Fresh from taking over the House and Senate for the first time since the Eisenhower administration, Republican leaders last week pledged to push a limited healthcare reform package in 1995.
Sen. Robert Dole (R-Kan.), who is in line to become majority leader in the Senate, said he would be willing to press for a package that included malpractice and insurance reforms, along with other modest measures. But he was unwilling to push any benefits expansions because he said he did "not want to create any entitlements."
Last week's election marked the larg-est swing of seats between parties of any nonpresidential election year this century. In the Senate, Republicans will hold a 53-47 advantage, a turnover of nine seats.
In the House, Republicans gained 52 seats, giving them about 230 seats in the 435-member chamber. Several races remained undecided late last week.
Among the Democratic casualties were a number of members who were closely aligned with healthcare reform, including Rep. Jim Cooper (D-Tenn.), House Speaker Thomas S. Foley (D-Wash.), Rep. Dan Rostenkowski (D-Ill.), Sen. Jim Sasser (D-Tenn.), and Sen. Harris Wofford (D-Pa.).
Invisible issue.The newly elected members of Congress will come to work having received mixed signals from the American public.
On one hand, healthcare reform was almost nonexistent as a campaign issue. According to several campaign consultants, healthcare emerged only as a symbol of what scared Americans about the Democratic Party.
"Healthcare had a very significant, but very indirect, effect on the election," said Mark Mellman, a Democratic consultant. "The Democrats paid a price for their failure in the public's mind to get things done, and nothing was more important symbolically than healthcare reform."
Curtis Gans, an analyst with the Committee for the Study of the American Electorate, said that the Clinton administration's healthcare reform plan made it possible "for Republicans to link Democrats to the (Clinton) 1,400-page healthcare reform bill, and that equaled big government in people's minds."
On the other hand, exit polls found that among voters who said they voted for change, healthcare reform (30%) was the No. 1 issue, followed by lower taxes (19%).
That gave some analysts hope that the healthcare reform movement might still have some life in 1995.
Scaling back.According to Doug Bailey, a Republican strategist, healthcare reform "is one issue where more will happen, but it will require the president to scale way back. There will be a modest healthcare reform plan that is labeled a first step. Republicans will want to do something because it takes the issue off the table for the 1996 elections."
Another promising sign was the bipartisan stance Republican leaders and President Clinton took in the days after the election.
"It's in everyone's best interests to get something done," said Republican National Committee Chairman Haley Barbour.
But while reform may still be alive, comprehensive reform almost certainly is not.
"I think the healthcare plan was sort of a symbol of the kind of policy that the American public is clearly not interested in," said Daniel Bourque, senior vice president of the VHA. "This election just kind of put a big exclamation point on the death of the (Clinton) healthcare plan."
"The word `incremental' is now fashionable again," said Frederick Graefe, a healthcare lobbyist with Baker and Hostetler in Washington. "Any comprehensive overhaul is certainly delayed."
For provider groups, the Republican landslide increased jitters about the prospects for massive Medicare and Medicaid spending reductions.
"I'm not sure health reform issues will get big play in the next Congress," said Charles Huntington, director of the Washington office of the American Academy of Family Physicians. "I think budget cutting, entitlement cutting and program cutting will be big issues."
Reform alive in Florida.In other developments, Democratic Gov. Lawton Chiles narrowly defeated Republican challenger Jeb Bush in an election that ensures Florida will continue its three-year effort toward reforming its healthcare system.
But the road to healthcare reform could potentially be more difficult for Mr. Chiles in the 1995 legislative session. Republicans in the state Senate gained a 21-19 majority. The state House remained in Democratic control, 63-57, although the party lost eight seats.
In August, with the Senate evenly split, Republican senators effectively blocked Gov. Chiles' bill to offer subsidized health insurance to 1 million low-income residents by expanding the Medicaid program.
In 1993, Mr. Chiles pushed through his landmark healthcare reform that allows businesses with fewer than 50 employees to join group purchasing alliances. Nearly 2,000 businesses have joined the regional alliances this year, saving as much as 25% on their health insurance policies.
In Oregon, Democratic state Senate President John Kitzhaber, a physician and author of the Oregon Health Plan, was elected governor. His experience in gaining bipartisan support for the Oregon plan-a universal coverage plan currently involving a Medicaid expansion-will help in its implementation, said Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems.
Dr. Kitzhaber has proposed a slower phase-in of mental health services in the Medicaid portion of the plan and established a group to study modifications to its employer mandate, an aide said.
Another physician, Republican Bill Frist, was elected to the U.S. Senate from Tennessee.
The Nashville surgeon dismissed questions about possible conflicts of interest arising from his ownership of $13 million worth of Columbia/HCA Healthcare Corp. stock. Dr. Frist said his experience in the healthcare field will be an asset in considering reform.
Dr. Frist didn't register to vote until 1988 and acknowledged that to his supporters.
"I was part of the problem. I'm now part of the solution," he said.