Introduction

One thing is very clear from the 2010 midterm elections: the 112th Congress will look and sound very different from the 111th Congress, and nowhere will that be felt greater than on health care issues. The election of numerous Republican candidates, including those affiliated with the Tea Party movement, means a more conservative outlook in the House of Representatives. The new candidates elected in 2010 seek quick, discernable change, though it is not immediately clear how the newly configured Republican Conference (the party caucus) will handle the demands of new conservative candidates who will undoubtedly propose significant cuts to federal spending. It is expected that the vitriol of the elections will carry over to the 112th Congress – and will undoubtedly affect the potential for compromise between parties, between the House and Senate, and with the President.

From a snapshot perspective, in the wake of the election, certain parts of the Affordable Care Act (health care reform law) are likely to come under fire, especially since full repeal of the law is clearly unlikely in a Democratic Senate, and in the face of Obama Administration opposition. As noted below, we expect congressional opponents to settle on an incremental approach to challenging ACA, taking advantage of its cost and gradual phase-in. Although less controversial and more popular provisions (insurance reforms, wellness programs) are less likely to be challenged, opponents are expected to launch efforts to erode employer penalties, individual mandates, Medicare funding cuts, Medicaid expansion, and even some of the more intrusive program integrity provisions. The result will be a war of attrition in the health policy arena, heightened by looming financial pressure from entitlements and the demand for more effective cost controls. Medicaid program reductions could be front and center in proposals from the House side because the federal government can use levers like rolling back mandates and reducing incentives to States to increase the size of the program. There will also likely be a groundswell for federal reform of medical malpractice.

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