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    How party "flips" will impact health care policy and practice

    This article is part of an ongoing series from the American Association of Clinical Urologists (AACU), based on a partnership between the AACU and Urology Times. Articles are designed to provide monthly updates on federal and state legislative issues affecting urologists. We welcome your comments and suggestions about topics for future articles. Contact Ross Weber, state affairs manager, at 847-264-5924, or Joe Arite, federal government affairs manager, at 847-517-1050 or

    Political party control of legislatures and governorships across the country changed hands this year, with the vast majority switching from Democrat to Republican.

    GOP lawmakers now control 55 legislative chambers, a pickup of 19, and 29 governorships, a net increase of six. The GOP “flipped” 12 seats, but lost control of six others. The Minnesota Senate will be in the hands of the GOP for the first time ever (partisan elections began in 1974). In Maine and Wisconsin, both legislative chambers and the governorship changed from Democrat to Republican, joining 18 other governments completely controlled by that party. Solidifying GOP gains were also made in the South, with a majority of legislative chambers controlled by Republicans for the first time since Reconstruction.

    These political developments will obviously impact public policy, including redistricting, state budgets, and matters that influence the practice of medicine.

    The once-a-decade redistricting process begins next spring, when census figures are transmitted to states. In most instances, the elected legislature and governor controls how state and congressional districts are drawn. GOP gains in Great Lakes states, which are expected to lose seats in Congress, were therefore especially important. Observers expect Republican legislatures in Pennsylvania and Ohio to draw new lines that combine two historically Democratic districts, thereby reducing that party’s number in Congress by at least one.

    The National Conference of State Legislatures estimates that states face budget shortfalls totaling $72 billion. Republican-led states will depend on across-the-board spending cuts, privatization, and public employee benefit reform. Of incoming Democratic governors, only New York’s Andrew Cuomo promises not to raise taxes. Other governments led by Democrats may face painful “revenue enhancements” to keep their budgets balanced. Illinois Gov. Pat Quinn (D), for one, continues to call for an almost 50% personal income tax increase.

    Winners from this fall’s elections will also face the increasing burden of providing health care to their states’ low-income population and implementing federal health reform. Medicaid and other low-income health programs will seek savings through provider payment cuts, transitioning to managed care organizations, and limiting eligibility. Democrat-controlled states may consider provider/facility taxes to fund Medicaid in light of withdrawal of federal stimulus funds.

    Many newly elected Republican leaders champion medical liability reform as a way to control health costs. They will look toward tightening evidence and expert witness requirements as well as limits on non-economic damages. Other issues likely to gain traction throughout the country include billing disclosure; restrictions on prescribing, referring, and performing diagnostic imaging; and provider network regulation.

    Health reform will certainly be a hot topic no matter the political make-up of particular states. In November, the Washington Post reported that, “Democratic governors and legislatures are likely to emphasize vigorous regulation and government oversight, while Republican state leaders are likely to put greater stock in privatization and other free-market approaches.”

    At least five more states may join the multi-state lawsuit challenging federal reform, including Maine, which will also consider repealing one of the country’s first forays into universal care, known as Dirigo. Even newly empowered Republican lawmakers will not simply refuse to implement the law, however. Indeed, at least six states suing the government created reform implementation panels and applied for grants funded by the law.

    The AACU State Society Network is on top of all of these developments and encourages urologists to join its grassroots advocacy team of physician representatives who influence legislative and regulatory outcomes.

    To learn more about legislative issues in your state, please visit AACU's Action Center today at www.aacuweb.org.

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