The midterm elections to be held on Tuesday, November 4, 2014, will not only determine control of the Senate and House, but may also play a significant role in shaping the final 2 years of the Obama administration and the outlook for the 2016 presidential elections.
When the polls close on November 4, the Republican Party is widely expected to retain control of the House of Representatives. Republicans currently hold a 33-seat majority (234 seats to the Democrats’ 201 seats). Partly because of the partisan process of redistricting at the state level, only 15 of the 435 House seats being contested are considered truly competitive (rated “toss-up” by the Cook Political Report). What’s more, an astonishing 367 seats are considered either solidly Republican or Democratic. For the Democrats to regain control of the House, their candidates would need to win all 15 of those “toss-up” races and a further 19 seats from races considered “lean” or “likely” Republican while retaining control of all the seats they currently hold. Quite simply, as things currently stand, Democrats face an almost impossible task in the race for control of the House.
In the Senate, despite the Democrats holding a clear 55-45 seat majority (including two Independents who caucus with the Democrats), the situation also looks daunting for the Democrats as they approach the final weeks of the campaign. Of the 36 Senate races being contested, Democrats must defend 21 seats, compared with just 15 seats currently held by Republicans. In addition, six of the races for the Democratic-held seats are considered “toss-ups” compared with just two for the Republican-held seats.
As Republicans cautiously eye their path to the majority in the Senate, the prospects for the Obama White House to further advance its agenda in the final 2 years of its term look increasingly dim. Even with the Democrats running the Senate, the administration has struggled to make progress on many of its policy priorities in the face of a hostile, hyper-partisan House and growing disillusionment in the Senate over the president’s ability to work with the legislative branch. The outcome of just a handful of key Senate races could set the stage for what promises to be a frustrating final 2 years for a president who swept into Washington on a promise of “hope and change.”
Impact of Congressional Elections on ACCP’s Medicare Initiative
ACCP’s Medicare Initiative is designed to position clinical pharmacists to participate as fully integrated members of the health care team in evolving care delivery and payment models. The process of care we propose is consistent with the vision for medication management in the patient-centered medical home (PCMH) endorsed by the Primary Care Collaborative (PCPCC) and is a necessary component to achieve many of the quality measures that accountable care organizations (ACOs) are required to meet. We have made it clear that our proposal is not designed to encourage individual pharmacists practicing in silos to “hang out their shingle” and bill Part B.
Recognizing the difficult economic situation that we are operating under and the challenges associated with enacting legislation that would ultimately add a new benefit to the Medicare program, we have gone to great lengths to position our initiative in a bipartisan manner. We have been successful in building a bipartisan working group of Senate offices that is working to develop a legislative strategy to advance this effort in the next Congress. Because of this bipartisan approach, we do not consider the outcome of the November election a significant factor, regardless of who controls the Senate when all the votes are counted.
Members of Congress from both sides of the aisle recognize that significant structural changes are needed to ensure Medicare’s long-term sustainability. For lawmakers who are primarily concerned about potential cuts in Medicare spending that would reduce benefits and limit options for seniors, we position our initiative as an opportunity to improve quality and outcomes for seniors while containing costs across the entire program. For lawmakers who prioritize deficit reduction and spending cuts, we present our initiative as an opportunity to modernize the Medicare program and integrate best practices from the private sector that will ultimately limit overall spending through reduced hospitalizations and other costly but often avoidable encounters.
Focus on Senate Races in Alaska, Colorado, Iowa, North Carolina, and Kansas1
As things currently stand, Republicans look almost certain to win the open Senate races in Montana, South Dakota, and West Virginia for seats vacated by retiring Democratic Senators Baucus, Johnson, and Rockefeller, respectively. Republicans are also heavily favored to pick off incumbent Democrats in Louisiana (Senator Landrieu) and Arkansas (Senator Pryor).
Because the Republicans need a net swing of six seats to gain the majority, strategists have identified Democratic-held seats in Alaska, Colorado, Iowa, and North Carolina as their best opportunity to tip the balance, whereas the race for the Republican-held seat in Kansas has emerged as an unlikely opportunity for the Democrats.
