So this is it.  The Final Blog.  Election Night 2014.  No pressure.  Why is this night different from all other nights I remember reciting as a kid? Now I know what was meant.  Will our country be realigned politically by the time you read this Wednesday afternoon?  Yup, as the Senate and House of Representatives are now under Republican control.  How will health care fare when the new Congress convenes in 2015?  Could the Affordable Care Act be turned inside out, upside down or overturned?

Within the legislative process, if a shift in the Senate occurs, changes to the ACA could occur through either the budget process or via appropriations.  Entitlement healthcare spending likely won’t change, but discretionary healthcare expenditures could be affected, as those dollars fall under annual budgetary spending decisions.  Appropriation committee decisions could limit funding to specific ACA programs, such as has occurred with the Independent Payment Advisory Board (IPAB, aka “death panels”).  Reconciliation could create changes to mandatory spending programs such as Medicare and Medicaid via a simple majority process.  In the Senate, the reconciliation omnibus bill has a 20-hour debate limit, so it can’t be filibustered, as directed by the 1974 Congressional Budget Act.  This process was used in the Deficit Reduction Act of 2005 to decrease Medicaid spending.  Obviously, presidential veto is a powerful tool that could be used to prevent major changes to the ACA.  Read more by downloading Leavitt Partners’ “The Future of Health Care Reform: The 2014 Midterm Elections.”

A brave new world will begin again, with red states and blue states blending into purple.  I hope our newly elected (and re-elected) officials choose to make the most of the opportunities they now have in front of them, and enhance positive change that benefits our country, including healthcare options.  As we approach the NHMS Annual Scientific Conference, which focuses on disability issues, it is important to understand that federal entitlement program funding is crucial to maintaining the quality of life, healthcare and education opportunities for citizens with disabilities.

I have been honored to serve as president of the New Hampshire Medical Society during the past year.  There were many opportunities to engage with others to make a difference and learn from those who served in this role before me.  Did I do everything well?  Probably not.  But I will learn from that as well.  I want to thank the entire NHMS staff for all their help and guidance.  I want to thank my office and hospital staff, family and friends who kept me focused and balanced throughout the year, including JMA, TEM and Donna S.

The vox clamantis in deserto will go silent now.  But there will be fulfillment in listening to the silence, and appreciation of what has come before.  Life never really ends, if the Force stays strong.  Energy can’t be created or destroyed.  My best wishes to Lukas for the upcoming year and all the great things that lay ahead.  Listen.


Stuart J. Glassman, MD

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Dear Stuart, I have appreciated your progressive and pointed blogs throughout your year. In the past I don't think it often mattered much who was the NHMS president, but I think you did make a difference. Don't give up your stimulating writing. We doctors need it to keep us thinking outside of ourselves. Keep the faith...Phil

Thank you Stuart for your most excellent blogs. I've shown them to others as they have dealt with topics (school shootings, Alzheimers and gun access) that impact us as providers and conservers of public health. Thank you for personalizing the stories as you did--they touch us as readers so much more that way. Elizabeth