The New Congress and Long-Term Care.

The race for the White House might have gotten most of the headlines, but the 2000 congressional elections were almost as bizarre. In Missouri, a deceased governor defeated an incumbent Republican senator. In Palm Beach, Florida, the confusing "butterfly ballot" designed by Democratic officials probably cost the Democrats a congressional seat. In New Jersey, a candidate spent nearly $40 million of his own money to win the election on a platform of campaign finance reform. And, of course, 2000 witnessed the first time that the wife of a president of the United States has sought and won elective office.

The most politically significant oddity of the 2000 elections, though, is that moderate incumbents of both parties were more likely than conservative Republicans and liberal Democrats to either lose or barely survive close contests. Rep. Connie Morella (R-Maryland), for example, was returned by a very narrow margin over pharmaceutical lobbyist Terry Lierman, while more conservative GOP colleagues achieved landslide victories in rural Maryland. The vulnerability of moderates of both parties, such as Rep. Morella, might prod them further toward bipartisanship. Their more ideological colleagues, on the other hand, learned the lesson that compromise on the issues does not offer much benefit in their safe congressional districts--and victorious ideologues outnumbered victorious moderates. Based on that, oft-stated hopes for bipartisan deal making might just have faded.

Getting down to the numbers, the new Senate will be evenly split between Republicans and Democrats since Sen. Joseph Lieberman (D-Connecticut) didn't make it to the vice-president's manse, and the House is also almost evenly split; a change of fewer than 2,000 votes in a half-dozen races across the country would have produced a Democratic majority. The razor-thin GOP edge on Capitol Hill means that a very small number of influential legislators could make a very big difference in the way that key committees address long-term care issues.

The Senate Finance Committee, the decisive body for nearly all Medicare and Medicaid legislation, was changed more by the November elections than almost any other congressional committee. The elections ended the political careers of six of the committee's 20 members. Its chair, Sen. William Roth (R-Delaware) was defeated, along with Sen. Richard Bryan (D-Nevada) and Sen. Charles Robb (D-Virginia). Three other Finance Committee members chose retirement: ranking Sen. Democrat Daniel Patrick Moynihan of New York, as well as Sen. Connie Mack (R-Florida) and Sen. Bob Kerrey (D-Nebraska).

In a move of particular interest to nursing home operators, Sen. Chuck Grassley, a Republican farmer from Iowa, is likely to succeed Sen. Roth as chairman of this influential committee. This is, of course, not the best possible news for the long-term care industry. Sen. Grassley has a history of bashing nursing homes, including staging headline-grabbing hearings to showcase abuse and neglect. Further, although Sen. Grassley recognizes that staffing problems are at the heart of nursing home problems, he has publicly stated reluctance to increase reimbursement rates because he doubts that nursing homes will invest the money in needed personnel.

Sen. John Breaux (D-Louisiana), Sen. Moynihan's likely successor as ranking Democrat on the Finance Committee, provides a sharp contrast. Sen. Breaux chaired a special commission on the future of Medicare and has been a very active member of the Special Senate Committee on Aging. Although little-known outside his home state of Louisiana, Sen. Breaux has consistently championed efforts to produce viable compromise on issues of interest to nursing homes, including last year s attempt to legislate a bipartisan prescription drug benefit.

Other Senate committees of interest to the long-term care industry--including Human Resources, Veterans Affairs and the Senate Appropriations Subcommittee for Health--emerged from the November elections with nearly all of their membership intact. Perhaps the nursing home industry's greatest loss of support in the Senate occurred earlier this year with the death of Sen. John Chafee (R-Rhode Island). His son, Lincoln Chafee, won his own six-year term in November. It is not clear whether the young moderate Republican will share his father's interest in care of the elderly.

One more oddity in relation to the Senate elections: Noting that the Senate hasn't had a 50-50 split in more than 80 years, some observers question whether either party can lay exclusive claim to committee chairmanships as they've evolved over the years. They raise the intriguing--and perhaps alarming--issue of committee co-chairmanships. How the Senate will deal with this could have political entertainment" value rivaling that of Bush-Gore in Florida.

Changes in the House of Representatives are less dramatic. For healthcare policy wonks, the most visible departure was the retirement of Rep. John Edward Porter (R-Illinois), formerly chair of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education. Because the House no longer operates on the basis of strict seniority, at this writing Rep. Porter's likely successor could be one of two Republican congressmen. Rep. Henry Bonilla, a former newscaster from West Texas, is a strong contender. Rep. Bonilla has not been a major advocate on healthcare issues, but he enjoys a reputation as a close ally of George W. Bush. The other major contender to replace Rep. Porter is Rep. Dan Miller, a former nursing home owner and operator who represents part of Florida's west coast. Rep. Miller began his career in the House with a flurry of activity, but has since become significantly less visible on healthcare issues, despite his personal expertise.

One final curiosity: Republicans' ability to hang on to their 50-50 share of the Senate could hinge on the health of a 98-year-old--specifically, Sen. J. Strom Thurmond (R-South Carolina). Sen. Thurmond has two years remaining in his current term and, although he is reputedly as healthy as might be expected of a survivor of seven decades of political warfare, it is conceivable he might find himself unable to complete his term. In that event, the Democratic governor of South Carolina would choose his replacement, presumably giving the Democrats a 51-49 Senate majority and undisputed chairmanship (at least for a while) of the key Senate committees.

The possibility of a Democratic Senate majority within two years doesn't match the Richter Scale impact of the Republicans' 1994 political earthquake orchestrated by Newt Gingrich. It could, however, have more impact on federal legislation than the November elections did.