For the first time in his political career, Leavitt will answer to a Democratic majority - something he never had to deal with in the Republican-dominated Utah Legislature and the GOP-controlled Congress during his tenure as administrator of the Environmental Protection Agency.

Democrats, now in power on Capitol Hill, are promising broad new scrutiny for a number of health programs, including the Medicare prescription drug benefit, food and drug safety, physician reimbursement, and stem-cell research. There are more than 20 committees in Congress that have oversight of some aspect of HHS operations.

"There couldn't be any less oversight" than under the GOP Congress of recent years, said Rep. Pete Stark, D-Calif., incoming chairman of the Ways and Means health subcommittee. "If we have one oversight hearing, it will be 10 times more than [Republicans] ever had. They had a lot of cheerleading sessions. Very rarely did we get down to anything you would call oversight."

Sen. Orrin Hatch, R-Utah, predicts there will be oversight with a vengeance.

"Based on what House Democrats have said recently, top officials should expect investigators from Congress to set up camp at their agencies next year," said Hatch, who is on two committees that oversee HHS. "The Democrats want aggressive oversight, and, let's face it, HHS is right in the middle of the programs they want to target."

Robert Blendon, a professor of health policy at Harvard University, said he expects Democrats will be pressing long-held views ignored by a Republican-controlled White House and Congress.

"When your party is in the majority, you don't face a lot of these hostile hearings," Blendon said. "The minute you switch, the hearings are more adversarial. You're asked to go there, there's more tension, more problems, plenty of TV lights.

"It's just the nature of the way it is, particularly on this issue where Democrats feel strongly the direction of health should be different than Republicans," he said.

For his part, Leavitt is looking to cooperate with Congress, forging bipartisan solutions wherever possible, said HHS spokeswoman Christina Pearson.

"Health care issues are about people, not political parties," she said. "We firmly believe that the issues we're focusing on have wide support on both sides of the aisle."

Stark says Democrats will be vigilant in their scrutiny of HHS, but don't plan to engage in witch hunts.

"Quite frankly, if you wanted to be tough on Leavitt and you wanted to revisit charitable contributions, we could begin to look at his family foundation and that might be quite interesting, but that doesn't help any," Stark said. He referred to recent news stories questioning whether the Leavitt family exploited a charitable tax loophole. "My point is, if we're going to do this, [it will be] in the spirit of cooperation."

Still, there are likely to be some early clashes.

When Congress returns next month, new House Speaker Nancy Pelosi says two health matters will be top priorities: revising President Bush's policy on stem-cell research, and directing Leavitt to negotiate for lower Medicare drug prices, a move that Leavitt has resisted.

Wendell Primus, health adviser to Pelosi, said at a recent Henry J. Kaiser Family Foundation forum that he also expects Congress to look at the response to "very important catastrophes" that have occurred, such as Hurricane Katrina and illnesses among workers who cleaned up the World Trade Center site in New York.

The implementation of the Republican-passed Medicare drug benefit is a ripe target for review, and Carol Guthrie, spokeswoman for Senate Finance Committee Chairman Max Baucus, said it will likely be the subject of ongoing hearings.

However, Mark McClellan, the former head of the Centers for Medicare and Medicaid Services under Leavitt, says the cost of the drug benefit has come in lower than expected and those enrolled in the program are generally pleased, making it harder to beat up on the program.

The push for price negotiation loses steam, he says, when it runs into the possibility that it could force Medicare to cover fewer medications.

"You don't get something for nothing in negotiations," McClellan said. "On the one hand, you want prices to be as low as possible for some drugs. On the other hand, we want people to have access to all the medications they need."

Another top health priority in the next Congress will be to renew the State Children's Health Insurance Program, a cooperative effort between the state and federal government that provides health coverage to more than 4 million youngsters.

The program is due to expire in October. Democrats say they will look to expand the number of children covered. There are likely to be fights over how far to push the expansion and how to pay for it.

But Stark says the program is one both parties agree needs to be continued and it provides a good opportunity for cooperation.

Leavitt hopes there are others.

"Our discussions with Democratic members indicate they share our desire to work together on the health care challenges faced by this nation," HHS spokeswoman Pearson said. "Though there may be areas of disagreement, HHS is committed to working in a way that is collaborative and bipartisan without compromising on our principles."

gehrke@sltrib.com