GOP win in Massachusetts Senate race seen hampering U.S. health reform legislation

The Democrats' powerful 60-seat majority in the U.S. Senate lasted just more than six months -- from the July 7, 2009, swearing-in of Sen. Al Franken (D, Minn.) to Massachusetts state senator Scott Brown's Jan. 19 victory over state Attorney General Martha Coakley in a special election. Brown's win has put an additional major hurdle in the way of Democrats' attempts to adopt national health system reform legislation.

Brown's victory reduces the Democratic caucus in the Senate to 59 -- 57 Democrats and two independents -- one shy of the 60 needed to end debate on controversial Senate measures and adopt legislation. Democratic leaders have been negotiating a merger between the House- and Senate-adopted reform bills since the beginning of the year.

Massachusetts' special Senate election was necessitated by the Aug. 25, 2009, death of Sen. Edward Kennedy. Brown, who campaigned in large part on promises that he would help block the Democrats' health reform measures, won 52% of the vote, while Coakley received 47%.

Brown will restore a needed balance to Congress, said Sen. Lamar Alexander (R, Tenn.), chair of the Senate Republican Conference. "Massachusetts voters have sent a clear message that the Democratic majority in Congress is not in touch with the American people and that we should restart the health care debate."

But Senate Majority Leader Harry Reid (D, Nev.) said Democrats will not back away from their priorities. "While Senator-elect Brown's victory changes the political math in the Senate, we remain committed to strengthening our economy, creating good-paying jobs and ensuring all Americans can access affordable health care."

Others echoed that sentiment. "The Massachusetts Senate election has complicated the prospects for comprehensive health reform, but the crisis of the uninsured remains very real to millions of Americans who have reduced access to health care because they don't have coverage," said American Medical Association President J. James Rohack, MD. "Our nation still needs reform of the health care system, and AMA will stay engaged in the process to get the best outcome for patients and physicians."

Dr. Rohack also noted that regardless of what happens on the broader reform issue, Congress still must tackle the urgent Medicare physician payment problem.

Reid said he hopes Brown is seated in the Senate as soon as possible. Although Democrats will lose their 60-seat supermajority as soon as that happens, at least two policy experts said Brown's victory wouldn't necessarily derail the national health reform legislation under negotiation.

The House does not appear likely to adopt the Senate bill as it currently stands. But it might do so if it can also adopt a separate, smaller bill with consensus language on such controversial provisions as health plan taxes and mandatory drug rebates, said Ron Pollack, the founding executive director of Families USA, a liberal health consumer organization.

Then, according to Pollack's strategy, Senate Democrats could adopt the separate, smaller measure with only 51 votes, under a parliamentary tactic known as reconciliation. The tactic allows simple majority approval in the Senate to overcome Republican opposition. However, any reconciliation legislation must directly affect the federal budget and could not be used to broker agreements on abortion funding, immigrant coverage or certain other remaining sticking points.

Pollack said he has pitched the idea to leading Democrats. "Privately, I've heard some encouraging reactions."

Joe Antos, PhD, a health care scholar at the conservative American Enterprise Institute in Washington, D.C, said that might be the best way for Democrats to proceed in the wake of the Brown victory. "That's a strategy that solves a lot of problems."

Antos said Democrats will keep fighting for health reform because, politically, they can't afford to fail on this issue. "There's enough determination on the part of the president and Reid and [House Speaker Nancy] Pelosi [(D, Calif.)] that they will find a way."

Pollack agreed. "At the end of the day, notable health reform legislation will pass the finish line."