In addition to attacking select ACA provisions, Republicans also may move to starve implementation of new healthcare reform
programs. Rep. Boehner has mentioned cutting the federal budget by $100 billion, which will reduce government outlays for
non-military discretionary funds down to 2008 levels. One part of this strategy is to curb appropriations needed by the Department
of Health and Human Services (HHS), the Internal Revenue Service, and other agencies to establish new ACA initiatives.
Taking healthcare reform to court
Making substantial reductions in federal spending, however, will not be any easier for Republicans than Democrats. With their
eye on ousting President Obama in 2012, Republicans may shy away from any talk of reforming social security or Medicare. And
most Republicans have their own lists of pet programs meriting federal support.
Complicating the situation is the need for Congress to immediately deal with some high-cost issues. Congress left town early
last fall to hit the campaign trail without finalizing the federal budget for fiscal year 2011, which now is months overdue.
Medicare fees for physicians will plunge by 30% Jan. 1, 2011 unless the legislators extend that deadline for another year.
And important Bush era tax breaks, which Republicans are eager to retain, also expire Dec. 31 unless Congress renews or extends
Big curbs on government spending could create problems for biomedical researchers. Reducing federal outlays, as Boehner proposes,
could be devastating to FDA, the National Institutes of Health (NIH), and various health and social programs. NIH would lose
about $3 billion, almost 10% of its current budget, and new FDA initiatives would fall by the wayside. Even if FDA and NIH
escape heavy cuts, needed increases in resources are unlikely.
The Republican takeover of the House also sets the stage for more intense scrutiny of administration policies by the committees
responsible for health and biomedical programs. The new leaders of the House Energy & Commerce Committee are eager to grill
HHS Secretary Kathleen Sebelius and her top aides on healthcare reform cost estimates and the effect of specific policies
on employer coverage, premiums, and benefits. The panel also plans to hold hearings on FDA policies and initiatives that could
be added to user-fee renewal legislation.
Rep. Darrell Issa (R-CA) is in line to chair the House Oversight and Government Reform Committee, where he will be able to
issue subpoenas to access desired government documents. At hearings this fall on FDA's handling of Johnson & Johnson's and
McNeil Consumer Healthcare's recall of adulterated over-the-counter medicines, Issa criticized FDA for taking too long to
shut down the noncompliant J&J plant and for withholding information sought by committee investigators.
Although Democrats retained control of the Senate, there will be notable changes in health-related committees. Sen. Orrin
Hatch (R-UT) will play a more prominent role in proposing healthcare reform changes as the ranking Republican on the Senate
Finance committee; Hatch replaces Sen. Charles Grassley (R-IA), a long-time critic of pharma and of FDA. The Senate Health,
Education, Labor and Pensions (HELP) committee lost two long-term members due to retirement: Democrat Chris Dodd of Connecticut
and Republican Judd Gregg of New Hampshire. Chairman Tom Harkin (D-IA) and ranking Republican Mike Enzi of Wyoming will continue
to be lead players in crafting health policy and FDA user-fee renewal legislation.