Public Reason / Nov. 6, 2026 / Counts Continue and Medicare Pay Changes

Winning elections is very different from successful governing. Democrats must decide what to do with their majority in the next Congress, and Republicans must decide how to manage the lame duck while they still have control.

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Plus, the lame-duck session and new Congress are bound to have lots of moving pieces that Public Reason will take on.

Teddy Brosevelt
Explainer extraordinaire

What's Loud
The Associated Press tally, updated at 11:30 a.m. Eastern Nov. 6, gives Democrats 253 House seats to Republicans' 160, with 22 seats still uncalled. In the Senate, Democrats have 54 seats to Republicans' 44, with two undecided.

What's Missing
In AP's Nov. 5 update, Mississippi Democrat Scott Colom led Sen. Cindy Hyde-Smith by 1,145 votes; provisional ballots remain, and the state has no automatic recount. Alaska Democrat Mary Peltola led Sen. Dan Sullivan by 637 votes; if nobody finishes above 50 percent, ranked-choice tabulation is scheduled for Nov. 18. These Nov. 5 margins remain unofficial.

What Matters
Control is settled; the governing choices are not. Democrats can negotiate with Trump and share credit for legislation, send him bills that force a veto decision or make investigations their priority. Keeping their new coalition together across those choices will be a leadership test, especially when members disagree about how much to cooperate.

On Nov. 4, the Centers for Medicare and Medicaid Services (CMS) finalized its 2027 hospital outpatient payment rule. It pays hospitals for drugs bought through 340B, a program offering discounted drugs to eligible providers, at average sales price minus 28 percent. CMS estimates lower payments will reduce patients' drug bills by $1.1 billion in the first year.

Lower drug payments finance higher payments for other outpatient services. The policy does not change the discounts manufacturers must offer hospitals. In a separate physician payment rule, the dollar multiplier used to price services for doctors outside arrangements that tie payment to care quality and cost falls 2.31 percent as a temporary increase expires.

Both rules take effect Jan. 1, 2027. The Supreme Court's 2022 ruling blocked the earlier 340B cut because CMS had not surveyed hospital acquisition costs. CMS says its survey found some coinsurance exceeded hospitals' drug costs.

CMS argues payments should reflect those costs. The American Hospital Association says the rate inadequately accounts for hospitals' financial challenges; America's Essential Hospitals warns the cuts threaten care.

On physician pay, the American Medical Association reports a 33 percent decline since 2001 after adjusting for practice costs. MedPAC, Congress's Medicare advisory commission, found patients' access to physician services generally strong. Patient savings do not settle whether hospitals can sustain services.

More in-depth summary and analysis are available in Deep Reason.

Congress
Congress sent the President H.R. 7730, the Bankruptcy Threshold Adjustment Act of 2026, on Nov. 5 after the House passed it by voice vote and the Senate by unanimous consent. It would raise the debt limit for small-business bankruptcies from about $3.4 million to $7.5 million. Businesses with more debt could then use that process.

Executive
Dept. of Labor
The Labor Department removed affirmative action requirements for Registered Apprenticeship sponsors in a final rule published Nov. 6. It takes effect Jan. 5, 2027, ending those program-specific obligations for sponsors.

CBP
Customs and Border Protection (CBP) issued an interim final rule requiring foreign importers to pass its supply-chain security validation or use a broker who has. The rule takes effect Jan. 5, 2027; brokers must fully comply by May 6, changing which brokers foreign businesses can use to bring goods into the country.

Courts
On Nov. 5, Judge Tanya Chutkan halted construction of the proposed arch near Memorial Circle for 14 days in a suit by D.C. and Virginia. Work stops while the case proceeds; the order does not decide the project's legality.

Ballot Measures
Abortion. Voters approved abortion-rights amendments in Nevada and Virginia and rejected an Idaho statutory right and a Missouri repeal of its 2024 amendment, Ballotpedia News reported Nov. 4. All results here are unofficial.

Voter ID and citizenship. Voters in Nevada, Ohio and North Carolina approved voter ID amendments, and State Court Report says four states approved citizens-only voting amendments. North Carolina's writes into the constitution a photo ID rule the legislature had already applied to absentee ballots, WFAE reported.

Taxes. MultiState reports North Carolina approved a 3.5 percent cap on the income tax rate, which is 3.99 percent in 2026 and scheduled to fall to 3.49 percent in 2027. Florida approved a larger homestead exemption, but Amendment 2, a farm-equipment exemption, failed at about 58 percent because amendments need 60. California's wealth tax and Colorado's graduated income tax remained uncalled in the Nov. 4–5 reports.

Other. Missouri voters rejected Proposition A, restoring the earlier congressional map, and Maryland approved an amendment paving the way for a redraw, per State Court Report. Alaska's Measure 2, repealing ranked-choice voting, was uncalled and trailing in early returns.

BLS
Employers added 165,000 jobs in October, and the unemployment rate was 4.1 percent, down from 4.2 percent in September, the Bureau of Labor Statistics (BLS) reported Nov. 6. Average hourly earnings rose 14 cents to $38.00. Revisions added 84,000 jobs to August and September combined, so the earlier estimates understated hiring.

IRS
The Internal Revenue Service (IRS) announced Nov. 5 its 2027 inflation adjustments: the standard deduction rises to $16,600 for single filers, $33,200 for married couples filing jointly and $24,925 for heads of household. Larger deductions reduce taxable income for filers who use them; the changes apply to returns filed in 2028.

The 119th Congress has enacted 138 public laws as of Nov. 3, compared with 106 at the same point in the 118th Congress and 214 in the 117th.

Nov. 9: The Supreme Court's argument calendar includes Nielsen v. Watanabe, about suing federal prison officials over medical care, and Hoffmann v. WBI Energy Transmission, about compensation for land taken for natural-gas infrastructure.

Nov. 9: The Justice Department must submit mediation paperwork in its Alaska election appeal, seeking to revive its suit over whether votes for challenger Daniel J. Sullivan were intended for Sen. Dan Sullivan.

Nov. 10: House Republicans are scheduled to vote on a minority leader for the new Congress, according to AP-based reporting from 13WHAM.

Nov. 10: BLS releases the October Consumer Price Index at 8:30 a.m. Eastern, updating the measure of consumer-price inflation.

Nov. 10: The Supreme Court hears Department of Labor v. Sun Valley Orchards (No. 25-966), on whether the department can decide cases seeking money from employers accused of violating temporary agricultural workers' employment terms.

Nov. 18–19, disputed: Bloomberg Government reports House Democratic leadership elections on those dates; Fox News reports mid-December; the reports conflict, and the date remains unconfirmed.

Dec. 11: Federal funding expires unless Congress acts.

Edition No. 40

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