Healthcare and the United States Senate
With Democrats remaining in charge in the Senate, there is likely to be little change in the dysfunctional nature of this body. If anything we may see more gridlock, as the Republicans have increased their filibuster opportunities. Senate committees will continue to be under Democratic control, so there may be some shuffling of the deck chairs, but there will likely not be much of a change in healthcare policy coming from the Senate for the next two years.
Healthcare and the United States House of Representatives
Now that Republicans have control of the House of Representatives, there will be some changes in the roll out of health reforms. One immediate impact next year will be the change in leadership of the House committees and subcommittees, particularly those with oversight over healthcare. New chairpersons armed with subpoena power and the ability to influence policy on the health reform legislation is going to have a significant impact over the next two years.
Healthcare and the States
With Republicans winning at least nine new Governor's offices, giving them a clear majority, there could be additional challenges to health reform legislation. There are still some key races to be decided and the razor thin margins in traditionally Democratic controlled states could create new dynamics regardless of outcomes. Voters in Arizona and Oklahoma amended their state constitutions Tuesday with measures designed to block the new federal mandate on individuals and some employers to buy health insurance, while voters in Colorado defeated a similar initiative. Most states are operating under huge deficits, and unlike the federal government, they can't just print more money. There will be intense budgetary pressure on the states, which can have an impact of the ability to match federal funds.
HITECH Act and Health Reform
I think there is virtually no chance that the unspent stimulus funds designated for incentives for the adoption and meaningful use of electronic health records will be rescinded. However, the threat of possible reduction in funding to states, combined with their inability in many cases to match the future funding, will cause some states to possibly spend the funds too quickly without adequate planning. The House of Representatives will also be having radically different committee meetings and there is little doubt that there will be a sharp focus on CMS and the ONC and their activities. While it unlikely that the HITECH Act will be repealed or unfunded, the election results have made it much more difficult for the Obama administration to implement its broader healthcare agenda.