Alaska
- Incumbent: Mark Begich (D)
- Democratic Candidate: Mark Begich
- Republican Candidate: Dan Sullivan
Latest Aggregate Polling: Republicans lead by 4.7% (Republicans: 45.7%; Democrats: 41.0%)
Background
Former Anchorage Mayor Mark Begich scored an unlikely victory in the 2008 Senate race, defeating six-term Senator Ted Stevens in the year that fellow Alaskan Sarah Palin was running at the top of the Republican ticket for vice president.
That Senator Stevens was convicted on federal corruption charges just days before the election was undoubtedly a factor in Begich’s 2008 triumph. Although Stevens ignored bipartisan calls for his resignation, the guilty verdict opened the door for Begich’s election.
This year, Begich faces a much sterner test in the form of former Alaska Attorney General Dan Sullivan, who has the backing of Republican establishment organizations, including the Chamber of Commerce and Club for Growth. Given that Begich managed to defeat convicted felon Stevens by only a single percentage point in 2008, he could struggle to repeat the feat against Sullivan.
Colorado
- Incumbent: Mark Udall (D)
- Democratic Candidate: Mark Udall
- Republican Candidate: Cory Gardner
Latest Aggregate Polling: Republicans lead by 0.8% (Republicans: 43.8%; Democrats: 43.0%)
Background
Colorado was historically a Republican state but, because of social and demographic shifts, has turned Democratic in recent years. A member of the storied Udall political family, the incumbent first won his Senate seat in 2008 with almost 53% of the vote. As a generally popular and well-respected member of the Senate, Mark Udall was assumed invulnerable in his bid for reelection.
However, GOP challenger Cory Gardner has run a formidable campaign, and he is considered a rising star in the Republican Party. Current poll numbers suggest 2014 will provide an opportunity for the Republicans to regain traction in a state that Democrats have dominated in recent elections.
Iowa
- Incumbent: Tom Harkin (D)
- Democratic Candidate: Bruce Braley
- Republican Candidate: Joni Ernst
Latest Aggregate Polling: Republicans lead by 2.8% (Republicans: 44.6%; Democrats: 41.8%)
Background
Since winning election to the Senate in 1984, Tom Harkin has been a stalwart of the Democratic Party and was an early favorite to win his party’s nomination for president in 1992. His retirement was always going to leave a void for the Democrats at both a national and state level.
The Democrats appeared to have found a worthy successor to Harkin when they nominated popular Congressman Bruce Braley to replace him. Republican State Senator Joni Ernst was originally considered an outside candidate, but since emerging from the Republican primary field with her party’s nomination, she has proven herself a strong campaigner and won important endorsements from the Des Moines Register, the U.S. Chamber of Commerce, and influential Republican figures including Mitt Romney.
Braley, meanwhile, is looking to recover from an embarrassing gaffe in which he appeared to disparage Iowa farmers and now trails Ernst among the rural voters, whose support is vital to electoral success.
North Carolina
- Incumbent: Kay Hagan (D)
- Democratic Candidate: Kay Hagan (D)
- Republican Candidate: Thom Tillis
Latest Aggregate Polling: Democrats lead by 4.2% (Democrats: 45.0%; Republicans: 40.8%)
Background
Democratic Senator Kay Hagan caused something of a stir in 2008, defeating high-profile incumbent Elizabeth Dole in a traditionally Republican state. Her candidacy was boosted in part by the high turnout among African American voters that accompanied Barack Obama’s Presidential bid. During her 6 years in the Senate, Hagan has shown her competency as a legislator, but she has cemented her close ties with President Obama and the national Democratic agenda.
Former State Speaker of the House Thom Tillis, who won the Republican Senate primary by a comfortable margin, has successfully defined himself as a business-minded problem solver free of the baggage Hagan carries after 6 years in Washington and her close association with a troubled president. The candidacy of Libertarian Sean Haugh could be a decisive factor in what will likely be a very tight contest in the Tar Heel State.
