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January 1, 2007
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The nation shifts toward the left—and greater interest in behavioral health policy?

The 2006 midterm elections brought changes few thought possible a year ago. The Democratic Party regained control of the U.S. House of Representatives for the first time in 12 years, elevating San Francisco congresswoman Nancy Pelosi to Speaker of the House. The Democrats also claimed control of the Senate, although they need the help of newly elected independent/socialist Bernard Sanders of Vermont to hold the majority (not to mention newly independent Joe Lieberman of Connecticut). The changes most important to behavioral healthcare, however, are likely to have occurred in state governments, where Democrats won truly historic victories.

At press time, the Democrats' Senate majority did depend on the health of South Dakota's Tim Johnson, who had emergency brain surgery in December. If Johnson is unable to return to duty at some point, it's possible that South Dakota's Republican governor will appoint a Republican to take Johnson's seat, creating an essentially 50/50 split among Republicans and Democrats in the Senate (with Vice-President Cheney breaking the tie, giving the Republicans control). Even if Johnson does not return to the Senate, Democrats will have more clout than before going into the election.

At least for now, Edward “Ted” Kennedy of Massachusetts returns to serve as chairman of the Committee on Health, Education, Labor, and Pensions. Kennedy has been a fervent supporter of mental health reform, but his interest in this field probably will take a backseat to his priorities of raising the minimum wage and reducing the cost of prescription drugs for Medicare beneficiaries. In addition to supporting the system “transformation” recommended by President Bush's New Freedom Commission on Mental Health, Kennedy's major behavioral health–related initiatives are likely to be limited to legal reimportation of prescription drugs from other industrial countries and full funding for the federal contribution to educational opportunities for children with mental or emotional disabilities.

The House has witnessed more sweeping changes. One of the most visible has been the return to prominence of Harlem's Charles B. Rangel. When Democrats last held a House majority, Rangel was well-known to the behavioral health community as chairman of the Select Committee on Narcotics Abuse and Control, which conducted oversight of the “war on drugs.” Rangel consistently favored greater investment in addiction treatment and prevention than the Reagan and Bush I administrations were willing to provide. Rangel now chairs the powerful House Committee on Ways and Means, with primary responsibility for Medicare as well as tax policy.

The powerful Ways and Means Subcommittee on Health is now chaired by Fortney “Pete” Stark of California, a veteran with close ties to Pelosi. Stark is closely aligned with the Bazelon Center for Mental Health Law. In 2005, he responded to a report critical of unlicensed and unregulated residential mental health treatment programs by cosponsoring the unsuccessful Keeping Families Together Act, which would have increased access to intensive day treatment for youth and lessened the attraction of private, unregulated residential treatment facilities.

One short-term impact of the election may be a greater willingness of the Bush administration to seek out advisors with bipartisan credentials. This already has occurred in the Substance Abuse and Mental Health Services Administration, where President Bush has selected Oklahoma Health Secretary Terry Cline, PhD, as the new administrator. Dr. Cline previously had been an appointee of Gov. Brad Henry, a Democrat.

The most lasting effects of the 2006 election may not result from which Democrats won but rather from which Republicans lost. The moderate wing of the Republican Party, centered mainly in the Northeast, was decimated. Nancy L. Johnson, an independent-minded Connecticut Republican who chaired the House Ways and Means Committee Subcommittee on Health, lost to Chris Murphy, a Democrat who had chaired the state legislative committee on health affairs. Moderate Republicans Charles Bass of New Hampshire and Sue Kelly of New York, a former nurse, also were defeated. These losses, coupled with the defeat of liberal Republican Sen. Lincoln Chafee of Rhode Island, suggest that it will be more difficult in the future for liberal Democrats to find compatible colleagues on healthcare issues among members of the GOP. In effect, the outcome may be a sharper ideological divide on Capitol Hill.

Yet most healthcare policy is made in state capitols rather than Washington, and the 2006 election might have broken legislative logjams in several states. Divided party control of state government ended in Arkansas, Colorado, Iowa, Maryland, Massachusetts, New Hampshire, and Oregon, as Democrats gained control of both the legislature and the governor's mansion in those states. In New Hampshire this is the first year that a Democratic governor has a Democratic majority in both legislative houses since the 19th century.

The Democratic surge in New Hampshire was so strong that it elected one candidate who refused to campaign for office. Maureen Nagle of Manchester said she had tried to get her name off the ballot after she entered a legislative race at the request of a local Democratic official who had assured her she would lose to the Republican incumbent. Nagle awoke the day after the election to find that she had been elected as part of the new Democratic majority in the 400-member New Hampshire House. As of this writing, she had not decided to resign, although she previously expressed concern that “the stress of serving in the House would greatly exacerbate the arthritis in my neck and shoulders.”