Upcoming election might not change much.

This spring, public opinion polls consistently report that fewer than two out of five Americans believe that President Bush is "taking the country in the right direction." Talking heads on the airwaves and cable have been consumed with the idea that this November, Democrats may be able to translate the loss of confidence in a Republican White House into legislative victories. Commentators debate the possibility that the Democratic Party may regain the majority in the Senate that it lost four years ago, and may even achieve a near-majority in the House of Representatives. This might sound like good news for nursing home professionals who hope a change in Congress may end the recent annual attempts to raid Medicare and Medicaid budgets.

Such hopes are likely to be disappointed. A return to a Democratic majority in the Senate is possible, although relatively few of this year's Senate races appear very competitive. Even if the Democratic Party wins three or four additional seats, the close balance of the two political parties in the Senate would leave policy making relatively unchanged.

Because the House of Representatives operates under different rules then the Senate, Democratic control of Congress's lower house could create a radical shift in the balance of power on federal health and housing policies. However, both majority Republican and majority Democratic states have created congressional districts that are drawn to keep incumbents in office. Looking at the records of recent elections, very few sitting members of the House of Representatives are likely to lose in November despite voter distrust of White House policies.

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The most vulnerable members of the House are newcomers who have not established a strong tie with their district's voters, and a very small number of longer-term incumbents who struggle each election to win a majority. In addition, William Jefferson (D-La.) is viewed as vulnerable in part because of an ongoing FBI investigation of charges of bribery and the loss of thousands of supporters who fled the flooding of low-income neighborhoods in New Orleans. Rick Renzi (R-Ariz.) also is viewed as vulnerable because the most populous county in his district is being flooded with thousands of recent retirees who have no history of voting for him. Jefferson, Renzi, and 13 other House members whose seats appear to be at highest at risk are listed in the table.

Except for Jefferson, the Democrats who are viewed as most vulnerable all are completing their first terms in the House of Representatives. These newcomers all won their seats in close races. However, Russ Carnahan's Missouri district has traditionally elected Democrats and is likely to continue to do so, while Melissa Bean (Ill.) faced what is likely to be her most difficult race last year when she replaced an experienced Republican incumbent. In effect, the Democrats are not likely to lose more than three or four House members running for reelection.

The nine Republicans in addition to Renzi whose House seats are most likely to face serious election challenges this year are a very mixed group that includes three representatives from cities in the West, four from the South, and two from Indiana. Five of them were first elected to Congress in 2002, and four--Robin Hayes (N.C.), John Hostettler (Ind.), Charles H. Taylor (N.C.), and Heather Wilson (N.Mex.)--are veteran House members.

Democrats would probably take greatest joy in defeating Katherine Harris who, as Secretary of State of Florida, presided over that crucial state's disputed presidential vote in 2000. She has yet to make a strong favorable impression on the voters of the Sarasota area who have provided slim majorities in her two congressional races. One reason may be that despite a large population of retirees and long-term care recipients, Harris has not been very actively involved in health issues. At this writing, she is not seeking reelection to her House seat, but has filed as a candidate for the U.S. Senate.

Hostettler would be another favorite target for the Democratic Party. He represents a congressional district in Indiana that frequently switches between the two parties and, despite nearly eight years in office, all of his reelections have been relatively close. One reason may be that Hostettler's main interests are social issues, such as protection of traditional marriage and relaxation of prohibitions against public religious observance. Another reason for his many narrow victories may be that some of his views are outside the mainstream, such as his contention that the Supreme Court is not the final arbiter of the Constitution. On healthcare, Hostettler is similar to Harris: Both have been strong supporters of the Medicare Part D prescription subsidy benefit and advocates of market-based approaches to extending long-term care coverage.

Hostettler's Indiana colleague Chris Chocola appears to be less concerned with the role of religion in government and much more active on long-term care. As a member of the House Ways and Means Committee, Chocola is one of the key votes on Medicare policies. During his brief tenure on Capitol Hill, he has used this position to successfully push for tax benefits for police officers, firefighters, and other public safety officers who purchase private long-term care insurance. One opponent has argued that Chocola's measure is designed more to dilute an incentive for union membership among public safety officers, but no one can disagree that his legislation contributes to improved access to long-term care.

Bob Beauprez (Colo.), a member of the House Ways and Means Committee, and Charles H. Taylor, a senior member of the House Appropriations Committee, also are extensively involved in long-term care matters. Taylor is widely celebrated among healthcare providers for his dogged efforts to limit the impact of frivolous and excessive malpractice lawsuits.

Four remaining members of the "endangered Republican" list--Phil Gingrey (Ga.), Jon Porter (Nev.), Robin Hayes, and Heather Wilson--recently joined Renzi in a recent letter to House Budget Committee Chairman Jim Nussle (R-Iowa) urging the elimination of steep cuts in Medicare reimbursement rates for SNFs and other healthcare providers proposed in the Bush administration's FY 2007 budget. The joint letter stated that its signatories "oppose the inclusion of these Medicare cuts in the House's FY 2007 Budget Resolution." One might argue that these five Republican incumbents have taken this dramatic step because they want to prove their independence as they enter hotly contested races. However, Gingrey is an obstetrician in his hometown of Marietta, Georgia, and Wilson had four years of experience as Secretary of the New Mexico Children, Youth & Families Department before running for Congress. If some Republican incumbents are fated to be defeated in this year's elections, the long-term care field may not benefit from the loss of these voices.

Perhaps more importantly, a Democratic victory in all of the races on the "endangered" House member list would not change the balance of power in Congress. Very simply, to win control of the House of Representatives, the Democrats would need to win at least two or three more "upset" victories in Republican-leaning areas and not lose a single Democratic incumbent. This is far from the likely scenario that some political commentators have argued will result from this spring of discontent.

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Table. The endangered house member list

                                                No. of  % of  % of
                   Congr.                       Terms   2004  2002
Name               District  Location           Served  vote  vote

Republicans
Bob Beauprez       Colo.-7   Denver suburbs     2       55    47
Chris Chocola      Ind.-2    South Bend         2       54    50
Phil Gingrey       Ga.-11    Marietta           2       57    52
Katherine Harris*  Fla.-13   Sarasota           2       55    55
Robin Hayes        N.C.-8    east of Charlotte  4       55    54
John Hostettler    Ind.-8    Evansville         4       53    51
Jon Porter         Nev.-3    Las Vegas area     2       55    56
Rick Renzi         Ariz.-1   rural Arizona      2       59    50
Charles H. Taylor  N.C.-11   Asheville          8       55    56
Heather Wilson     N.Mex.-1  Albuquerque        5       54    55

Democrats
John Barrow        Ga.-12    Athens             1       52
Melissa Bean       Ill.-8    Chicago suburbs    1       52
Russ Carnahan      Mo.-3     St. Louis area     1       53
William Jefferson  La.-2     New Orleans        8       65    64
John Salazar       Colo.-3   western state      1       50

*At this writing, Harris is a candidate for the Republican nomination
for the U.S. Senate and is not seeking reelection to the House.