The 1994 mid-term elections will have a significant effect on healthcare reform efforts next year regardless of whether Republicans gain as many seats as they anticipate.
One reason is that several of the most influential and visible reform advocates, particularly in the Senate, are retiring or in danger of losing their seats.
"Many of the people who understood the healthcare issue at its roots are leaving," said Martin Corry, director of federal affairs at the American Association of Retired Persons. "They are the people who had driven the car before."
The most notable retirement is Senate Majority Leader George Mitchell (D-Maine), whom many people say passed up a seat on the Supreme Court to tackle healthcare reform. If Democrats continue to control the Senate, Mr. Mitchell's dealmaking savvy and power will be impossible to replace.
If Republicans control the Senate, current Minority Leader Robert Dole (R-Kan.) would take over as majority leader. While he could clearly match Mr. Mitchell's political skills, he might be less inclined than Mr. Mitchell was to bring healthcare reform legislation to the floor, especially if he becomes an announced presidential candidate.
Republicans would have to pick up seven seats to gain control of the Senate.
Other members who have long been associated with healthcare reform also are leaving. Several members of the Senate bipartisan "mainstream coalition," including Sens. David Durenberger (R-Minn.), John Danforth (R-Mo.) and David Boren (D-Okla.), are retiring.
Mr. Durenberger's departure is particularly significant to hospital groups. Over the past several years, Mr. Durenberger has been one of the hospital lobby's most reliable members, often sponsoring legislation sought by hospitals.
"(Mr. Durenberger) is one of the members that created all the momentum for healthcare reform; he really understood how changes to Medicare and Medicaid affected hospitals," said Brent Miller, legislative director at the American Group Practice Association.
Aside from those leaving of their own volition, several incumbents closely associated with reform are in danger of losing their re-election bids.
For example, Sen. Edward Kennedy (D-Mass.) whose Labor and Human Resources Committee passed a comprehensive reform plan, is in a virtual tie with Republican businessman Mitt Romney, according to polls.
In Pennsylvania, Democratic incumbent Sen. Harris Wofford, whose 1991 dark-horse victory was a rallying cry for reform advocates, is running a tight race with Republican Rep. Rick Santorum.
In Oklahoma, Democratic Rep. Dave McCurdy, who has been a hospital ally, is in a tight race with Republican Rep. Jim Inhofe for Mr. Boren's seat.
In the House, most of the chairmen of the leading healthcare-related committees are safe. However, Speaker of the House Thomas Foley (D-Wash.) is behind attorney George Nethercutt in several polls. Other members who have been hospital industry allies, such as Rep. Peter Hoagland (D-Neb.), also are in tight races.
Several other members, including House Ways and Means health subcommittee members Mike Andrews (D-Texas) and Fred Grandy (R-Iowa), lost bids for other offices and will not be returning to the House.