NEJM Series Examines Election’s Impact on Health Care

Starting with this week's issue, the New England Journal of Medicine will be running a series of six weekly articles about the "principal [health policy] challenges facing the Bush Administration and Congress, as well as the major policy alternatives" (Epstein et. al., New England Journal of Medicine, 3/1). This week, the Journal examines how Republican and Democratic voters responded to health care issues and looks at the prospects for federal legislation on those issues:

• Role of government: Republican voters were "less interested" in expanding government and "favor[ed]" using the budget surplus to cut taxes. Democratic voters, however, preferred having government "play a role" in solving problems and were "more likely" to support using the surplus for health care.
• The uninsured: Democrats and Republicans supported Bush's plan to use tax credits to help the uninsured purchase health coverage, and both supported Gore's proposal to extend government programs. However, Democrats are "much more likely" to support "a large scale effort" to reduce the number of uninsured Americans. Therefore, legislation that offers a "compromise" between the Bush and Gore plans has a "reasonable chance" of being enacted. The Journal says that a proposal that includes medical savings accounts and tax credits while it also expands funding for Medicaid and CHIP programs "can be enacted."
• Federal regulation of health care: GOP voters are "less likely to be dissatisfied" with health care costs and accessibility issues, and they were "significantly" less likely than Democrats to support increased federal involvement to ensure access to health care or to regulate "specific aspects of health care." A majority of voters in both parties favored federal standards to ensure quality care in nursing homes and to "safeguard" patients' rights. In spite of voter concern over pharmaceutical expenses, it is "very unlikely" that legislators will regulate drug pricing in the private market. In addition, the government is not expected to limit the growth of private health plans or to restrict their mergers. However, patients' rights legislation that allows a "limited" right to sue HMOs and includes appeals for denied services may be enacted.
• Medicare: Voters in both parties favored amending Medicare to give seniors a choice between traditional Medicare or an HMO. Gore voters were more likely than Bush voters to support an expansion of Medicare to cover prescription drug costs. Bush voters tended to support using federal dollars to purchase private coverage for seniors. Given voters' "deep philosophical differences" over the future of Medicare, it is "unlikely" that Medicare reform will be enacted before the 2002 election. However, the prospects for a Medicare drug benefit are slightly "better." A "possible" outcome is a plan that would provide low-income seniors drug assistance through block grants to the states.
• Abortion: Researchers found that Republican voters were "more likely" to support "substantial" restrictions on access to abortion services than Democratic voters. While the "broad" issue of Roe v. Wade will likely go unresolved, the Journal predicts legislative efforts will attempt to ban "partial-birth" abortions and "restrict" access to abortion services both in the United States and abroad.
• Biomedical research: With a majority of voters in both parties supporting an increase in spending on biomedical research, the Journal writes that federal expenditures in the area will "likely ... increase," even though the issue was not discussed "extensively" during the campaign.