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Four Questions After the Election

November 7, 2008
by Daniel Guarnera
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Tuesday's presidential election marked the end of a campaign season that offered all the drama, subplots, and excitement that a follower of politics could hope for. Now that we know the next president, 97 members of the new Senate (Minnesota, Georgia, and Alaska are doing recounts or run-offs), and nearly every new Representative, here are some questions whose answers will determine the addiction policy outlook over the next several years.

1. How will the ongoing economic downturn/potential recession tie the hands of the new Administration and Congress when it comes to spending?

President Obama made several campaign promises--particularly his promised tax cuts for the middle class--that would be politically difficult for him to turn away from and yet involve either new spending or reduced revenues. The federal government's current budget (a continuing resolution from last year) expires in March 2009--it'll be interesting to see what constraints are handed down as Congress debates its budget for the rest of the year.

2. Who will fill key health care posts in the new Administration?

The transition team appointments process is the political equivalent of NCAA March Madness and leads to frantic speculation and discussion within the Beltway. For addiction treatment and recovery advocates, the most important posts include SAMHSA Administrator, Secretary of Health and Human Services, and Director of the Center for Medicare and Medicaid Services. But there are other posts that will affect the nation's addiction treatment systems as well, including Secretary of Veterans Affairs, HRSA Administrator, Director of the National Institutes of Health, and many more.

Former Senator Tom Daschle from S.D. has been mentioned by some observers as the leading candidate for Secretary of HHS. Daschle was a leading advocate of the Clinton health care reform proposal in the early 1990s and was an early Obama endorser and advisor. Since losing his Senate seat in 2006, the former Senate Minority Leader has continued to make health care reform a personal priority, and he's published a book with some of his suggestions.

Of course other names have been mentioned as well, including Howard Dean (DNC Chair) and Kathleen Sebelius (governor of Kansas) ...

3. When will President Obama seek to introduce his health care reform plan?

President Clinton did not begin to seriously push his health care reform proposal until autumn of 1993, and some analysts argue that by that time Clinton had exhausted some of his early political capital on issues like NAFTA and don't-ask-don't-tell. That logic says that if President Obama wants to make sure that health care reform gets done, he's better off starting with it.

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Doug, thank you for your comment. I haven't heard very much specifically about any of those three candidates' backgrounds on addiction issues (beyond the fact that they're supportive of treatment).

Oversight of the proposed health care reform is the biggest issue that faces the new HHS Secretary, and that's where Gov. Dean (who expanded Vermont's health care program when he was governor) and Sen. Daschle (who's been a health care wonk since the early 90s) have their expertise. Gov. Sebelius's most newsworthy health care experience came when she was the Kansas Insurance Commissioner, and she blocked an attempted merger between Kansas Blue Cross Blue Shield and Anthem (based in Indiana), which she said would have raised costs for policyholders.

Do any of our readers from Vermont, Kansas, or South Dakota have additional intel on the three leading candidates for HHS Secretary?

Dan, do we know if Gov. Sebelius, Sen. Daschle, or Gov. Dean have any specific experience with addiction issues?

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Daniel Guarnera

Daniel Guarnera is the Director of Government Relations for NAADAC, The Association for...