State Highlights:
November Elections.  Tuesday was Election Day in the Commonwealth of Virginia, with the statewide offices and all 100 seats in the House of Delegates up for election.  The Republican Party swept all three of the statewide races, taking over control of the Governor’s Office from the Democrats and retaining control of the offices of Lieutenant Governor and Attorney General. 
Governor:                      Bob McDonnell (R)
Lieutenant Governor:      Bill Bolling (R)
Attorney General:           Ken Cuccinelli (R)
 
Going into the election, Republicans held a 55 (including two Independents who caucus with the Republicans) to 45 majority in the House of Delegates.  In the lead-up to the election there were 11 incumbents who retired or were defeated in primary contests.  Coming out of the election, the Republicans had a net gain of at least 5 and potentially 6 additional seats.  The Republicans flipped seven Democrat seats with the Democrats capturing two Republican seats.  One seat is still in contention with a margin of 16 votes -- the 21st district in Virginia Beach between incumbent Bobby Mathieson (D) and challenger Ron Villanueva (R).  Senior Republican Phil Hamilton (R-Newport News) was defeated.  Delegate Hamilton was the chair of Health, Welfare and Institutions, vice chair of House Appropriations, the chair of the Health and Human Resources Subcommittee for House Appropriations, vice chair of the Joint Commission on Health Care, and a budget conferee.  There will be 19 and possibly 20 new members in the 100-member House in January.

The Speaker will appoint the membership of committees in mid-January.  Other than Delegate Hamilton, all committee chairs are expected to return to their leadership positions.  The Republican gains will require the Speaker to slightly adjust the party representation on the committees.  Currently the House rules dictate that there be, as close as practical, 13 Republicans and 9 Democrats on each standing committee.  In January the ratio will change to 14:8.

In local election news, Cynthia Newbille was elected to Richmond City Council.  She replaced Betty Squire who temporarily represented the district after Delores McQuinn resigned to take a seat in the House of Delegates.  Newbille is expected to take the oath of office prior to the City Council meeting on Monday, November 9th.

Election results can be found on the Virginia State Board of Elections website.

H1N1 Update.  The Virginia Department of Health (VDH) reported this week that the number of H1N1 deaths in Virginia has risen to 21.  Local health officials are trying to distribute the H1N1 vaccine as quickly as possible and the vaccine will be available for the general public at pharmacies, healthcare provider offices and local health departments in mid-November.  For a list of public vaccination sites and school vaccination sites, please go to the VDH website.

Federal Highlights:
Healthcare Reform.  According to House leaders, the House is tentatively scheduled to vote on healthcare reform legislation Saturday evening at 6:00 p.m.  The Manager’s Amendment (a package of numerous individual amendments agreed to by both sides) was filed late Tuesday evening, giving House members at least 72 hours to study the legislation.  The Rules Committee is scheduled to meet at 2:00 p.m. on Friday to determine the rules for the final health debate.

Prior to a final vote, an impasse among Democrats must be resolved.  Anti-abortion Democrats want to amend the bill to strengthen its prohibitions against the use of federal funds for abortions and insiders state that they have 40 Democratic votes, enough to keep the healthcare reform bill from reaching the minimum of 218 votes needed to pass the legislation.  Currently, federal law known as the Hyde Amendment prevents the federal funding of abortion.

On Tuesday, House Republicans released a substitute version of healthcare reform legislation.  A summary of the bill outlines key elements including:

• Lowering the costs of healthcare premiums

• Creating Universal Access Programs that expand and reform high risk pools and reinsurance programs for individuals with pre-existing health conditions

• Imposing caps on medical malpractice lawsuits

• Allowing Americans to purchase insurance across state lines

• Prohibiting the use of federal funds to pay for abortions

House Republicans will be allowed to offer their plan as an amendment to the Democratic bill when it is brought to the floor, though there is little to no chance of their bill passing.

On the Senate side, Senate Majority Leader Harry Reid is waiting to receive cost estimates from the Congressional Budget Office (CBO) on different variations of his bill, which will most likely not be completed until next week. 

340B. Language extending the 340b pharmaceutical discount to an inpatient setting has been included in the Senate healthcare reform package but not in the current version of legislation in the House.  At present, VCU only receives 340b drug discounts for outpatient services.  If Congress voted to expand this discount to inpatient services, VCU could save approximately $8 million a year on pharmaceutical costs.   

Medicare Physician Reimbursement.  Late last week, House Democratic leaders from the Ways and Means Committee and the Energy and Commerce Committee introduced HR3961, a bill that would repeal the current system of paying physicians under Medicare.  The “Medicare Physician Payment Reform Act” would repeal a 21% fee reduction scheduled for January 2010 and replace the physician payment formula with a more stable system.  Under HR3961, the sustainable growth rate (SGR) formula would be replaced with a new formula.

On the Hill.  A special election was held in New York for the United States House of Representatives with Bill Owens (D) winning the seat over Doug Hoffman (R).  The seat was held by former GOP Rep. John McHugh, who resigned in September to serve as Secretary of the Army.  The race received national attention when Republican Dede Scozzafava withdrew from the race and threw her support to Owens.  Additionally, John Garamendi (D) won a special election in California to replace former Rep. Ellen Tauscher (D), who resigned to become Under Secretary of State for Arms Control and International Security.  With the additional seat pick-up in New York for the Democrats, the 435 member House will now be composed of 258 Democrats and 177 Republicans. 

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