On the lowest level of the J.W. Marriott in downtown D.C., hundreds of leading health care experts attending the AcademyHealth's conference are still reeling from the announcement of Daschle's withdrawal.  

"Honest to god, I'm stupefied by this," said Marie Michnich from the Institute of Medicine, shortly after the news broke this afternoon. "Now, to see all the work that's been lost. We had a sense of how it was going to work--how we were going to coordinate [health care reform] with the White House. And now we're just spinning." Others seemed similarly flabbergasted. "No, no, no--oh no!" exclaimed Judith Leavitt, a writer for the American Journal of Nursing, who joined a group of conference-goers who were shaking their heads as they scanned their Blackberrys. "There was a lot of momentum. Now we're starting again from square one--this changes all the dynamics." Another conference attendee was even more despondent. "I'm going to go shoot myself now," he muttered as he headed for the hotel escalators.  

Only hours earlier, Senate Finance Chairman Max Baucus had delivered a plenary speech that had buoyed the spirits of the pro-reform crowd, promising to make getting reform passed this year his "number one priority." By the time she sat down for lunch, Jessica Bahthin, an economist at HHS, said it was inevitable that Daschle's withdrawal was "going to slow things down"--not only in terms of achieving substantial health care reform, but also at agencies like the FDA and Centers for Medicare & Medicaid Services, where the top leadership posts remain vacant. Jill Zorn, a staffer for a health care advocacy group in Connecticut, added that delays in Washington could also slow reform on the state level, as legislators braced themselves to draft their next budgets. "We need to know what's going on here and make sure we're all moving in the same direction" before enacting major reform, Zorn said, as waiters cleared away unfinished plates of salad.  

At the least, Bahthin said she hoped that Jeanne Lambrew--the well-respected Clinton veteran who was slated to be Daschle's White House deputy--would stay on to continue the battle. Lambrew, who was yesterday's plenary speaker at the conference, has already dug in at the White House, strongly arguing that health care reform has become even more urgent because of the economic crisis. In the meantime, as one AcademyHealth staffer announced to the conference's packed ballroom this afternoon: "The floor is now open for nominations."  

--Suzy Khimm