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Cardiothoracic surgeon Larry Bucshon, MD, representative from Indiana.

AAOS Now

Published 12/1/2010
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Alanna G. Porter

Election Results Portend Change

Partisan politics, short-term SGR fix likely

Composition of the 112th Congress (PDF)

The national midterm elections on Nov. 2 resulted in significant gains for the Republican party and will mean substantial changes in both houses of Congress. The impact of the election will be felt not only in how President Obama will have to change strategies to get legislation passed, but also in what legislation is addressed.

In the House
Republicans will have a solid majority in the House of Representatives for the 112th Congress, which convenes in January 2011. Although seven House races remain undecided and could take weeks to resolve, Republicans picked up 60 seats, giving them total of 239 seats, substantially more than the 218 seats needed to obtain majority status. The Democrats will have 189 seats at a minimum.

Among the new Republican Representatives are six doctors—Larry Bucshon, MD, of Indiana, a cardiothoracic surgeon; Andy Harris, MD, of Maryland, an anesthesiologist; Dan Benishek, MD, of Michigan, a general surgeon; Joe Heck, DO, of Nevada, an emergency physician; Nan Hayworth, MD, of New York, an ophthalmologist; and Scott Desjarlais, MD, of Tennessee, a family practitioner.

Because the 112th Congress will have a majority Republican House, the committee structure and leadership positions will change. Rep. John Boehner (R-Ohio) will likely become Speaker of the House; the Democratic Minority Leader has not yet been determined.

With this majority, Republicans will likely attempt to follow through on campaign promises such as repealing healthcare reform. Because Democrats will still control the Senate and the White House, however, a full repeal is unlikely.

Republican control of the House not only enables the new representatives to set a new legislative agenda, it also gives them control of the federal purse, because all revenue-raising legislation must originate from the House of Representatives. Thus, although Republicans may not be able to repeal healthcare reform totally, they may be successful in dismantling unfavorable components of healthcare reform, such as the Independent Payment Advisory Board (IPAB).

In the Senate
In the Senate, Republicans will pick up 6 seats, narrowing the lead held by Democrats to 53–47. One physician—Republican Rand Paul, MD, of Kentucky, an ophthalmologist—joined colleagues in the Senate, bringing the total number of physicians serving in Congress to 19.

The Senate of the 112th Congress will include 51 Democrats, 2 Independents who caucus with the Democrats, and 47 Republicans. These margins will significantly affect the way legislation moves through the Senate because neither party is close to having a filibuster-proof majority. To achieve the 60 votes needed to move forward with legislation, Senators will need to reach across the aisle, resulting in either bipartisan cooperation or gridlock.

Senate leadership is likely to stay the same for both parties; Nevada Democrat Sen. Harry Reid will probably remain Majority Leader, with Kentucky Republican Sen. Mitch McConnell as Minority Leader.

The Orthopaedic PAC
During the 2009–2010 election cycle, the Orthopaedic Political Action Committee (PAC) raised more than $3.7 million; more than 26 percent of members of the American Association of Orthopaedic Surgeons (AAOS) contributed to the Orthopaedic PAC.

The Orthopaedic PAC contributed to a total of 237 Congressional campaigns in the 2008–2010 election cycle. Of the 27 Senate campaigns that received contributions from the Orthopaedic PAC, 26 candidates were elected (a 96 percent success rate). The Orthopaedic PAC also made contributions in 210 House campaigns; 180 of the supported candidates were elected (an 86 percent success rate), with 5 races still undecided.

The Orthopaedic PAC will continue to support Democrats and Republicans who support issues of importance to orthopaedic surgeons, including medical liability reform, a new method for calculating Medicare physician payments, and smooth implementation of health information technology. In addition, the PAC continues to encourage orthopaedic surgeons to participate in the political process.

What does it all mean?
Members of the 111th Congress—many of whom will not be in the next Congress—returned to Washington in mid-November for the final “lame duck” session. (A lame duck session is when Congress reconvenes in an even-numbered year following the November general elections to consider various items of business.)

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Cardiothoracic surgeon Larry Bucshon, MD, representative from Indiana.
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Emergency physician Joe Heck, DO, representative from Nevada.
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General surgeon Dan Benishek, MD, representative from Michigan.

Several pressing matters need to be addressed before the 111th Congress adjourns, including passing a tax package and finalizing appropriations bills. To physicians, however, one of the most significant matters is addressing the expiration of the most recent sustainable growth rate (SGR) fix for Medicare.

In June, Congress passed a 6-month “patch” that provided for a 2.2 percent increase in Medicare payment rates. This patch expires on Dec. 1, 2010, however, and unless Congress takes action, physicians are facing a 23 percent reduction in Medicare payment rates that will increase to 24.9 percent on Jan. 1, 2011.

Fears that physicians will refuse to see Medicare patients will probably prompt Congress to pass another short-term patch, extending for only a few months. But figuring out how to pay for a longer-term or permanent fix will be left to the 112th Congress.

Similarly, any action on the IPAB—an independent body that is charged solely with reducing costs within the Medicare program—is also likely to be deferred until the 112th Congress. Developed by the Senate during the healthcare reform debate, the IPAB has been extremely unpopular in the House among both Republicans and Democrats.

State elections snapshot
The 2010 elections also held great significance for state governments, and Republicans were quite successful in these races as well.

Although Democrats held the majority in 52 of the 88 state legislative chambers facing elections, they lost control in 19 chambers. The Oregon House and the Alaska Senate are both evenly split between Republicans and Democrats, and control of the New York, Oregon, and Washington Senates is still undecided.

For the first time since Reconstruction, Republicans control the Alabama legislature, and for the first time in history, the Minnesota Senate will be controlled by the GOP.

In many cases, the party that control state legislatures will have a long-term impact on federal elections and the shape of Congress. After every decennial census, such as the most recent one in 2010, Congress reapportions the 385 House congressional districts that are determined by population (each state automatically gets one seat, bringing the total number of House seats to 435).

Although Congress decides the number of districts in each state based on the census results, the states decide how those districts are shaped. In 11 states, nonpolitical commissions are used; in the remaining 39 states, state legislatures draw congressional districts. Thus, the party in power during redistricting can control how districts are drawn, enabling it to gain or preserve as many congressional seats as possible.

For purposes of redistricting, 20 of the 39 state legislatures that create redistricting plans are completely controlled by Republicans; 14 are completely controlled by Democrats; 3 have split control; Nebraska has a nonpartisan legislature; and New York is undecided.

Republicans made gains among the 37 races for governor. Going into the election, 26 of the 50 state governors were Democrats. Now, 29 governors are Republicans, 20 are Democrats, and one—Lincoln Chafee, a former Republican—is an Independent.

Thus, Republicans now have total control (entire legislature and governorship) of 20 state capitols, and Democrats have total control in 10 states. Control in the remainder of the states is either split or yet to be decided.

Staff from the AAOS office of government relations have met with several new members of Congress, and many AAOS fellows have established relationships with these new members. AAOS will continue to work with leadership from both parties to advance orthopaedic issues.

If you know or have a relationship with a member of the 112th Congress, the Orthopaedic PAC would like to hear from you. E-mail pac@aaos.org or visit www.aaos.org/pac

Alanna G. Porter is senior manager, government relations in the AAOS Washington office. She can be reached at porter@aaos.org