress on public and global health.
Between the Voice of the People and the Health of the People
Public health has rarely, if ever, been important in U.S. elections. Although foreign policy issues sometimes matter to voters, finding evidence that U.S. approaches to global health swayed voters on polling day would be a fool's errand. The attention that climate change has received in U.S. electoral politics has primarily—and divisively—concerned mitigation of greenhouse gas emissions rather than addressing the health threats that climate change creates within and beyond the United States. The invisibility of public and global health in the midterms elections reflects these historic patterns.
However, the continuation of these patterns in the 2022 election cycle raises hard questions. A national political reckoning on public health following the worst health disaster in the country's history is needed. But in the nation's most fundamental process for holding politicians accountable and directing their future policies, the COVID-19 pandemic seemed less than an afterthought. Likewise, despite mounting evidence within the United States of the dangers of climate change, this danger to the public's health was nowhere among the issues that voters said were most important to them.
These features of the midterm elections could indicate that the United States is, once again, repeating the "crisis and complacency" pattern identified in past U.S. responses to serious disease events. But the lack of interest in population health by a self-governing people who have suffered a catastrophic pandemic suggests that the disconnect between American democracy and public health is a deeper phenomenon. And coming on the heels of the pandemic are the health threats associated with climate change, which makes the gap between the voice and the health of the people more alarming.
A New Shine on Those Aviator Shades
Elections matter for how the executive and legislative branches of the federal government exercise their respective constitutional powers. In the midterm elections, the Democratic Party retained control of the Senate, and the Republican Party won a majority of seats in the House of Representatives. Power in the Congress is now divided, but the elections have strengthened President Biden's hand, especially in foreign policy.
The Republican majority is unlikely to fund President Biden's foreign policy promises on climate change
Unexpectedly, the Democratic Party delivered a strong performance, and the Republican Party produced underwhelming results. These outcomes emerged without the crisis, chaos, and violence that marred the 2020 elections, demonstrating a resilience in American democracy that many had started to doubt. Instead of being fatally weakened in an electoral rout of the party that he heads, President Biden emerges with more political clout—an effect evident in his post-election trips overseas. This boost will help the Biden administration pursue its plans for improving domestic public health, strengthening global health security against future pandemics, and confronting climate change at home and abroad.
And Now for the Rest of the Story
The additional leeway that the midterm elections provide the Biden administration on public and global health do not mean that success is assured. The administration has developed many plans and strategies, but effective implementation of those policies requires substantial funding. President's Biden biodefense strategy comes with a $88.2 billion price tag, and the president has promised billions in foreign policy spending on pandemic preparedness and climate change.
Unless funded before the new Congress is seated in January 2023, the president's spending priorities will run through a House of Representatives controlled by the Republican Party. Congress already faces a budget showdown in December that involves the need to avert a government shutdown and raise the national debt limit. In that context, the administration is unlikely to see Congress approve substantial increases for public and global health before the new Congress convenes.
In addition, the Republican Party's majority in the House is so slim that a small number of right-wing members will have disproportionate influence over what the party supports and opposes. The recriminations about the Republican Party's poor performance in the midterm elections, and Donald J. Trump's announcement that he is running for president in 2024, will exacerbate the party's internal turmoil, which will adversely affect the functioning of the House for the next two years on every issue. In particular, the Republican majority is unlikely to fund President Biden's foreign policy promises on climate change.
By maintaining control of the Senate, the Democratic Party can protect the Biden administration from investigations that Senator Rand Paul promised to conduct on the administration's policies and performance concerning COVID-19. Such investigations were unlikely to produce constructive legislative action, so the president will welcome the dissipation of that threat to his administration’s efforts on public and global health. Unless, of course, Republicans in the House decide to launch the kind of hearings that Senator Paul had proposed, in which case, things will get ugly in these policy realms over the next two years.
The Rough Road to 2024
The midterm elections—and their restorative and surprising outcomes—have jump-started political machinations for the general election in 2024. At the moment, the Republican Party is on the verge of tearing itself apart. Although elated by the midterm results and the internecine warfare among Republicans, the Democratic Party did not enjoy a "blue wave" in 2022 and confronts concerns about whether President Biden should run again in 2024. In both parties, the politicking ahead is unlikely to deliver the national reckoning on public and global health that the pandemic and climate change make imperative.
