The dramatic power shift that brought Democrats control of the U.S. Senate last month has been just a swirling weather mass on the radar screen of the healthcare industry. This week, the hurricane will hit as patients' rights legislation is debated on the Senate floor.
But the depth and intensity of the midyear upheaval on healthcare remain to be seen.
Capitol Hill staffers and healthcare lobbyists can only guess at what might follow managed-care reform and what will be changed as a result of new Democratic leadership. Democrats now head the two Senate committees with jurisdiction over healthcare. Sen. Edward Kennedy (D-Mass.) is chairman of the Health, Education, Pensions and Labor Committee, and Sen. Max Baucus (D-Mont.) leads the Finance Committee.
Many feel the only issues that will be approached differently from before will be the patients' bill of rights and Medicare reforms, including a prescription-drug benefit.
"That is where you have real dramatic differences," says Richard Pollack, the American Hospital Association's executive vice president and director of government and public affairs. Pollack says the Democratic leadership means a new starting point for issues. That starting point for a patients' bill of rights is with legislation introduced by Kennedy and Sen. John McCain (R-Ariz.), which would give managed-care beneficiaries a greater chance to sue their health plans than most Republicans favor.
Some have predicted that Kennedy may use the health committee chairmanship, which he last held from 1987 to 1994, to conduct liberal-minded inquisitions on the evils of HMOs, insurance companies and pharmaceutical firms. One healthcare lobbyist didn't doubt that possibility but guessed that trips to the committee woodshed would be used only if those industries get in the way of the Democrats' approaches to patients' rights and Medicare prescription drugs.
"The extent to which they see these people as reasonable or unreasonable will drive the reaction," says the lobbyist, who asked not to be identified.
Other healthcare issues penciled onto this year's federal legislative agenda, including regulatory reform, workforce development, Medicare payment increases, reducing the number of uninsured and increasing patient safety, won't be handled differently from before, say Capitol Hill insiders.
"Those issues have been dealt with on a bipartisan basis so far and will probably continue to be dealt with on a bipartisan basis," says Pollack, who adds that the AHA hasn't changed its advocacy strategies on these issues.
A possible exception to bipartisan camaraderie is legislation to make it illegal for hospitals to force nurses and other staff to work overtime. The cause is consistent with Kennedy's pro-labor ideology, and nursing groups have positioned the issue as one that will help bring more nurses back to the bedside. More than 18% of licensed nurses are not in the nursing workforce.
Banning mandatory nurse overtime is on a short list of issues on which Kennedy will seek action in the coming months, says Jim Manley, the senator's press secretary.
Another is patient safety. Kennedy, along with Sen. William Frist (R-Tenn.) and key federal officials, took a field trip several weeks ago to two Pittsburgh hospitals to learn more about computerized systems for medication ordering and other clinical quality improvement initiatives.
Dean Rosen, staff director for Republicans on the Senate public health subcommittee, predicted at a briefing last month that "there is a better than 50-50 chance" that some sort of medical-error legislation will pass this year.
The health committee's staff director, David Nexon, hints that legislative attention to medical errors would be a way of controlling cost and improving access. "I am convinced that we can save an awful lot of money if we can do a better job of analyzing the way healthcare is delivered at the patient level," Nexon says. He discussed a study released last week that showed a decline in the percentage of people who received health insurance from their employers.
Few expect that much will change with how health issues are handled in the Finance Committee. Baucus and Sen. Charles Grassley (R-Iowa), the former chairman and now ranking Republican, have demonstrated a willingness to work closely on issues.
"They were really working collaboratively with each other, and I don't see that work changing much," says Herb Kuhn, vice president for advocacy at the Premier hospital alliance. Kuhn adds that the two senators have a common interest in rural healthcare.
Insuring the uninsured
Another issue carrying political momentum is reducing the number of Americans without health insurance, now at 43 million.
"I think in the short term the most important thing we can do is work on the coverage side," Nexon says.
Kennedy and Sen. Olympia Snowe (R-Maine) introduced a bill in March to expand the State Children's Health Insurance Program to cover low-income adults.
As for President Bush's interest in helping the uninsured buy private insurance through "refundable tax credits," whereby the government would give money for insurance even to those uninsured who don't pay taxes, Nexon is skeptical. "I wouldn't rule it out as a possible part of the solution, but I wouldn't see it as the primary option."
Regardless of the uncertainty, the mood in Washington is optimistic that the new order will bring action on healthcare issues. Says Edward Howard, executive vice president of the Alliance for Health Reform, a Washington-based think tank: "If I had to bet, I would bet there would be less rhetorical flourish and more legislative craftsmanship."