Washington shuffle

The impact will be felt on several fronts, including Medicare, and how providers are paid for their services. Look for more activism and pro-consumer initiatives. Insurance companies, pharmaceutical companies, health maintenance organizations can expect to be subjected to more attention. For example, Democrats have already signaled that they want to negotiate prescription drug prices directly with pharmaceutical companies; a move they say will cut subscriber costs by up to 25 percent.

'Significant shift'

"This is a significant shift for us," one lobbyist said. "Some key allies are no longer in Congress. But we'll build relationships and develop new relationships with the new people in power. Change happens in Washington, and we'll adapt, just as we have done in the past."

Beginning in the new 110^th Congress, there will be 59 new members - 53 in the House and six in the Senate, which will shift from 55 Republicans, 44 Democrats and one Independent to 49 Republicans, 49 Democrats and two Independents, both of whom will caucus with the Democrats, giving them a narrow 51-49 majority.

In the House, the margin switches from 232 to 203 Republican majority to a 231 to 200 Democrat edge. (Four races, at press time, were still undecided.)

Spoils of victory

With victory comes the spoils, and, in Congress, that means Democrats are now in charge of all of the Congressional committees. Not only do they chair the committees, they get the most members and more staff than the Republicans. It's a reversal of what's been a Republican advantage for the past 12 years.

In the Senate, Sen. Ted Kennedy (D-MA) now runs the Senate Health, Education and Pensions (HELP) Committee, where he immediately declared removal of barriers to stem cell research a major priority. That, no doubt, will set up what could be an emotional confrontation with President Bush.

"We will be back again and again next year until we succeed in overturning the restrictions on stem cell research that hinder the search for new cures, and delay the day when the hope of a better future becomes a reality for patients across America," Sen. Kennedy said in a post-election statement outlining his priorities for the new Congress.

In the House, led by the new Speaker Nancy Pelosi (D-CA), the chairman of the House Energy and Commerce Committee is Rep. John Dingell (D-MI), who has also laid down some markers. In late November, Rep. Dingell promised he and other Democrats would carry out several investigations, including at least one involving Medicare. Rep. Dingell has been a strong critic of the Medicare prescription drug program, for example.

A Rep. Dingell ally is Rep. Henry Waxman (D-CA), the new chairman of the House Energy & Commerce Subcommittee on Health. Last year, Rep. Waxman and some other leading Democrats introduced the "Medicare for All Act", which would make healthcare coverage available to every American by expanding the Medicare program to those under age 65. Under the proposal, citizens could choose health insurance coverage through Medicare or through any of the plans available to members of Congress, the President or other federal employees.

Early Medicare test

An early test of how this new Congress will approach physicians' concerns involving Medicare will be seen in the response to efforts by the medical profession to roll back Medicare physician pay cuts of some 5 percent on average scheduled to take place January 1. The current schedule calls for reductions totaling nearly 40 percent through 2015, while practice costs during the same period are expected to increase by more than 20 percent, according to the American Medical Association. (See Congress' December 9th response)