As the new year begins, some discussion of how the new Congress and the renewed Bush White House may affect the Practice Directorate's federal legislative agenda seems in order. But first, it's necessary to look at how the elections changed or maintained the landscape.
The election's impact
The Senate partisan balance shifted from 51 Republicans, 48 Democrats and 1 Independent to 55 Republicans, 44 Democrats and 1 Independent. While the Republicans expanded their control slightly in the 109th Congress, they remain short of the 60 party-line votes necessary to stop a filibuster, a mechanism often employed to block contentious legislation. Of the 34 Senate seats at stake in the election, 26 incumbents ran and all won their races except Tom Daschle (D-S.D.), who lost by fewer than 5,000 votes.
With Daschle's loss, the Democratic Party loses its leader in the Senate, and psychology loses a champion of our issues. It was Daschle who fought for weeks to keep Medicare psychology internship training funds as part of the 2003 Medicare reform bill, only to have it stripped out at the eleventh hour of the negotiations. Fortunately, Daschle's replacement as minority leader, Sen. Harry Reid (D-Nev.), also is a strong supporter of psychology's issues and someone with whom we have a good relationship.
In the Senate races with no incumbent, six seats were filled by Republicans and two by Democrats. Interestingly, five of the six new Republican senators previously served in the House of Representatives. Of these, Sen. Johnny Isakson of Georgia was a co-sponsor of parity legislation while in the House.
In another notable Senate race, longtime friend and psychology supporter Sen. Daniel Inouye (D-Hawaii) easily won an eighth term of office.
On the House side, all 435 seats were contested. The Republicans also expanded their majority in the House by a handful of votes. After two runoff elections in Louisiana are held, the Republicans likely will occupy 231 of the 435 seats. Also of note, the psychologist members of Congress--Brian Baird (D-Wash.), Tim Murphy (R-Pa.) and Ted Strickland (D-Ohio)--easily won their races. In fact, Strickland ran unopposed.
Looking to the future
Given the continuing Bush administration combined with the congressional results, we in the Practice Directorate essentially will pick up our federal legislative agenda where we left off at the close of the 108th Congress. Parity is a priority that will, no doubt, still garner considerable bipartisan support as in the past. The key question, however, will continue to be whether the issue can find its way to a vote on the floor of each chamber.
Because association health plans (AHPs) have been a component of President Bush's health reform agenda, we anticipate that there will be a reinvigorated push to enact this legislation, a proposal that did not succeed in the last Congress. AHPs are health plans that enable small businesses to join together for purposes of insuring employees as a larger pool and, therefore, at less cost. This proposal is intended to increase the availability of insurance for small business employers, a laudable goal, for certain. Unfortunately, one consequence of creating AHPs through federal law is that the law will preempt many existing state laws that assure quality care and adequate benefits, including mandated mental health benefits and state parity laws. Given this consequence, the Practice Directorate opposed the AHP legislation in the last Congress.
President Bush has also identified tort and medical malpractice reform as a key component of his health reform agenda. Malpractice insurance coverage issues have not been problematic for psychology in the same way as they have for physicians, so the Practice Directorate has not previously entered the legislative debate on this issue. However, as one consequence of Congress considering reform of this type, it likely will make it much more difficult to get the necessary support for patient-protection legislation, which includes right-to-sue accountability language. After all, with a legislative effort afoot to limit lawsuits, expanding legal opportunities to sue negligent managed-care companies may not be so well received by many in Congress.
In any event, health care was among those domestic issues that received considerable attention from candidates running for office in 2004. Hopefully that will translate into significant reform efforts. To say that this country's health system is badly in need of reform is to state the obvious. The critical question is whether partisan politics can give way to bipartisan solutions to fix the problem. The country's health-care system, and the health of the country, depend on it.