Changing of the guard puts spotlight on health policy

The Democrats are back on top in the House and Senate after more than a decade playing second fiddle to the GOP. Although health reform was not a prime issue moving votes this November, health policy is on the Democrats' "100 hours" to-do list.

The savings from government price negotiating theoretically would provide funds to fill in the much-maligned "donut hole" in Part D, which is just now hitting thousands of seniors. Funding to support a more comprehensive Medicare drug benefit also could come from new payroll taxes on workers and employers, or Congress may push to expand imports of low-cost drugs to help cut drug costs overall.

Another Democratic target will be Medicare payments to private plans. The shift in control of Congress puts long-time industry critic Rep. Pete Stark (D-Calif.) at the helm of the House Ways and Means Heath subcommittee. Stark has long complained that Medicare pays private plans too much money and is planning hearings and investigations into the Medicare Advantage program and managed care. At the same time, Stark says he doesn't want new Medicare legislation for fear of killing the whole drug benefit, but plans to attack a range of issues such as drug pricing, private plans and government waste and fraud.

Stark's position reflects a major shift in political philosophy at the powerful subcommittee, which oversees tax policy and Medicare and Medicaid spending. Liberal Democrat Charles Rangel of New York replaces conservative Bill Thomas (R-Calif.) as Ways and Means chairman. And Stark takes over from Nancy Johnson of Connecticut, who lost her re-election bid.

In addition, Rep. John Dingell (D-Mich.) returns to the helm of the House Energy and Commerce Committee, a prime platform for criticizing administration health policy and pressing for changes in the Part D drug benefit. Similarly, Rep. Henry Waxman (D-Calif.) will step up investigations of health and pharmaceutical issues as chair of the House Government Reform Committee.

The debate on health issues promises to be less contentious in the Senate, where the Democrats' narrow majority will require bipartisan cooperation to move legislative initiatives. Sen. Ted Kennedy (D-Mass.) takes the helm of the Health, Education, Labor and Pensions (HELP) Committee, but has a good working relationship with the top Republican, Sen. Mike Enzi of Wyoming. The Senate Finance Committee will be headed by Sen. Max Baucus of Montana, who has worked closely with former chairman Sen. Charles Grassley of Iowa. They will continue to focus on Medicare and Medicaid and investigate healthcare spending and related tax issues.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.