Kansas
- Incumbent: Pat Roberts (R)
- Independent Candidate: Greg Orman
- Republican Candidate: Pat Roberts
Latest Aggregate Polling: Independents lead by 5% (Independent: 45%; Republicans: 40.0%)
Background
The last time Kansas elected a non-Republican to the Senate was in 1932, but there is a realistic possibility that Independent candidate and businessman Greg Orman could buck this trend in November.
Incumbent Republican Senator Pat Roberts was first elected to the Senate in 1997 and most recently won reelection in 2008 with a comfortable 60% of the vote. However, despite emerging victorious from a bruising primary contest against Tea Party–backed radiologist Milton Wolf, Roberts faces a deeply divided Republican base, and conservatives in his party are threatening to sit out the race rather than back their incumbent senator.
Independent Greg Orman has waged an astute campaign, positioning himself as a problem solver capable of legislating in Washington, rather than a divisive partisan. However, his election would still represent a significant upset, and few would have predicted that the most vulnerable GOP senator this election cycle would hail from a genuine Republican stronghold such as Kansas.
Your Contribution to ACCP-PAC Can Help Advance Our Medicare Coverage Initiative
The political reality is that a legislative initiative cannot move forward purely on the strength of its own merits – grassroots advocacy and financial contributions are key to showing support for our initiative from elected officials’ own districts and states.
A well-funded political action committee (PAC) will give ACCP the resources it needs to support our friends on Capitol Hill. ACCP-PAC is the only PAC dedicated to electing members of Congress who are committed to advancing our Medicare Initiative. Contributions from ACCP-PAC to members of Congress will raise our profile on Capitol Hill, improve our standing among key lawmakers, and provide unique opportunities to discuss our initiative with potential congressional champions. Our PAC will also help ensure that elected officials who support our initiative remain in office to advance the goals of our proposal in the future.
Only ACCP members are eligible to contribute to the PAC and allow us to make these vital political contributions. With its more than 15,000 members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, we need the widespread support of our membership.
If each ACCP member contributed just $25, ACCP-PAC would raise $350,000. All ACCP members should consider making a donation of at least $25 to ACCP-PAC. CLICK HERE to support your PAC today!
Now Accepting Applications – ACCP/ASHP/VCU Pharmacy Policy Fellow Program
The Congressional Healthcare Policy Fellow Program is a collaborative effort of ACCP, the School of Pharmacy at the Medical College of Virginia/Virginia Commonwealth University, and the American Society of Health-System Pharmacists.
The program provides a unique health care policy learning experience designed to demonstrate the value of pharmacy-government interaction and facilitate practical contributions to the effective use of scientific and pharmaceutical knowledge in government policy development. Fellows spend a month with each of the professional organizations as members of their respective government and professional affairs staff. In November of the fellow year, they begin working in a legislative environment requiring health care input on the staff of an individual senator or representative or a relevant congressional committee.
The program is an enriching opportunity for the fellow to develop legislative evaluation and policy development skills, improve research and writing skills, and integrate practical policy experience with theory. The fellow will be expected to undertake a wide array of responsibilities, including researching and preparing briefs on health care issues, assisting with policy decisions, drafting memoranda, and planning, organizing, and carrying out program and management objectives. The congressional office (personal or committee) placement should ideally be with one of the committees that predominantly deal with health issues, such as the Senate Health, Education, Labor, and Pensions (HELP) Committee and the Senate Finance Committee or the House Ways and Means or Energy and Commerce committees.
Applications Now Open for the 2015–2016 Pharmacy Healthcare Policy Fellow Program
Interested candidates should visit the Pharmacy Healthcare Policy Fellow program’s website for more information and instruction on submitting an application.
Contact Us! For more information on any of ACCP’s advocacy efforts, please contact:
John K. McGlew
Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue NW
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]
1All polling data taken from “Real Clear Politics.” Available here. Accessed October 1, 2014.