The Election's Consequences for Health-Care Law

Temptation to claim a "status quo" outcome ignores broader trends in health and Medicare debates.

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Jonathan Ernst/Reuters

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."

And yet, 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, 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."

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Richard E. Cohen is a senior correspondent with Kaiser Health News.

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