Languishing healthcare legislation could gain new potency after last week's midterm elections, but Republican control of Congress does not necessarily mean lawmakers have found an elixir for easing gridlock.
Controversial issues including Medicare prescription drug coverage, medical liability reform and provider payment relief still will require 60 votes to pass the Senate, which despite a Republican majority is likely to continue mirroring an almost evenly divided electorate.
"There will have to be some coming toward the middle," said Ron Pollack, executive director of Families USA, a consumer advocacy group in Washington. "Anything purely ideological and partisan will have a tough time getting passed."
Lobbyists and political analysts said a unified Congress can make it more difficult to advance an agenda because there are no alternate routes when one strategy or party doesn't get the job done. With a Republican margin of two dozen members in the House and only two or three in the Senate, partisan politics are not likely to disappear.
"I see us moving backward," Rep. Pete Stark (D-Calif.), the ranking Democrat on the House Ways and Means Committee's health subcommittee, said in a postelection interview with Modern Healthcare. "I don't see any hope for expanded benefits or broader access or improved quality in the healthcare arena. What I do see is pressure toward vouchers and privatizing Medicare."
"There will be a lot of gridlock," predicted Nancy Bradish Myers, senior healthcare research analyst for Lehman Brothers in Washington. "Because you now have the Republicans taking the majority doesn't mean they get to push any agenda they want."
Myers said she expects the new Congress to focus on rising healthcare costs, possibly scrutinizing hospitals and other providers the way it has the pharmaceutical industry.
Incoming Senate Majority Leader Trent Lott (R-Miss.) echoed the gridlock sentiment last week when he told reporters "the majority leader is not a ruler. The Senate is a place where it's very hard to ... get movement and bring together leaders and members of both parties."
In the case of prescription drugs, Republicans favor a market-based approach whereby private companies would administer a benefit with funding from Medicare. Democrats want the federal government to fund and run the program. That philosophical difference, as well as practical considerations, so far have prevented a bill from reaching President Bush's desk.
Ongoing concerns about gridlock notwithstanding, Republican control could change that-especially if even a few Democrats in the Senate cross the aisle to support a drug plan similar to one passed last summer in the House.
Despite losing the Senate, the Democrats will continue to work toward a "real prescription drug benefit that covers all seniors in this country and brings down costs," Terry McAuliffe, chairman of the Democratic National Committee, told reporters in Washington last week.
McAuliffe's Republican counterpart, former Montana Gov. Marc Racicot, said the Democratic-controlled Senate recently had a drug bill within its grasp but failed to act. The midterm election results, he said, "suggest that issues will be resolved in one fashion or another with more speed and dispatch."
Legislation to reform medical liability could be one such issue. Myers and others agreed the new Republican Senate quickly would take up House-passed legislation to limit liability exposure that fell flat in the Democratic Senate last month.
Each day the American Medical Association learns of more obstetricians giving up their practices and maternity wards closing because of malpractice insurance costs, said Donald Palmisano, M.D., the AMA's chairman-elect. Medical liability, he said, is "out of control."
Not so, according to veteran healthcare lawmaker Stark. "There is clear evidence that insurance premiums have nothing to do with the damage awards," Stark said. Rising costs, he said, are not the fault of aggressive trial lawyers but of "insurance companies trying to make up for bad underwriting in the past or to increase their profits."
Palmisano said he hopes lawmakers will address the "broken" physician payment formula during the lame-duck session set for this week, arguing that if the formula isn't repaired physicians will be paid less in 2005 than they were paid in 1991.
In the newly fashioned Senate, Charles Grassley (R-Iowa) will become chairman of the Finance Committee, replacing Max Baucus (D-Mont.). Capitol observers said Grassley is known for his bipartisan approach and concern about hospital reimbursement rates.
"I'll work for committee and Senate approval of a bill to offer a Medicare prescription drug benefit and to modernize Medicare, and to build Medicare equity for low-cost states that are shortchanged under current Medicare formulas," Grassley said in a written statement last week. "I'll work for full Senate approval of my bipartisan legislation, which the committee passed, to help the families of children with disabilities buy into Medicaid."
At the Senate Health, Education, Labor and Pensions Committee, previously run by Edward Kennedy (D-Mass.), Judd Gregg (R-N.H.) will take over. He may adopt a more conservative healthcare agenda that would limit attention paid to issues such as the reimportation of prescription drugs, lobbyists said.
During its lame-duck session this week, the Senate also could revisit a $43 billion provider relief package Grassley and Baucus introduced in September. The Bush administration opposes the bill, arguing it's too broad and expensive. Several observers agreed Congress is more likely to work on the physician payment formula during the lame-duck session than to pass a sweeping provider bill.
Lobbyists and others were mixed on the prospects for provider relief next year, but some said it could be more difficult to pass a large package given the Republican leadership and the budgetary constraints that may be amplified by a costly confrontation with Iraq.
For teaching hospitals, which have counted Democrats as strong allies in recent years, the shift to a Republican Congress represents a new challenge. "We've got to do a better job of making our case, and this will cause us to have to do that," said Dick Knapp, executive vice president of the Association of American Medical Colleges in Washington.
Health insurers will push for tax credits to help low-income people afford coverage and new measures to encourage the purchase of long-term-care insurance, according to the Health Insurance Association of America.