How Election Results Change 2005 Health Prospects

Daniel B. Moskowitz

Disclosures
In This Article

Introduction

At first blush, the outlook for legislation and regulation affecting prescription medications, health care policy, and MCOs next year should not have altered much from the results of the 2004 election. After all, there was no change in the White House or in the control of either house of Congress. But the victories have emboldened Republicans to push harder for reforms that they previously let fall by the wayside because of Democratic opposition.

The difference is not merely the 4 additional Senate seats and the 3 House seats that the GOP picked up, but an opportunity to call the election results a mandate that will get wavering centrist members of the party on board. The voters' validation of the Republican positions will diminish the influence of Sen Edward Kennedy (D, Mass), long a powerhouse on health issues.

At the same time, voters seem hungry for action on health care issues. Results of a post-election poll taken by the Blue Cross and Blue Shield Association (BCBSA) found that citizens ranked high drug prices and related health care issues as the second most important domestic issue (1 point behind the economy and jobs) and Medicare and Social Security as the third most important issue.

"It is crystal clear from this poll that the rising cost of health care is one of the greatest concerns facing American consumers today," summed up Scott P. Serota, president and CEO of BCBSA. Respondents told the BCBSA pollsters that ensuring health coverage for all Americans was the most important issue that lawmakers should address, with the affordability of prescription medications the second most important.

Among the Republican initiatives whose prospects for passage have therefore improved are:

  • Attacking the problem of the uninsured with a package of proposals that include letting small businesses form associations expressly to jointly purchase health insurance for their employees free of the constraints of state mandates, expanding health savings accounts, and creating new health care tax credits.

  • Revamping the entire Medicaid structure or, at least, putting a cap on federal expenditures for the program—a change that governors of both political parties vehemently oppose.

  • Reexamining the cuts in physician payments for treating Medicare patients that are scheduled to go into effect in 2006 unless Congress acts.

On the other hand, chances for the passage of a "patients' bill of rights" measure have diminished, with members of Congress loathe to impose on managed care any new requirements that could be blamed for increasing costs.

With Sen Judd Gregg (R, NH) moving to take over the US Senate Budget Committee, Sen Michael Enzi (R, Wyo) moves into the chairmanship of the Health, Education, Labor and Pensions (HELP) committee. This means that the HELP panel will be devoting more time to the rural health issues that particularly interest Enzi, such as changing the formula for funding community health centers so that more money can be funneled to sparsely settled areas by including such criteria as the distance patients must travel to see a provider. Enzi was a sponsor of Gregg's bill to allow individual patients to import drugs from Canada—and later to allow wholesalers and pharmacists to import drugs as well—but he is not expected to put as much energy into getting it through the HELP committee as Gregg would have done.

Beyond Congress, "we will see an acceleration in process of carrying out the new Medicare law, issuing rules for the drug benefit and setting standards for electronic prescribing," predicts Craig Fuller, CEO of the National Association of Chain Drug Stores. The entire pharmaceutical industry, from retailers to manufacturers to third-party payers, had worried that a Kerry victory would lead to a delay in the implementation of the Medicare drug benefit or a reworking of the structure.

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