What the 2004 Elections Mean to Health Care
Voters in this year's presidential election ranked health care fifth among the factors that influenced their vote—behind moral values, the war in Iraq, terrorism, and the economy. However, with the reality of the baby boom generation fast approaching beneficiary status for both the Medicare and Social Security programs, these programs are likely to be catapulted to the top of the agenda for the 109th Congress convening in January.
Presidential Priorities
We do not expect to see the president pushing for comprehensive, system-wide reforms in the health care arena. More likely, we will see attempts to use the tax code to entice health insurance expansion. We also expect an increased focus on health information technology to reduce medical errors, as well as continued—and potentially successful—attempts at medical liability reform. Indeed, the president's first postelection press conference offered hope for the ACR and other physician groups as Bush cited medical liability reform as one of his key domestic priorities for the coming year, along with Social Security reform, permanent tax cuts, education reform, and job creation.
A major problem that will dominate the administration's domestic spending agenda is the president's commitment to halve the federal deficit within the next 5 years. Congress will return to a "budget reconciliation" mode in dealing with domestic issues, most certainly when considering any policy change to the Medicare program. Unfortunately, physician reimbursement policies will be legislated in a deficit reduction environment.
The president has justifiably declared that this election has earned him substantial political capital, and he intends to spend it on his priority initiatives. His ability to use this capital will be front-loaded in the next 2 years, and we can anticipate an accelerated legislative schedule to optimize this political reality.
Republicans Expand Their Margins in Both Chambers
Republicans firmed up their control in Congress, netting an additional 4 seats in the Senate and potentially adding 4 seats in the House, depending on the outcome of 2 run-offs in Louisiana. When the 109th Congress convened in January, Republicans held 233 of 435 House seats and 55 of 100 seats in the Senate. Although the Senate is still 5 seats shy of a filibuster-proof margin, the Republicans' gain is expected to be enough to move forward on class action reform and other Republican priorities. Medical liability reform will be a high priority, but whether there are now enough votes to succeed is still uncertain.
New Physicians in Congress
Four new physicians were added to Congress. These include 1 physician in the Senate, Dr Tom Coburn of Oklahoma; and 3 physicians in the House, Dr Tom Price of Georgia, Dr Joe Schwarz of Michigan, and Dr Charles Boustany of Louisiana. Coburn is a family physician/obstetrician; Price is an orthopedic surgeon; Schwarz is an otolaryngologist; and Boustany is a retired thoracic and cardiovascular surgeon.
Shifting Leadership/Realigned Committees
The House
The House leadership will stay roughly the same for the time, with Dennis Hastert (Ill) holding on to the position of speaker, Tom Delay (Tex) as the majority leader, Roy Blunt (Mo) as the majority whip, and Nancy Pelosi (Calif) as the minority leader. The committee chairs are also likely to carry over into the next Congress, although several committee seats will be jockeyed due to retirements and election defeats.
Energy and Commerce
Leaving the Energy and Commerce (E&C) Committee is Richard Burr (NC), who defeated Erskine Bowles in the race for the Senate seat vacated by Sen John Edwards (NC). Also departing from the committee are retiring members W. J. “Billy” Tauzin (La), Karen McCarthy (Mo), and Jim Greenwood (Pa), as well as Chris John (La) and Peter Deutsch (Fla), who were defeated in their quest for higher office.
Rep Sue Myrick (NC ) has already been added to the E&C roll, replacing Gov Ernie Fletcher of Kentucky. Many insiders consider Price another likely addition to the committee and its 6 open seats.
Ways and Means
The defeats of Phil Crane (Ill) and Max Sandlin (Tex) and the retirements of Jennifer Dunn (Wash), Jerry Kleczka (Wis), Scott McInnis (Colo), and Amo Houghton (NY) open up 6 seats on the Ways and Means Committee. Rep Phil Gingrey (Ga), an ob-gyn, has been frequently discussed as a possible new addition to the committee; his name has also come up, though, as a candidate for the E&C Committee.
