Elections affect congressional committees with jurisdiction over ESRD program

Abstract

On November 4, 2008, Sen. Barack Obama (D-IL) made history by becoming the first African-American elected president, the first sitting senator in 48 years to be elected president, and the first Democratic presidential candidate to receive a majority of the popular vote since Jimmy Carter. He also saw his party solidify their majorities in the House and the Senate, giving Democrats control of government for the first time since 1993. Democrats padded their existing majorities in the House and Senate, but not as much as they had hoped before the elections. Importantly, Democrats will not have a 60-vote filibuster-proof supermajority in the Senate, meaning they will still have to get support from a handful of Senate Republicans on most legislation. The expanded majority will give Democrats additional leverage to sculpt the new president's agenda and pass it through the House and the Senate. President-elect Obama has identified reform of the healthcare system as a priority. Any healthcare system reform will likely contain a solution for the Medicare physician payment fee schedule and possibly include additional changes to the end-stage renal disease (ESRD) program. However, the exploding budget deficit will be a major impediment to the Democratic agenda, especially with the increased number and influence of the conservative Blue Dog Democrats and their emphatic support of the Pay-As-You-Go Rule. This rule requires that if spending is increased or tax revenues are decreased, spending must be cut or revenues must be raised in other areas to ensure that the legislation does not increase the deficit. Any healthcare system reform will likely contain a solution for the Medicare physician payment fee schedule, and possibly include additional changes to the ESRD program. In the House, Democratic Leader- ship and Committee Chairmanships had not been expected to change from the 110th Congress, but Energy and Commerce Chairman John Dingell (D-MI) is being challenged for leadership of the panel by the Democrat next in seniority, Henry Waxman (D-CA). Regardless of the chairmanship contest, the committee roster will change because seven members retired from the House. The retirees include two Democrats, Tom Allen (ME) and Darlene Hooley (OR), and five Republicans, Barbara Cubin (WY), Mike Ferguson (NJ), Vito Fossella (NY), Charles “Chip” Pickering (MS), and Heather Wilson (NM). The most significant committee changes will be on the Ways and Means Committee, where Congressman Jim McCrery (R-LA) retired, leaving open the ranking Republican position. Congressman Wally Herger (R-CA) is the most senior Republican on the panel, but he faces a challenge from Congressman Dave Camp (R-MI), chairman of the Health Subcommittee and an original cosponsor of the Kidney Care Quality and Education Act. House Republican leadership will have four additional openings to fill on the committee as a result of five retirements and two incumbents losing their bids for reelection. There are also changes to the committee's Democratic roster. On November 6, committee member Rahm Emanuel (D-IL) accepted the position of White House chief of staff, adding to the Democratic vacancies left by the retirement of Congressman Michael McNulty's (NY) and the death of Congresswoman Stephanie Tubbs Jones (OH) earlier this year. Additionally, the change in the committee ratios should create four additional openings for Democrats. In the Senate, there likely will be two openings on the Finance Committee resulting from the November elections. Senator John Sununu (R-NH) lost his Senate race. Senator Gordon Smith (R-OR) was also defeated; although there may be a recount that could alter the outcome. With his emphasis on healthcare reform during the campaign, it is expected that Obama and his administration, coupled with strengthened Democratic majorities in the House and Senate, will ensure that healthcare reform will be high on the legislative agenda. However, the kidney-care community will have to wait and see what impact reform will have on the ESRD program.