The leaders themselves wield enormous influence over what issues the House will consider, and in what order, and changes in the roles of the elected officials can also lead to major changes in which legislative aides have a say over what.
Especially in areas such as insurance, in which lawmakers may have come to Congress with little in-depth expertise, the aides may have a quiet but enormous role in helping their bosses decide what to say and think about matters such as health plan network adequacy, whether health plans ought to include agent and broker compensation in Patient Protection and Affordable Care Act (PPACA) medical loss ratio calculations, and whether PPACA ought to stay on the books.
For a look at three Republicans who could play a much bigger role in PPACA policymaking, and unmaking, in the coming year, read on.
1. Rep. Paul Ryan, R-Wis.
Chairman of the House Ways and Means Committee
Ryan, now the chairman of the House Budget Committee, seemed likely to beat out a rival, Rep. Kevin Brady, R-Texas, to succeed Rep. Dave Camp, R-Mich., as chairman of Ways and Means, and he did.
Ryan could gain clout from his new ability to influence federal budget negotiations, and from his years of efforts to come up with proposals for shoring up the finances of Medicare and other entitlement programs. One major program, the Social Security Disability Insurance (SSDI) trust fund, is now expected to run dry around the time the next national elections come around.
He also has developed budget proposals that include PPACA repeal provisions.