(11-12-08) The 2008 election proved to be exactly what all the pre-election hype suggested it would be: an election of historic proportions that saw a major revamping of the balance of power in the American political system.
- The emergence of President-Elect Barack Obama as a transformational candidate was completed on election night, when he carried the largest percentage of the vote of any Democratic candidate in 32 years, was awarded nearly two-thirds of the votes in the Electoral College, and became the first African-American elected to our nation’s highest office.
- The movement of Congress away from the small government, “Contract with American” mentality of the 1990s, blossomed fully in 2008. Democrats captured seats that historically have been held by Republicans and retained most seats that previously had been captured, expanding their majority in the House from 235 seats to approximately 255 seats, with a few close races still undecided.
- In addition, they gained at least six seats in the Senate. While not enough to block Republicans filibusters on key legislation, it certainly provides much more breathing room for Democratic party leadership activity, at least for the next two years.
Within this large picture, a number of specific upcoming changes in the Congress are worth noting. Among them are:
The losses of a number of moderate Senate Republicans, including Gordon Smith (OR) and possibly Norm Coleman (MN). The remaining Republican Minority likely will be more conservative, more confrontational and less amenable to compromise.
Similarly, the losses by House Republican moderates such as Chris Shays (CT) and Joe Knollenberg (MI) will also have implications for House comity, which is not all that good anyway. In fact, there is a reasonable chance that the remaining House Republicans will seek to overthrow parts of the current leadership. A challenge has already been announced to Minority Whip Roy Blunt, and Conference Chair Adam Putnam has voluntarily stepped down.
With Senator Kennedy’s health being watched closely, there is a possibility of a change of leadership at the helm of the Senate Health, Education, Labor and Pensions Committee. While he plans to return in January, he may be unable to do so. In that event, Senators Dodd, Harkin and Mikulski are next in line, although the first two would have to give up existing chairmanships to take this one – something that legislators do not often do.
In the House, Republican retirements will bring significant changes on the Appropriations subcommittee that funds education and health programs. As many as four current seats are now vacant, although Republicans may have fewer seats available to them because ratios change due to loss of seats.
What Does It Mean for Policy?
The transformational political developments described above occurred against the backdrop of an economic calamity the likes of which we have not seen since 1929. With the stock market in the tank, severe credit restrictions in place through a banking system that is in disarray after eight years of neglect, energy prices skyrocketing up and crashing down in a period of less than a year, and a housing market that is seeing nearly as many foreclosures as new starts, the new Administration and the new Congress will confront enormous and complicated issues.
Taking office during a period of rising expectations, pent-up demand for programs, and genuine need on the part of their constituencies, they also are faced with a severely restricted ability to respond because of the very economic calamity that causes that need (and that led to their political success). The federal budget deficit is approaching $1 trillion, and, while domestic discretionary spending is a small percentage of the federal budget, it is in some ways the most visible and exposed part of federal spending.
To put this in perspective, all federal earmarks that politicians like to rail against (except for those they support!) total about $18 billion in their broadest definition – not even 2 percent of the deficit. The entire budget of the Centers for Disease Control and Prevention is $6.5 billion; the NIH budget totals $29.3 billion. Even the war in Iraq, if it were to end tomorrow, would save less than $150 billion after we addressed the need for greater involvement in Afghanistan and the incredible costs that our veterans’ support network will incur as a result of limb and traumatic brain injuries, post-traumatic stress disorder, and the other remnants of the war.
In the face of this, both the President-Elect and the new Congress are determined to revamp our healthcare system to – first and foremost – enhance access to the system for the 47 million Americans without coverage. Expect to see this issue come to the forefront fairly early in 2009. House and Senate staffs have been working on crafting healthcare reform legislation for months with the goal of having an access-focused bill ready for introduction in January.
After addressing access, the key committees involved are expected to turn their attention to cost issues, and finally to workforce issues. Obviously, the cost of health care services has a substantial impact on the availability of those services, and increasing access to insurance is of limited utility if there are not enough providers to treat patients.
Healthcare reform will be an enormous undertaking, and, while there is serious interest in addressing it early in the Obama Administration, this could very well be a two- or even four-year long effort as Congress struggles to find the right path to advance the cause.
And What Will Congress Do for the Rest of the Year?
With all the anticipation of the new Congress and the new Administration, it is important to remember that Congress will be returning for what is expected to be a one-week lame duck session on November 17.
Overall, this session probably will not address major issues related to osteopathic medical education. There will, however, be an effort to add up to $1.9 billion of biomedical research funding at the National Institutes of Health (NIH) to the economic stimulus bill that Congress is expected to consider.
The argument for this funding will essentially position it as a job creation and job retention issue. Funding for biomedical research has remained nearly flat for six years, and many grants are already approved but are stalled due to a lack of funding. Research advocates will argue that funds can be moved from NIH to research institutions quickly, and that the money will spread throughout the economy.
At the same time, many in Congress will argue that this legislation will need to be kept as tightly focused as possible. At this point, inclusion of these funds looks like a long shot, but one that AACOM is watching closely.
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