Healthcare's impact on the election wasn't as strong as predicted, but experts feel it will be a key issue on the Hill - and in PR circles - for the next four years.The election is over, but healthcare issues that surfaced during the campaign season will remain top-of-mind in Washington. Even though healthcare was not a deciding issue for voters this election - as some pre-election polls suggested it could be - the debate over the cost of healthcare will continue to get mileage during the Bush Administration's second term. Mike Tuffin, VP at APCO Worldwide and former director of strategic communications for America's Health Insurance Plans, notes that healthcare was not a top priority at the polls because of foreign-policy concerns. But he adds that healthcare will resurface as a major issue as soon as Americans feel more confident about the international situation. "Politicians ignore healthcare at their peril," Tuffin says. The government currently pays for 45% of healthcare costs, he adds. "That's an honest and important policy issue." The next four years Peter Pitts, SVP of health affairs at MS&L and the former top communicator at the Food & Drug Administration, is similarly certain that healthcare will be a major issue over the next four years. "Just because you're not running a campaign anymore does not mean you don't have to communicate about healthcare," he says. "The sound-bite messages, such as 'drugs are too expensive,' are going to be used by those who aren't interested in advancing public health." And as policymakers, lobbyists, and the public continue to advance drug-pricing issues, health communicators will play a key role in shaping the dialogue. "You will clearly see questions of access for seniors. Closely behind will be continued discussion of importation from Canada - that's not going away," says Jeff Nesbit, MD of Chandler Chicco's Washington, DC, office and the former chief of staff to an FDA commissioner. The President will continue to promote his Medicare Modernization Act, which, among other measures, will provide prescription drug coverage to senior citizens in 2006, Nesbit adds. Tuffin notes the "fault line" between the political parties is how much control the government should have in controlling the cost of healthcare. A Republican administration, for instance, is likely to focus on personal responsibility - such as encouraging senior citizens to establish health savings accounts - rather than regulatory measures to control costs. But Nesbit notes that legislative action is likely to result from three prescription drug controversies that emerged this year: Merck's recall of painkiller Vioxx, the contamination of half of the country's flu-shot supply, and the debate over whether anti-depressants increase the suicide risk for children and adolescents. "There will be congressional or regulatory action to deal with that," Nesbit says, referring to post-marketing safety data and more stringent facility inspection guidelines. For PR, that means that "you will need to be smart and sophisticated in how you talk about drugs in the pre-launch," he adds. If industry wants to avoid legislation, Tuffin notes, it will have to make a strong push by communicating with stakeholders and following up with action. "Polls show that Americans are increasingly receptive to government in healthcare," he says. "If you're representing [a healthcare company], you've got to help them make a strong push about why the market-based approach is better for ... a working family or a small business." Pitts says that health PR professionals must move toward the "philosophy that industry is not the enemy; industry is a partner." But he notes that he's not referring simply to sound bites, but to the divide that exists between what regulators think the public should know about their health and how marketers convey information. He points to direct-to-consumer promotion as an example and how changes in DTC rules could affect how companies communicate the risks and benefits of prescription drugs. "The FDA is a science-driven agency. But when you talk about advertising, it's a social science," he says, referring to philosophical differences between marketers and regulators. He adds that lines of communication first must be more firmly established between the FDA and marketers, who then interface with the public. Hotbed industry issues John Kamp, an attorney who was recently appointed to head the Coalition for Healthcare Communication, says there likely will be greater debate on the Hill over the value and purpose of marketing. He also predicts that DTC advertising will continue to face criticism on both the state and federal level. In California, for instance, which represents about 20% of the drug market, legislators recently passed mandatory limits on gifts that doctors can accept from drug companies, Kamp notes. Although the President does appoint the heads of the FDA, as well as the Department of Health and Human Services, "It's not just Washington; it's the states," Kamp says. "Health is a major pocketbook issue for everyone in the US," he says. "We [as health communicators] can all be more fully aware of what's important to voters and fully articulate the value of marketing." But although Kamp expects a greater crackdown on false marketing claims, he notes that health communicators can also largely expect the status quo from a second Bush term. But Nesbit notes that measures with bipartisan support - such as a mandatory clinical trial database - will probably be advanced during Bush's next four years. "Traditionally, in a second term, it's not unusual for a President to reach across the aisle to the other party," he says. To stem support for drug importation - another issue with bipartisan support - Tuffin notes that PR pros need to do a better job of helping the public understand why drug costs vary from country to country. He points to price controls in other markets that raise prices here. "Opponents of allowing foreign imports into the states have to make the case that Americans pay for R&D in other countries," he says. "When other countries impose price controls on their medicines, Americans pay the price for that. American payers are subsidizing the research costs in other countries." With physicians emerging as an important political group in this election, medical-liability reform - another top issue for the President - will likely remain part of the public discussion. "I think there will be a continued strong push by the President and his allies for medical-liability reform," Tuffin says. "It's not just the cost of the actual lawsuit; it's the cost of defensive medicine. Everyone's premiums are higher." But regardless of which party is in power, drug and health insurance companies must still address reputation issues. Surveys from this past summer show that less than 50% of respondents indicated that they approve of the job the healthcare industry is doing. Moreover, the reputation of the industry is now on par with that of tobacco companies. "Now is an opportunity for the pharmaceutical industry to put its best foot forward," Nesbit says. "One of the really big movements in communications is from a corporate branding standpoint." He notes that companies are putting more resources into building alliances with third-party partners, particularly in the nonprofit sector. They also will continue to promote corporate social responsibility programs. "I wouldn't be surprised to see less money in DTC [advertising]," Nesbit says. "I think you will see more money in PR." But what won't be impacted by the administration is which drugs are approved. With exit polls indicating that "moral values" were a frequently cited political concern, some experts questioned whether these findings would have reverberations for PR. Even this spring, when Barr Laboratories failed to receive over-the-counter status for its prescription morning-after pill, some critics had speculated that the FDA had let politics rule on the issue. But Pitts, who was then the associate FDA commissioner for external relations, notes that "moral values" is not likely to become a healthcare issue, nor will it impact which drugs receive FDA approval. "Those decisions are based purely on science," he says. "The FDA committee would never let politics get in the way of sound science."