It is looking increasingly likely that the Democratic party will win big in November – with GOP strategists expecting a loss of 20 House and 6 Senate seats, along with the White House. Optimistic Dems are hoping for even more; it is possible they could win up to 11 Senate seats and another ten in the House. (for purposes of this post, we’re assuming there is a Democrat in the White House in 2009)
Analyst Larry Sabato predicts 8-14 seats moving to the Democrats; given he accurately predicted the result of the 2006 midterm election his opinion bears consideration.
If we go with the Sabato midpoint, 2009 will begin with a 247-188 Democratic-Republican split in the House. But the House is not the key, the Senate and the White House are. In the Senate, look for the split to end up somewhere around 56 – 44.
House Speaker Nancy Pelosi (D CA) has been biding her time, building her power base and infrastructure while waiting for what she anticipates will be an increasingly Democratic House. If the numbers come in as expected, the Speaker will be able to deliver on her commitment to avoid the “dangerous narcotic of incrementalism.”
But without a supermajority in the Senate, Pelosi, and Pres. Obama, will not be able to get much through Congress. That’s the conventional wisdom; conventional, but when it comes to health care, wrong. Not only will there be a new political climate in Washington, there will be increasing pressure on both parties to deliver on their campaign promises. Moreover, there is bipartisan agreement on some of the thornier issues related to health, with broad support for incremental (increasing SCHIP funding) and major (overhaul of the health insurance system) changes. This agreement has been overshadowed by Bush’s unwillingness to compromise on most issues, forcing members of his own party to craft legislation that will pass the President’s requirements.
Add to the mix the likelihood that Sen Clinton will become majority leader of the Senate. Despite the demonization of Clinton by some on the right, she has a well-deserved reputation for working effectively with her Republican colleagues, a reputation that will serve her well in her new role.
While the Dems would love to begin with a huge overhaul of the entire health system, they’ve learned that doing really big things takes time, consensus, and foundation-building. Instead, the new year will likely start with fixes to current programs and ‘corrective action’ to address issues of little concern to the Bush Administration.
Expect the new political year to begin with incremental fixes to specific programs – SCHIP likely first out of the blocks. After the back and forth battles, marked by confusion and consternation from Republicans who felt Pres. Bush threw them under the bus by vetoing a bi-partisan bill to extend SCHIP earlier this year, enough Republicans are likely to cross the aisle to support funding of a somewhat-expanded program.
Also on the table will be reduced funding for Medicare Advantage, a program that has long struck Democrats as a giveaway to big healthplans. Foolishly. the insurance industry worked hard, and effectively, to block reductions in MA this year. As Bob Laszewski notes, with Congress and the White House changing hands, the bill they stopped this year will look great compared to what they’ll get next. Expect MA subsidies to be slashed, in what could, and should, be seen as a shot across the bow of the insurance industry.
The FDA will also be under the microscope. Despite passage of the Food and Drug Administration Amendments Act of 2007, ostensibly fully funding the FDA and giving it the staff needed to do its job, the FDA continues to stumble. With a Democrat running the Administration, expect increasing oversight, much more post-approval monitoring, and much less tolerance for patent-extending gamesmanship.
The biggie will likely be Medicare physician compensation. With docs scheduled to see their reimbursement drop by around 15% in 2009, the caterwauling will be heard loud and clear inside the Beltway. Don’t look for a major policy change, but rather something to satisfy the physician community and build a little equity for the future.
That future will likely begin in January of 2010, when the Congress and President will take on health care reform.
Jun
24
