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.
2. Rep. Jason Chaffetz, R-Utah
Chairman of the House Oversight and Government Reform Committee
Chaffetz, who was a starting placekicker on the Brigham Young University football team in the late 1980s, got the attention of the health insurance community in 2010 when he asked President Obama why Obama had not kept his promise to have the debates on the proposals that became PPACA aired live on television.
His half-brother is the step-son of former Democratic presidential candidate Michael Dukakis.
He follows in the footsteps of Rep. Darrell Issa, R-Calif., whose staff produced a series of hard-hitting reports on problems at the HealthCare.gov exchange enrollment system development team.
3. Rep. Larry Bucshon, R-Ind.
Member of the House Energy and Commerce Committee
Bucshon — a heart and chest surgeon — will be on a committee that that has a major health subcommittee. The health subcommittee has been competing with House Oversight in the PPACA investigative report arena over the past few years.
Bucshon is the son of a nurse and the husband of a nurse. He worked at a hospital for veterans in Milwaukee, and he served in the U.S. Navy Reserve.
In the past, he has supported replacing PPACA with a combination of risk pools, federal reinsurance programs and health care cost transparency efforts.