On November 11, the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a statement regarding the 2014 midterm elections overview and implications:
In the midterm elections of November 4, the Republican Party won control of the Senate and added members to its majority in the House. Republicans now control both houses of Congress for the first time since the 109th Congress during President George W. Bush’s presidency. The current balance of power in the new Congress, compared with the current Congress, is described below. A majority in the House is 218 votes, while a majority in the Senate is 51 votes (60 votes for a filibuster-proof majority).
Net Gains for Republicans in the 114th Congress (Beginning in January 2015) are Significant
As of today, Republicans have gained seven U.S. Senate seats, which gives them 52 seats, the Democrats have 44 seats, and there are two Independent seats in the Senate and both caucus with the Democrats. There are still two Senate seats undecided. The Louisiana Senate race will head into a December runoff and the Alaska Senate race is still too close to call. In the U.S. House, the Republicans picked up 12 seats for 244 seats, and the Democrats have 188 seats. As of this writing, seven U.S. House seats are still undecided.
The Republican Party’s ability to retake the Senate and add to its majority in the House has major implications for the healthcare agenda of the 114th Congress. Discussed below are predictions for the lame-duck session and the future of the Affordable Care Act (ACA).
Potential Impact of Elections on the Lame Duck Session
The House and Senate will reconvene November 12. The Senate has not released a schedule beyond November 14, and the House has not scheduled votes after December 12. The length of time and substance of the lame-duck session remains in question. During the lame-duck session, Republicans are expected to reorganize committees and leadership and seek greater collaboration between the House and Senate. The question going forward will be if the Republicans will be able to negotiate and govern, or if they will merely force votes that prompt presidential vetoes.
The legislative accomplishments of the lame-duck session may serve as an early indication of whether the Republican leadership or Tea Party members are driving the Republican agenda moving forward. Incoming Senate Majority Leader Mitch McConnell (R-KY), Speaker of the House John Boehner (R-OH), and ranking House and Senate Republicans have indicated that they would like to use the lame-duck session for must-pass legislation, including an omnibus spending bill, in order to create a fresh start for the 114th Congress. Current Senate Majority Leader Harry Reid (D-NV) has stated that he also would like to move significant legislation during the lame-duck session. Senators Ted Cruz (R-TX) and Mike Lee (R-UT), on the other hand, envision the lame-duck session being used only to pass a short-term continuing resolution.
The Future of the ACA
While the majority of Republicans have stated that they seek to repeal, replace, or otherwise amend the ACA, it is likely to stay largely intact. A full repeal of the ACA appears unlikely given that the President still wields veto power and stated in a November 5 press conference that he will halt any attempted repeal. Republican piecemeal reform of the ACA and continued diminution of its funding are expected to continue.
In the 114th Congress, after expected ACA repeal votes in the Senate, McConnell and the Republican-controlled Senate may attempt to enlist Senate Democrats to vote on parts of the bill, including the medical device tax, employer mandate (including the 30-hour workweek standard), and the individual mandate. On November 5, the day after the election, McConnell stated that he wished to focus the new Congress on a repeal of these three elements of the ACA.
- Medical Device Tax: A repeal of the medical device tax seems most likely to be advanced, given its bipartisan unpopularity. In addition to support by House and Senate Republicans, there are several high-profile Democrats who also support a repeal of the tax. However, the cost of a medical device tax repeal is significant; the tax generated $913 million in the first half of 2013 and is expected to raise $20 billion between fiscal years 2013 and 2019. Former Indiana Democratic Senator Evan Bayh recently stated that President Obama would be amenable to a repeal of the tax if there were an offset. Fiscal conservatives will similarly demand a pay-for to compensate for the repeal.
- Employer and Individual Mandates: The Republicans may be able to reach a vote in the Senate on the employer and individual mandates. However, repeal of the individual mandate is unlikely; its repeal would pose a significant threat to how the ACA is funded. The President said in a November 5 press conference that he would also veto any legislation that undermines the structure of the ACA. The insurance industry would also strongly oppose repealing the individual mandate. Democrats and Republicans, however, may be able to reach a compromise on certain changes to the employer mandate such as the 30-hour work week.
Physicians Retained in the 114th Congress
The 113th Congress was composed of 13 Republican physician representatives, four Democratic physician representatives, and three Republican physician senators. The 114th Congress will include at least ten Republican physician representatives, and three Democratic physician representatives.
Representatives Paul Broun, MD, (R-GA) and Phil Gingrey, MD, (R-GA) were both defeated in their respective Senate primaries while Representative Bill Cassidy, MD, (R-LA) will participate in a December runoff for a Louisiana Senate seat. The seat of Representative Ami Bera, MD, (D-CA) is in jeopardy and remains too close to call. The 114th Congress will retain two physicians in the U.S. Senate, Senators Rand Paul (R-KY) and John Barrasso (R-WY). Neither was up for reelection in 2014. Senator Tom Coburn (R-OK) is resigning.
NAAOP will continue to keep its membership informed as the lame-duck session progresses and the 114th Congress approaches. For more information, visit www.naaop.org or e-mail [email protected]