The 2008 election certainly made for some great theater – and will have serious policy consequences for years to come.  Just to (almost) wrap it up, here is the latest information on the results of the election:

• President-Elect Barack Obama defeated Senator John McCain by a significant margin.  He carried the Electoral College 365 to 173; he won the popular vote by 8.5 million votes (67.1 million to 58.5 million), which computes to a 53 percent to 46 percent victory.
• In the House of Representatives, the current numbers show the Democrats with 257 seats and the Republicans with 178 seats.
• In the Senate, the Democrats gained seven seats to bring their current majority to 58 to 41 over the Republicans, with the Minnesota Senate race still embroiled in a recount.  At the time of this writing, Republican incumbent Norm Coleman is ahead of Democratic challenger Al Franken by 303 votes out of 2.9 million, with 200,000 ballots still to be recounted.

As the final details of these tight races are resolved, they will not change the fundamental impact as discussed last month:

• The new group of Senate and House Republicans may be more conservative, more confrontational, and less amenable to compromise.
• House Republicans have “fired” two of their top three leaders, with Minority Leader John Boehner surviving a challenge.
• Senator Ted Kennedy is giving every indication of returning to health and to the chairmanship of the Health Committee in the Senate, but House Democrats ousted Energy and Commerce Committee Chair John Dingell, opting instead for the more progressive Henry Waxman of California.

All of these developments will have implications for policy in 2009 and beyond in such areas as health care reform, health research and services appropriations, education funding and policy, and more. 

January 2009:  Hit the Ground Running

The title above utilizes the cliché du jour in Washington.  We are expecting no additional relevant action in 2008 (when Congress reconvenes during the week of December 8, it will be to address the problems of the automobile industry).  But January should be a different story.

As indicated last month, there will be an effort to have additional funds directed to the National Institutes of Health (NIH) included in the economic stimulus bill that Congress is expected to consider.  A bill filed in November included $1.0 billion, but the steadily falling economy has created the possibility of a bigger overall stimulus bill (perhaps $400 billion, rather than $100 billion).  This may create opportunities for a higher level of increase.

In addition, as much of the focus for the stimulus package has been on infrastructure improvements, the higher education community has argued that construction projects at public and private colleges and universities, whose facilities have long been neglected, should be considered.  This argument has gotten traction with some on Capitol Hill and elsewhere, so additional funding opportunities may occur.

Finally, it now appears possible that Congress will attempt to pass in January the FY09 appropriations bills that have been languishing for months.  If that happens, it could mean additional funding for such items as the diversity programs under Title VII, the Agency for Healthcare Research and Quality, and the NIH.

Health Professions and Primary Care Reinvestment Act Introduced

During a brief lame duck session, Senator Hillary Clinton introduced the Health Professions and Primary Care Reinvestment Act (S. 3708), which was endorsed by AACOM and other organizations prior to its introduction.  The legislation recognizes that primary care is a vital component of our health care system and that a well-trained primary care workforce is necessary for the success of health care reform efforts. 

When introducing the legislation, Senator Clinton stated, “A stronger health workforce and a greater focus on prevention will help provide more Americans with access to necessary health care.”  By encouraging more health professionals to pursue the practice of primary care and providing incentives for primary care training, this legislation builds upon the existing Title VII programs to foster the workforce necessary to provide high-quality, coordinated care for patients. The Title VII program has been operating under an expired authorization since September 2002, and this legislation is a first step toward reauthorizing the program.  Although Senator Clinton has been selected to join the Obama administration, other members may adopt the provisions in this bill and introduce them as part of health-related legislation next Congress.

Health Care Reform Efforts Underway

Although the 111^th Congress does not convene until January, health care reform efforts are already underway.  Health care reform is a priority for the Obama administration, but Congress is expected to take the lead on the issue. Both Senate Health, Education, Labor and Pensions Committee Chairman Ted Kennedy (D-MA) and Senate Finance Committee Chairman Max Baucus (D-MT) have already begun outlining plans for reform.  The two chairmen, along with other key Senate health care players from both sides of the aisle, met before Thanksgiving to discuss their plans.

Prior to the meeting, Chairman Baucus released a white paper entitled “Call to Action,” outlining the principles he sees guiding health care reform discussions.  He envisions the enactment of a policy that ensures meaningful coverage and care to all Americans while placing emphasis on higher quality and less costly care.  He also is committed to weeding out waste, eliminating overpayments and designing a sustainable financing system.  In his white paper, Baucus clearly states that a strong emphasis on primary care is vital to the creation of a high-performing health system.  Potential changes to the GME system were also raised in the “Call to Action.”

While Chairman Kennedy has not and will not release a white paper on the topic, he has outlined principles to guide the reform effort.  Key areas of the Kennedy reform plan are as follows: (1) primary care, which includes medical homes and improving medical education; (2) chronic disease management; (3) health information technology; (4) comparative effectiveness research; (5) transparency in the national process, which will provide consumers with information to make health care decisions based on value; (6) systemic payment reform addressing quality and efficiency; (7) prevention and wellness addressed on multiple levels with employers and communities; and (8) focusing on racial minorities and improving their access to medical care.

On the House side, Ways & Means Health Subcommittee Chairman Pete Stark (D-CA) has also released highlights of his health care reform agenda, which include the adoption of health information technology, comparative effectiveness research, expanding health coverage and strengthening Medicare.  While the principles of all three Chairmen appear to overlap, we are still awaiting the details of their plans from all the committees with jurisdiction over health care.

We expect that the health care leaders in both the House and Senate will continue to work closely with President-elect Obama and will have legislation ready for introduction early in the 111^th Congress.

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