By Richard E. Cohen for Kaiser Health News
At first glance, Tuesday's election does not appear to have altered much the country's health care politics: Many of the same key players and issues will dominate the congressional debate.
Yet the temptation to claim a "status quo" outcome from the election ignores broader trends in this year's health and Medicare debates, according to longtime congressional observers.
The similarities for the upcoming 113th Congress are evident: Republicans will hold comfortable control of the House, while Democrats have added to their narrow majority in the Senate. And the prospective agenda will seem familiar, although the deadlines for action are more pressing on a host of fiscal and entitlement issues.
This election is likely to have consequences-in both explicit and more nuanced ways. For example, the Democrats' continuing control of the Senate likely preserves President Barack Obama's health law, though they might seek minor modifications. The GOP-dominated House will continue to press for major cost savings from entitlements to avoid the end-of-the-year deadlines that have been imposed for spending cuts and tax increases. And both sides will likely claim mandates from the election results.
Republicans, for example, have exulted not only in their continuing House majority but also in their ability to withstand Democrats' harsh attacks on their budget blueprints, which called for major changes in Medicare. "There is no evidence that the Democrats' message got through," said a senior House GOP leadership aide. "Our House Republican position has become stronger."
Speaker John A. Boehner said Tuesday night that the results showed that "the American people have also made clear that there is no mandate for raising tax rates," and he embraced the House-passed GOP budget "that begins to solve the problem." But he struck a more conciliatory tone Wednesday afternoon, saying, "If there is a mandate in yesterday's results, it is a mandate for us to find a way to work together on solutions to the challenges we face together as a nation. My message today is not one of confrontation, but of conviction."
Even veteran Republican insiders concede that the GOP should be careful not to view the campaign skirmishes over Medicare as a complete victory. "The result is muddled," said Bill Hoagland, a longtime senior Senate GOP aide who recently became senior vice president of the Bipartisan Policy Center. "The Democrats' complaints didn't have much leverage. But the result will be short of an endorsement [of the House GOP budget] by voters....Any proposal to limit Medicare will be analyzed carefully in its impact for cost-sharing" for beneficiaries.
Obama reached out to Republicans in his election speech. "Tonight you voted for action, not politics as usual ...," he said. "And in the coming weeks and months, I am looking forward to reaching out and working with leaders of both parties to meet the challenges we can only solve together."
But congressional leaders were more circumspect, including on their views of health care issues.
When House Budget Committee Chairman Paul Ryan, R-Wis., was tapped by Republican presidential nominee Mitt Romney to be his running-mate, Democrats claimed that they would benefit from the increased focus on the Ryan-crafted budget. But Democrats and their allies concede that their rhetorical attacks largely fell short.
"I had felt that Medicare would have a big impact on the election. That didn't happen," said John Rother, president of the National Coalition on Health Care. "Admittedly, Republicans had a complicated proposal. But Democrats could have done more to raise the fear factor. I don't think that [their point] got through that the proposal would erode the core benefit promised" in Medicare. He added that this year's campaign revealed a growing political trend: "Issues have become less important than partisan ID, especially in moving voters."
The House Democrats' failure was not from lack of effort. Of the more than 100 video advertisements that the Democratic Congressional Campaign Committee ran this fall in battleground House districts, roughly half focused on health-care issues-chiefly Medicare.
"Keith Rothfus praised a plan that would end our Medicare guarantee ... costing seniors an extra $6,400 more a year," said a typical DCCC ad that was designed to defeat the GOP challenger to Rep. Mark Critz, D-Pa. A similar ad attacked freshman Rep. Ann Marie Buerkle, R-N.Y., for having "voted to essentially end Medicare ... end guaranteed Medicare benefits ...[and] put the insurance industry in charge...." Rolfus won; Buerkle lost.
Democratic analysts contended that their disappointing showing in the House resulted from other factors, such as local issues, the impact of redistricting, plus the advantages of incumbency in many cases. "We won the policy argument. We would welcome the Republicans continuing an argument that has been rejected politically," said a veteran House Democratic leadership aide.
They also sought to defend the strategic decisions of Democratic Minority Leader Nancy Pelosi, D-Calif., who was instrumental in enacting the health-care law in 2010 when she was speaker, and in leading the attacks on the House GOP budget in the past two years. The disappointing results fueled continued speculation that Pelosi may step down from her leadership post. Her likely successor would be Minority Whip Steny Hoyer, D-Md., who has been far more supportive of bipartisan efforts to seek a "grand bargain" on the budget deficit-including entitlement cutbacks.
Veteran observers of health-care policy said that the campaign paid unexpectedly little attention to those issues, despite the efforts of both parties. "I was wrong when I wrote [in August] that Congressman Ryan's selection would be a game-changer," said Robert Blendon, a professor of public health and political analysis at Harvard University. "At the end of the day, it did not play out that way. The Republican counter-strategy focused on the $716 billion in the Affordable Care Act that they said Democrats moved from Medicare."
Hoagland said that Republicans are unlikely to make much progress with their promises to repeal the Affordable Care Act, especially with the success of Obama and Senate Democrats. But he added that "there will be opportunities for fiscal changes" in that law, with pressures from both parties. "It's not written in stone."
Blendon added that Democrats scored a significant win because the election results make it virtually certain that the 2010 health-care law will be implemented. "The campaign hasn't moved the views of a single person," he said. "But I don't agree that this is a status quo election. There will be a significant change in American health policy, starting in 2014."