By Holly Owens

While the nation has been stunned by the events following the Presidential election that have left the country without a President-elect through mid-December, it is safe to say that the impact of these events will be felt for many years to come with regard to healthcare policy.  The degree of impact is yet to be determined, but certainly the growing animosity between the two major political parties, which has already plagued policy-making over the last several years, will continue to threaten future healthcare-related initiatives.

Traditionally at this time of year the country would be enjoying a cooling-off period between election day and the start of a new administration and Congress.  The months between these two events are usually quiet while the President-elect and the presumptive administration appointees are busy with their transition and legislators take a break between the stress of election day and the activities of a new session of Congress.  However, the compression of this year's transition cycle and the residual bitterness from the Presidential campaign make such a honeymoon unlikely.

Regardless of who ultimately occupies the White House, the contested election could severely hinder efforts on Capitol Hill (including work on healthcare-related legislation).  As you may know, a brand new Congress (the 107th, to be exact) will be convening on Jan. 3 and will face major changes in the legislative climate.  If Governor Bush should indeed become our next President, for the first time the Senate will be evenly split, 50/50, by the parties.  The Constitution states that the Vice President is also the President of the Senate, therefore giving the Vice President the tie-breaking vote in this body.  Senate Republicans have maintained that they will still be the majority party in the Senate. Senate Democrats, however, have already begun to insist on equality as far as memberships on the committees as well as having equal say in floor procedures.  Currently, given that Democrats have been in the minority since 1994, they have held two less seats than Republicans on most committees and have had no say in the way the Senate procedures are developed.  Democratic leaders contend they will not be satisfied with anything less than equal representation on all committees, but Senate Majority Leader, Trent Lott (R-MS), has stated publicly that will never happen. What will likely occur is that Democrats will get one more seat on each committee, giving Republicans the majority by one member at the committee level.

No one really knows what to expect with a 50/50 split in the Senate.  Some are arguing that the split will force bipartisanship and compromise, while others contend that it will further divide the body resulting in a minimalist agenda.  Specifically, when it comes to Medicare policy, the parties couldn't be more at odds.  Republicans favor privatizing the Medicare program, giving plans more autonomy and ability to negotiate prices. On the other hand, Democrats favor the government-run system and would like to expand coverage to include prescription drugs.  Congress struggled with the issue of reforming the 35-year old entitlement program this past session and will likely resume the debate in the 107th Congress, but the fallout from the recent election will certainly affect the outcome.

Other changes in the Senate will also impact healthcare policies. One key issue is whether the Senate Finance Committee, which has sole jurisdiction over the Medicare program, will get a complete makeover in its membership.  Two of the leading experts in the Senate on Medicare policy will not be returning this Congress.  Senator Bill Roth (R-DE), the Chairman of the Finance Committee lost his election and Senator Pat Moynihan (D-NY), the Ranking Member on Finance, retired at the end of the 106th Congress.  Both Senators were leaders on all Medicare-related legislation.  Senate leaders have yet to vote on who will succeed the Senators on the Finance Committee leadership, but most expect Senator Charles Grassley (R-IA) to become the Chairman and Senator Max Baucus (D-MT) to become the Ranking Member.  You may remember it was Senator Grassley, while Chairman of the Senate Aging Committee, who held a hearing about the oversight of the ESRD program last July and promised that he would be much more active in ESRD issues overall.  This could provide some much needed sunshine on the workings of the Medicare ESRD Program and the patient outcomes it produces. However, some Washington observers felt that the July hearing was part of a broader effort to pad Sen. Grassley's resume on healthcare issues in advance of his pursuit of the Finance Chair, and not necessarily a meaningful attempt at crafting policy.

On the other side of the Capitol, the House of Representatives will maintain the status quo with Republicans as the majority party, although their margin has narrowed a bit.  The elections had little impact on the makeup of the House, but as in the Senate, the committees with jurisdiction over the Medicare program will see new leaders.  Due to term limits that House Republicans imposed on themselves in 1994, the majority of the committees in the House will receive new chairmen (Democratic leadership in the House committees will go unchanged), and the subcommittees will see new leadership as well.  This is important because yet another expert on Medicare policy, Rep. Bill Thomas (R-CA), will no longer be the Chairman of the House Ways and Means Subcommittee on Health.  The likelihood is that Nancy Johnson (R-CT) will ascend to the subcommittee chair.  Rep. Johnson has long been involved in Medicare issues but has focused most of her efforts on issues related to the treatment of various forms of cancer and does not seem to have as broad a scope on general health policy as Rep. Thomas. 

The changes in Congress are important because they will all affect the way that ESRD-related issues, as well as healthcare policy in general, are debated.  Republican control of Congress would seem to guarantee vigilant oversight of HCFA, and as such, continued evaluation of the more costly aspects of the Medicare program, such as the provision of ESRD care, would fall under this review.   Such oversight could result in the improvement of some of HCFA's policies and procedures, but may also result in funding reductions if the Congress deems such action appropriate.

Holly Owens is AAKP's policy consultant. She works and lives in the Washington, DC area.

This article originally appeared in aakpRENALIFE, Vol. 16, No. 4, January 2001.

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