After many long and expensive months of difficult campaigns in key states, Americans voted to transfer power in the Senate and increase the Republican majority in the House of Representatives to its largest since 1928, further complicating President Barack Obama’s final two years in office.

Most of the GOP gains in the House came from solidly Democratic seats that President Obama easily carried two years ago.

ACEP members running for reelection to Congress fared well, with Rep. Joe Heck (R-NV) winning re-election to a third term with a decisive 61–36 margin over Democratic challenger Erin Bilbray. Rep. Raul Ruiz was elected to serve his second term in Congress, defeating Republican challenger Brian Nestande by a margin of 53–47.

Both ACEP members were supported by ACEP’s political action committee, the National Emergency Medicine PAC (NEMPAC), with direct contributions to the campaigns and through independent expenditures in the form of television and radio ads and direct mail. An independent expenditure is a political activity intended to assist or oppose a specific candidate for office that is done without the coordination or direct knowledge of the candidate. Additional information on NEMPAC’s participation in the 2014 elections is available on the NEMPAC website, http://www.emergencyphysicianspac.org.

Senate Highlights

Going into election day, there were 13 competitive seats impacting the potential change—Republicans needed to win nine of them to attain the 51-seat majority. Of the four targeted purple-state Senate races, Republicans picked up three in Colorado, Iowa, and North Carolina. The race in Louisiana between physician candidate Rep. Bill Cassidy (R) and Sen. Mary Landrieu (D) will be determined in a run-off on Dec. 6. NEMPAC is supporting Rep. Cassidy.

House Highlights

Republicans won a total of at least 244 seats in the House, their largest majority since 1928. This expanded GOP majority in the House means that Speaker John Boehner (R-OH) will have an easier time passing legislation in the House without Democratic support, and Republicans will also have an easier time holding on to their majority in future elections.

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For comprehensive information on the 2014 elections, please go to CQ/Roll Call election coverage (http://media.cq.com/elections/2014).

H.R. 36/S. 961 Cosponsor Survival

Of the 88 House and Senate cosponsors of ACEP’s legislation, the Health Care Safety Net Enhancement Act (liability protection for EMTALA-related services), 12 will not be returning to Congress due to retirement or defeat. One House cosponsor, Sen.-elect Shelley Moore Capito (R-WV), will now serve in the Senate, and another, Rep. Bill Cassidy (R-LA), may be elected to the Senate in a December runoff.

Physician Members and Candidates Update

There were 20 physicians serving in the 113th Congress but not all will return. Thirteen physicians were reelected: Rep. Dan Benishek (R-MI), Rep. Ami Bera (D-CA), Rep. Charlie Boustany (R-LA), Rep. Larry Bucshon (R-IN), Rep. Michael Burgess (R-TX), Rep. Scott DesJarlais (R-TN), Rep. John Fleming (R-LA), Rep. Andy Harris (R-MD), Rep. Joe Heck (R-NV), Rep. Jim McDermott (D-WA), Rep. Tom Price (R-GA), Rep. Phil Roe (R-TN), and Rep. Raul Ruiz (D-CA). In addition, Sen. John Barrasso (R-WY) and Sen. Rand Paul (R-KY) will return as they were not up for reelection this cycle.

The new Congress will need to deal with the Sustainable Growth Rate (SGR) again as well. There was a bipartisan, bicameral agreement earlier this year to repeal the SGR and replace it with a performance-based payment system.

Physician-member Rep. Bill Cassidy (R-LA), will be in a runoff on Dec. 6 for the Louisiana Senate seat.
Two physicians in Congress, Rep. Phil Gingrey (R-GA) and Rep. Paul Broun (R-GA) gave up their House seats to run for the Georgia Senate and were defeated in the primary. Del. Donna Christensen (D-VI-AL) and Sen. Tom Coburn (R-OK), an obstetrician-gynecologist, retired.
Eighteen physicians ran who were not currently serving in Congress. None of these physicians won, so there are no new physician members of congress. NEMPAC supported five of these candidates. The new Congress will have 15 physician members, with the possibility of 16 if Dr. Cassidy is successful.
Two dentists, Rep. Paul Gosar (R-AZ) and Rep. Mike Simpson (R-ID), were also reelected, and another dentist, Republican candidate Dr. Bruce Babin, was newly elected to represent TX-36.

Health Care Issues

The first order of business related to health care might be a formal vote to repeal the Affordable Care Act, followed by more realistic efforts to modify the law. With Republicans in control of the Senate, expect votes on full-replacement plans such as those put forth by the Republican Study Committee and Coburn-Hatch-Burr. After that, narrower measures aimed at repealing the medical device tax, redefining full-time work as 40 hours per week, and repealing the Independent Payment Advisory Board (IPAB) are likely. Efforts to further delay the employer mandate are also possible

The new Congress will need to deal with the Sustainable Growth Rate (SGR) again as well. There was a bipartisan, bicameral agreement earlier this year to repeal the SGR and replace it with a performance-based payment system. Six key committees and both the House and the Senate agreed to the permanent fix. The House passed the fix, but it was not taken up by the Senate. Instead, Congress passed another “patch,” which runs through March 31, 2015. A permanent fix to the SGR would cost about $140 billion over 10 years, according to the Congressional Budget Office. Congress continues to struggle with agreeing on the offset.

In coordinated grassroots efforts, ACEP and a coalition of physician groups including the AMA, is urging Congress to repeal the SGR before Congress adjourns for the year.

ACEP Advocacy With the New Congress

As the 2014 Congressional elections began to take shape, we heard from ACEP members around the country and from leaders in our state chapters about candidates in their states and home districts who were worthy of consideration by the NEMPAC Board of Trustees. More than 150 ACEP members hosted ED visits for congressional candidates to educate them on issues of particular concern to emergency physicians and their patients, interviewed and educated candidates, attended fund-raisers in their home districts, and presented NEMPAC checks to candidates.

In the upcoming weeks before the 114th Congress convenes, ACEP staff in the Washington, D.C., office will begin a campaign to meet as many newly elected members as possible and will be working to set up introductory meetings back home with ACEP members either through emergency department visits or more informal coffees. If you are interested in meeting with your member of Congress in the next few months, please contact Jeanne Slade in the ACEP office at jslade@acep.org. We will provide you with talking points and materials to help you educate your legislator on issues of importance to emergency medicine.

Ms. Slade is ACEP’s political action director.