Healthcare

The most immediate effect of a House led by Democrats is a potential cut in payments to Medicare HMO plans, a move that could reduce profits for the state's health insurance companies.

Democratic Representative Pete Stark of California takes over the healthcare subcommittee of the House Ways and Means Committee, replacing Connecticut's Nancy Johnson , a Republican supporter of legislation that has favored the health insurance industry. Stark, House Democrats, and consumer groups have said they want to roll back a 2003 law pushed through by Republicans that boosted payments to Medicare HMO plans offered by private insurance companies.

The HMO payments -- about 11 percent higher than those paid by Medicare to doctors and other providers -- have benefited insurance companies, including Harvard Pilgrim Health Care , Tufts Health Plan , and Blue Cross Blue Shield of Massachusetts .

Insurance consultant Robert Laszewski of Health Policy and Strategy Associates, a Washington firm, said even if House Democrats can't get a veto-proof bill approved in the Senate, they will use their leverage over the federal budget to reduce payments to Medicare HMO plans.

"The budget starting in 2007 will be heavily influenced by Pete Stark and his allies," Laszewski said.

But Charles Baker , chief executive of Harvard Pilgrim, said he believes the 2003 enhancements of the Medicare HMO plan have long enjoyed bipartisan support.

"I wouldn't assume right out of the gate there is going to be a dramatic change in status," Baker said.

The effect of the changing political landscape in Washington on hospitals and doctors is not yet clear. Teaching hospitals are hoping more research dollars flow to their institutions from the National Institutes of Health, which sends about $1 billion to Massachusetts scientists annually.

And if the Senate tips into Democratic hands, Senator Edward M. Kennedy would become chairman of the Committee on Health, Education, Labor and Pensions, giving him new powers to protect federal payments to healthcare providers.

"I think its good news if our delegation gains clout," said John Erwin , executive director of the nonprofit industry group Conference of Boston Teaching Hospitals .

CHRISTOPHER ROWLAND