Election 2006: bigger changes at state level.

Senator Harry Reid (D-Nev.) describes this November's election as "historic." He means, of course, that the election results restored a Democratic majority to the House of Representatives for the first time since 1994. (The Senate was somewhat less "historic"; see below.) The election also elevated an unprecedented number of women and minorities to major congressional posts.

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In addition to the election of Nancy Pelosi (D-Calif.) as Speaker of the House, perhaps the most visible change will be the return to prominence of Harlem's 76-year-old congressional representative, Charles B. Rangel. Beginning this January, Congressman Rangel becomes the first African-American to chair the powerful House Committee on Ways and Means, a body with primary responsibility for Medicare, as well as tax policy. He has spent the past six years delivering caustic but generally well-informed criticism of Bush administration healthcare policies in an accent sounding remarkably like that of the late actor-comedian Jackie Gleason. As chair, however, he sees nothing funny about the difficulty of engineering major changes in Medicare or healthcare policy. Asked about his agenda, Rangel replied, "The first thing I have to do is bring some civility and trust to the committee."

The new chairman of the subcommittee on health is likely to be one of two African-American members of the Energy and Commerce Committee, once a powerful oversight body under its longtime chair Congressman Henry Waxman (D-Calif.). Waxman has moved up in seniority to chair the House Committee on Government Reform. One possible choice as his replacement is Edolphus "Ed" Towns (D-N.Y.), who occasionally expresses an interest in geriatric care issues, but has little reputation as a legislator. He contrasts sharply with Congressman Bobby L. Rush (D-Ill.), another potential chair of the health subcommittee. Rush is more energetic on heath issues, but his former career as a leader of the Black Panther Party and his outspoken attacks on the profit motive in medical practice might raise eyebrows within the healthcare industry.

Most importantly, the Democrats achieved their majority in the House by replacing several Republican incumbents with relatively conservative newcomers. Incoming congressmen Ron Klein (D-Fla.), Chris Murphy (D-Conn.), and Joseph Courtney (D-Conn.) are rare examples of Democratic state legislators with extensive backgrounds in geriatric care policy who defeated incumbent Republicans without moving to the ideological left. Several of the new Democratic congressmen are, in fact, former Republicans who may be sympathetic to some Bush healthcare policies.

In the Senate, the 2006 congressional election did not produce truly sweeping results for long-term care. The Senate was closely divided before the election and remains so. Thanks to independent socialist Sen. Bernard Sanders of Vermont, Democrats can claim "control"--but, then again, the Democrats had a majority in the Senate as recently as from 2000 to 2002, a period that offered some of the most difficult times for the long-term care field. Although 74-year-old Sen. Edward M. "Ted" Kennedy (D-Mass.) has been reinstated as chairman of the Senate Committee on Health, Education, Labor, and Pensions, he apparently does not plan to use this opportunity to pursue his recently introduced package of long-term care reforms dubbed The CLASS Act. Instead, Kennedy has announced that his healthcare priorities will be reducing the cost of prescription drugs for Medicare beneficiaries and permitting legal reimportation of prescription drugs from other industrial countries. An additional Kennedy agenda item that does have potential implications for long-term care is his support of a significant increase in the minimum wage.

Indeed, for the long-term care community, the election results definitely had a downside. Several GOP House and Senate members who have been consistent supporters of the nursing home industry were among the incumbents who lost. These included Rep. Nancy L. Johnson (R-Conn.), chair of the House Ways and Means subcommittee on health and a longtime "friend" of the industry, and Sen. Mike DeWine (R-Ohio), a strong defender of fair Medicaid reimbursement and cosponsor with Kennedy of The CLASS Act. Sue Kelly (R-N.Y.), one of the few registered nurses to ever serve in Congress, lost her upstate New York seat to pop songwriter John Hall, and Charles Bass (R-N.H.), best known for attacking his party leaders' predilection for legislative pork projects, was also defeated.

Of course, more healthcare policy these days is made in state capitols than in Washington, and the 2006 elections may produce unexpected benefits (or difficulties, depending on your political point of view) in breaking legislative logjams at the state level. Divided party control of state government ended this November in Arkansas, Colorado, Iowa, Maryland, Massachusetts, Montana, New Hampshire, and Oregon, as Democrats gained control of both the legislature and the governor's mansion in each of those states. As shown in the table, the election results left 16 states under Democratic control and 10 states under Republican control.

To asurprising extent, many of the Democratic victories at the state level in 2006 were achieved by candidates who had retired from full-time employment. 2007 will be the first year that New Hampshire has had a Democratic governor and a Democratic majority in both legislative houses since the 19th century and about one-third of the newly elected members in the 400-member New Hampshire House of Representatives are at or near the age for Medicare enrollment. Similarly, in North Carolina, the three Democrats who defeated incumbent Republican state legislators are, respectively, a retired sheriff, a retired minister, and a retired Xerox employee. The more widespread election of older, retired Americans to state legislatures under unified Democratic control may have more impact on long-term care policy than the Democratic victory in Congress.

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Table. 2006 Election Breakdown.

        STATES WITH DEMOCRATIC                STATES WITH REPUBLICAN
        GOVERNOR AND DEMOCRATIC  STATES WITH  GOVERNOR AND REPUBLICAN
        CONTROL OF THE           MIXED PARTY  CONTROL OF THE
        LEGISLATURE              CONTROL      LEGISLATURE

2006     8                       29*          12
2007    16                       24           10
CHANGE  +8                       -6           -2

*Nebraska legislators are elected without party identification.