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Brown's Senate Win Creates Health Reform Dilemma for Democrats

 |  By  
   January 20, 2010

In what many are calling one of the biggest political upsets in American history, Republican Scott Brown beat Democrat Martha Coakley in the special Senate election in Massachusetts Tuesday, which ends the Democrats' super majority in the Senate and could allow Republicans to filibuster health reform legislation.

Brown garnered 52% of the vote compared to Coakley, the commonwealth's attorney general, who picked up 47% of the vote. The Republican will complete the final two years of the late Edward Kennedy's Senate term.

With his victory, Brown will become the 41st vote against health reform, which opens the door for a possible Republican filibuster on health reform—or at the very least, it could force Democrats to give the GOP a place at the negotiating table.

Brown's victory is also being seen as a possible harbinger of things to come in the 2010 Congressional elections and may force Democrats to change their strategies in the fall elections. It could also push Democrats to back away from some provisions in the health reform legislation.

During his acceptance speech Tuesday night, Brown made it clear that he is against the current health reform proposals. He said people don't want a health reform bill that will destroy jobs, hurt Medicare, and run the nation deeper into debt.

"It is not in the interest of our state and our country, and we can do better," he said.

Brown's victory in "the bluest of blue states" didn't seem possible only a week ago, but Coakley's sluggish campaign coupled with an unpopular governor, growing discontent with the State House and Washington, and a new face in statewide politics that connected with voters created a powerful combination that led to Brown's win.

The victory leaves Democrats in Washington with the difficult choice of what to do with health reform. They could:

  • Rush through legislation, such as the Senate's bill, in hopes of passing the measure before Brown takes office.
  • Utilize the reconciliation option, which is a complicated process that could allow Democrats to remove any threat of Republican filibuster.
  • Work with Republicans in hopes of coming up with a reform proposal that would garner enough GOP support to pass without the filibuster threat.
  • Step back and start over on health reform.

Massachusetts health leaders react
Political pundits and politicians have had their say about Brown's victory, but what do Massachusetts health leaders think of the win and what will it mean for health reform.

David C. Harlow, principal of The Harlow Group, LLC, a healthcare law and consulting firm in Newton, MA, says, "Is the pending health reform plan perfect? No. Better than the status quo? Probably. Will doing nothing ensure further cost and quality meltdown? Almost definitely. Will that meltdown lead to some form of public option down the road? Entirely possible."

Harlow says the election may be a referendum on health reform in Massachusetts, which created its own reform that was seen as the basis for much of the national proposal. Though the state's experience has shown "impressive coverage figures," Harlow says, reform has also brought about costs that are more difficult to support during a recession.

"What are the implications for health reform? While Brown's victory enables a GOP filibuster blocking a Senate vote, Democrats have at least two options: House adoption of the Senate bill or the informal reconciliation process. Leadership is already exploring both options. The better approach may be to go back to the drawing board—but only in the unlikely event that the GOP can act as a true partner," says Harlow.

Meanwhile, Joseph C. Kvedar, MD, director of the Center for Connected Health at Partners HealthCare System in Boston, says Massachusetts voters may have been "short-sighted" on Tuesday, but healthcare delivery reform is inevitable. "If Brown is good to his word and won't cast his vote for the health reform bill, it will be a short-term setback. However, all of the discussion, and all of the thinking, have propelled many in the industry to a place where they will be moving in the direction of care delivery reform because it seems inevitable. We won't be waiting for the federal government to get their interests lined up," says Kvedar.

Mario Motta, MD, president of the Massachusetts Medical Society (MMS), says his organization shares similar viewpoints with the new senator. Both supported the state's universal health program, believe all Americans deserve healthcare coverage, and they agree healthcare costs must come down.

"Physicians share these concerns. Affordable insurance, reducing costs, preserving access to care, liability reform, primary care services, and fixing the Medicare payment system for physicians are some of the major issues facing providers and patients. We look forward to working closely with Senator Brown, as we have with the entire Massachusetts Congressional delegation, to resolve the issues facing our nation's physicians and to improve healthcare access and quality for all patients in Massachusetts and the nation," says Motta.

Les Masterson is an editor for HealthLeaders Media.

Follow Les Masterson on Twitter.

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