The Senate
Minority Leader Tom Daschle's (SD) defeat to former Rep John Thune (SD) paves the way for Sen Harry Reid (Nev), currently the number 2 Democrat in the Senate, to move ahead. Less than 12 hours after Daschle conceded defeat, Reid announced that he had the votes to be the new minority leader. Sen Richard Durbin (Ill) is slated to replace Reid as the minority whip.
On the Republican side, there are not likely to be any major leadership changes in the short term; however, with majority leader Frist's current plans to retire in 2 years, his colleagues may soon be vying for rank in the Republican leadership. Most bets are on Sen Mitch McConnell (Ky) to fill the position. Thereafter, we can anticipate a domino effect as Republican senators jockey for positions.
As for committee appointments, with 4 more Republicans in the Senate, committee ratios are likely to be adjusted, giving Republicans at least one extra seat in each committee. Also, retirements, election losses, and Republican Caucus–imposed committee chair term limits, are creating vacancies on several key committees, including a few chair positions.
Finance
Charles Grassley (Iowa) will continue as chair of the Finance Committee, and Republican leaders are expected to make 2 new appointments to the committee. Sen Mike Crapo (Idaho) has long been a favorite to fill the seat of retiring Sen Don Nickles (Okla). With the anticipated addition of an additional Republican seat on the committee, Sen George Voinovich (Ohio), who has expressed interest in the committee, might get a seat as well.
Democrats will need to fill the 3 vacancies created by the departures of Senators Daschle, Breaux, and Graham. Among the names being circulated as lead contenders for those seats are Charles Shumer (NY), Hillary Clinton (NY), and Bill Nelson (Fla).
Judiciary
Orrin Hatch (Utah) has served 6 years as the chair of the Judiciary Committee and, thus, must turn the reins over to a successor—most likely Arlen Specter (Pa). Grassley is technically next in line to be chair; however, because he has 2 years remaining as chair of the Finance Committee, he will likely remain there. While Specter voted for cloture on the 3 medical liability reform votes during the 108th Congress, his son is a leading trial attorney in Philadelphia. However, Specter owes President Bush and the RNC for getting him reelected, so he will likely stick with the presidential agenda and the Republican Party policy on this issue.
Health, Education, Labor, and Pensions
Term limits also are affecting Health, Education, Labor, and Pensions Committee Chair Judd Gregg (NH). Gregg is expected to pass the torch to Michael Enzi (Wyo). Like Gregg, Enzi is a supporter of the MICRA approach to medical liability reform. However, during the 108th Congress, Enzi also introduced legislation, S 1518, that would establish a demonstration program for medical liability reform alternatives such as a medical tribunal. Gregg will become chair of the Budget Committee.
Appropriations
Thad Cochran (Miss) is the likely successor to Appropriations Committee Chair Ted Stevens (Alaska), who will become chair of the Commerce Committee.
