Election Impact on Healthcare. Clearly no other topic seems to matter this week as pundits and analysts in and outside of Washington assess the impact of a Republican takeover of the House, gain of six Senate seats and major gains in makeup of state legislatures. What these changes mean for the Electronic Health Record (EHR) Incentive Program and the Accountable Care Act will play out over the next weeks and months. As we begin this process, some cautions are in order. Rumors, dire predictions and speculation will be plentiful and it is well not to overreact precipitously and make major changes in current plans in the absence of facts.
Beginning in January, the House will be controlled by Republicans with Rep. John Boehner (R-Ohio-8) serving as the next likely Speaker. From a large Democratic majority in the 111th Congress, the 112th will look very different—239 Republicans versus 187 Democrats, representing a gain of 60 seats for the GOP. Democrats still hold a majority in the Senate, but lost six seats, ending with 53 to the GOP’s 46. Alaska still remains undecided. In state legislatures, Republicans also made big gains, taking control of at least 19 Democratic-controlled state legislatures, picking up 682 seats. With responsibility for drawing district boundaries for the U.S. House, which takes place next year, decisions of state legislatures will have a major influence on Congressional elections for years to come.
Just how Republicans at the national level choose to flex their newly won muscle will play out as committees organize and the GOP leadership assesses its strategy. During campaigning, many of the new House freshmen vowed to repeal the unspent stimulus funds and the Accountable Care Act—good sound bites, but not so easily done. While the House may quickly pass a bill repealing health reform and unspent stimulus funds to be followed by overriding a presidential veto, the Democratic-led Senate is not likely to go along. Another route is the appropriations process, by denying funding to implement the Accountable Care Act. Implementation costs over the next 10 years, according to the Congressional Budget Office, could run from $5 billion to $10 billion each for the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS). It is unclear how much of that would need to come from budget increases. In recent years, both the IRS and HHS have survived with their existing budgets.
Other tactics are likely. For example, Rep. Joe Barton (R-Texas-6), who could become the next House Energy and Commerce Committee chair, has outlined his ideas that include subjecting HHS Secretary Kathleen Sebelius and Centers for Medicare & Medicaid Services Administrator Donald Berwick to regular questioning on the reform law and investigating the Obama administration actions on cost estimates of the law before its enactment.
Numerous oversight hearings on the reform law and stimulus programs are anticipated. The new majority, however, is likely to focus mainly on the former, while the Health Information Technology for Economic and Clinical Health Act’s EHR Incentive Program is perhaps a less visible target in that its funding will be incrementally distributed over several years. Further, the initial Office of the National Coordinator for Health information office was created by President George W. Bush, and many of the early legislative proposals were bipartisan. This bipartisan support remains critically important and CHIME and health IT’s many other proponents will continue to emphasize this point on Capitol Hill. With increased oversight hearings, attention may focus on details of the EHR Incentive Program and its aggressive timelines, for example. Certainly, the congressional changes and the overall impact on healthcare are critically important for CIOs and we will continue to track these issues and report on emerging developments in the coming weeks.