Congressional Priorities
The Republicans are expected to act early to set an agenda for the coming Congress. As with the president, medical liability reform is going to be a top priority. Immediately after last week's election, congressional leadership released the following list of some of the issues likely to rise to the top of their wish list for next year:
- Class action reform
- Welfare reform
- Bankruptcy reform
- Iraq supplemental
- Highway bill
- Energy bill
- Budget resolution
- Bush tax cut permanency
- Available free trade agreements
Meet the New Members
Senate Republican Freshman
Richard Burr (NC)
Tom Coburn (Okla)
Jim DeMint (SC)
Johnny Isaakson (Ga)
Mel Martinez (Fla)
John Thune (SD)
David Vitter (La)
Senate Democratic Freshman
Barack Obama (Ill)
Ken Salazar (Colo)
House Republican Freshman
Mike Conaway (Tex, 11th)
Geoff Davis (Ky, 4th)
Charlie Dent (Pa, 15th)
Thelma Drake (Va, 2nd)
Mike Fitzpatrick (Pa, 8th)
Jeff Fortenberry (Neb, 1st)
Virginia Foxx (NC, 5th)
Louie Gohmert (Tex, 1st)
Bob Inglis (SC, 4th)
Bobby Jindal (La, 1st)
Randy Kuhl (NY, 29th)
Dan Lungren (Calif, 3rd)
Connie Mack (Fla, 14th)
Kenny Marchant (Tex, 24th)
Michael McCaul (Tex, 10th)
Patrick McHenry (NC, 10th)
Cathy McMorris (Wash, 5th)
Ted Poe (Tex, 2nd)
Tom Price (Ga, 6th)
Dave Reichert (Wash, 8th)
Joe Schwarz (Mich, 7th)
Mike Sodrel (Ind, 9th)
Lynn Westmoreland (Ga, 8th)
House Democratic Freshman
John Barrow (Ga, 12th)
Melissa Bean (Ill, 8th)
Dan Boren (Okla, 2nd)
Russ Carnahan (Mo, 3rd)
Emanuel Cleaver (Mo, 5th)
Jim Costa (Calif, 20th)
Henry Cuellar (Tex, 28th)
Al Green (Tex, 9th)
Brian Higgins (NY, 27th)
Dan Lipinski (Ill, 3rd)
Cynthia McKinney (Ga, 4th)
Gwen Moore (Wis, 4th)
John Salazar (Colo, 3rd)
Debbie Wasserman Schultz (Fla, 20th)
Allyson Schwartz (Pa, 13th)
RADPAC's Role
RADPAC made contributions to 156 candidates for Congress in the 2003-2004 election cycle. Of the 154 races decided on November 2, 143 candidates supported by RADPAC were victorious, giving RADPAC a success rate of 93%. More specifically, RADPAC contributed to 22 Senate candidates, 19 of whom were victorious. RADPAC contributed to 132 House candidates, 124 of whom were victorious.
For the 2003-2004 election cycle, RADPAC has had more than 3,000 contributors, has raised more than $940,000 from members of the College, and has contributed more than $958,500 to candidates, political parties, and political action committees. The amount of money that RADPAC both raised and spent during the cycle placed it in the top 5 among political action committees in the health industry nationwide.
In 2004 alone, RADPAC was represented at more than 240 fundraising events for candidates, political parties, and political action committees. This high level of activity increased the visibility of RADPAC and the College on Capitol Hill.
For a complete list of candidates, parties, and political action committees to which RADPAC contributed in the 2003-2004 election cycle, visit RADPAC's Web site at www.radpac.org.
Governors and State Legislatures Breakdown
Republicans won governor seats previously held by Democrats in Missouri and Indiana, and the Democrats replaced a GOP incumbent in New Hampshire and won in Montana. Democrats managed to keep control of the governorships in Delaware, North Carolina, and West Virginia. Republicans held in North Dakota, Vermont, and Utah. Republican Max Blunt, son of House Majority Whip Roy Blunt, won a narrow victory in Missouri in one of the nation's closely watched races. In addition, Mitch Daniels, former Bush administration official, ousted Democratic Indiana Governor Joe Kernan from the position he fell into the prior year. New Hampshire's incumbent, Republican Governor Craig Benson lost his bid for reelection in an early morning outcome to Democrat John Lynch. The Washington State race still has ballots that are being counted at the time of this analysis.
In addition to governors' elections, 44 states held electoral contests for state legislatures, nearly 80% of the seats were up for grabs. In these statehouse races, changes began to take place in 8 states. Democrats control the state legislature in 17 states and the District of Columbia. Republicans control 21 states, while 11 states remain split. One state, Nebraska, is nonpartisan. The GOP continued to make gains in the South capturing control of the Tennessee Senate and the Georgia House, prompting the Georgia legislature to be under total Republican control since the Reconstruction. The Oklahoma House switched to being Republican for the first time in 83 years, according to the National Conference of State Legislatures. In addition, the Indiana House also went Republican.
The Republican gains in various legislatures, along with key pickups in the gubernatorial races could mean an increased opportunity to pass meaningful medical liability reform, along with other legislation that may benefit radiologists.