Zaun swings at Boswell, hits Latham and King

by: desmoinesdem

Tue Aug 10, 2010 at 06:40:00 AM CDT

Bleeding Heartland readers who are familiar with the workings of the Iowa Senate may be amused by backbencher Zaun calling someone else a "follower." Technically, Zaun is one of four assistant Iowa Senate Republican leaders; that's a four-way tie for the number 3 spot in an 18-member caucus. He isn't exactly a commanding presence at the capitol. Boswell was much more influential as Iowa Senate president in the 1990s before his first election to Congress. But I digress.

Zaun misleads by implying members of Congress can only be judged by the bills they sponsor, and I'll have more to say on that after the jump. First, let's see how Iowa's two Republicans in the House of Representatives look through GovTrack's prism.  

Most Iowans with pre-existing conditions won't get help until 2014

by: desmoinesdem

Thu Jul 01, 2010 at 10:42:16 AM CDT

During the last presidential campaign and more than a year of health care debates on Capitol Hill, countless politicians swore they were committed to ending discrimination against Americans who have pre-existing medical conditions. After reviewing the interim regulations, Jost has good news and bad news for adults who lack health insurance because of a medical problem.

The ban on preexisting conditions exclusion found in the Affordable Care Act is much broader than the preexisting condition exclusion imposed by the Health Insurance Portability and Accountability Act [of 1996].  It prohibits any limitation or exclusion of benefits in a group or individual plan based on the prior existence of a medical condition.  The provision not only prohibits the exclusion of coverage of specific benefits based on a preexisting condition, but also the complete exclusion from the plan of a particular person if the exclusion is based on a preexisting condition.   The regulation does not, however, prohibit coverage exclusions that apply regardless of whether a condition is a preexisting condition or not.   The provision applies to enrollees under the age of 19 effective the first plan year beginning after September 23, 2010, but to adults only beginning in 2014.

In the summer of 2009, many progressives were disturbed to learn that the draft House health care bill delayed implementation of the pre-existing condition provision until 2013 (the date was pushed back to 2014 later in the legislative process). Why should Americans with previous or chronic medical problems continue to be denied health insurance for four more years? Don't worry, we were told: new high-risk pools will be created to bridge the gap for people with pre-existing conditions.

We are now learning more about how the new Pre-Existing Condition Insurance Plan will operate. Eligible Iowans will be able to start applying for our state's plan on July 15. But uh oh:

The new program, expected to start in a few weeks, will be financed with $35 million in federal money from the new health care reform law. That money will be enough to help only 975 Iowans, state administrators have concluded.

"$35 million doesn't cover as many people as you'd hope," said Susan Voss, Iowa's insurance commissioner.

Another twist is that Iowans who participate in the state's current high-risk insurance pool won't be able to switch into the new pool, which will be significantly less expensive.

Federal experts have estimated that 34,500 Iowans could be eligible for the new pool.

The money is supposed to last until 2014, when private insurers will be banned from discriminating against people with pre-existing health conditions. At that point, such people should be able to buy their own insurance just like anyone else, health reform proponents say.

You see immediately what Jost was getting at: few Iowans with pre-existing conditions will benefit from the new high-risk pool (perhaps 3 percent of the eligible population). For those who get in, though, the benefits are immense: insurance for about the same price a healthy person would pay.

While helping 950 uninsurable Iowans obtain coverage is significant, it would have been better to implement the health insurance reform on a faster timetable. Because Congress lacked the political will to impose significant costs on insurance companies, 97 percent of Iowa adults with pre-existing conditions will have to wait until 2014 to reap the full benefit of the health reform.

That sounds like over-promising and under-delivering to me. But I can't say I wasn't warned a long time ago.

UPDATE: Democrats will talk up the health reform changes that take effect sooner, such as new Medicare reimbursement rates. Those are expected to increase payments to Iowa doctors and hospitals. But the public case for health care reform wasn't built on wonky issues like Medicare reimbursement rates. It was a simple moral argument, and not letting insurers discriminate against people with a pre-existing condition was at its core.  

Boswell's opponents are not ready for prime time

by: desmoinesdem

Wed May 19, 2010 at 15:24:26 PM CDT

Four of the seven Republicans running against Boswell have no chance of winning the nomination. Jason Welch hasn't attended any candidate forums, and I wonder why he went to the trouble of qualifying for the ballot. Pat Bertroche and Scott Batcher are ill-informed sideshows who will be lucky to win 5 percent of the vote. Mark Rees seems to have the firmest grasp of the issues, but there aren't enough moderate Republicans anymore for someone like Rees to win a primary. Rees could affect the election, because a strong showing for him (10 to 20 percent of the vote) would increase the chance that no candidate receives at least 35 percent in the primary. But whether Republicans pick a winner on June 8 or at a district convention later, Rees will not be Boswell's general election opponent.

That leaves the Washington establishment candidate Jim Gibbons, State Senator Brad Zaun and tea party favorite Dave Funk. After watching yesterday's forum featuring six of Boswell's opponents, Graham Gillette argued that Funk, Gibbons and Zaun "are all capable of putting together a strong general election effort." After the jump I explain why I disagree.

Iowa to form new insurance pool for people with pre-existing conditions (updated)

by: desmoinesdem

Sat May 01, 2010 at 10:11:49 AM CDT

Iowa will accept $35 million in federal funds over the next four years to operate its own temporary health insurance plan for high-risk individuals.  This step will help cover uninsured Iowans as the country transitions toward implementation of federal health insurance reform.

"Every Iowan should have access to affordable health care," Governor Culver said. "This action is an important first step in reaching this goal.  These funds will allow Iowans who have been among the uninsured for extended time periods to get coverage, in spite of health problems and without waiting periods for existing conditions."

Iowa will establish a new pool alongside its current high-risk pool structure that will comply with the federal requirements. Under the terms of the federal funding formula, Iowa will be eligible to receive a grant of approximately $35 million in reimbursements to subsidize the cost of the fund until 2014. The state's next step will be to submit a plan for federal approval.

Here are more details about the program:

Consumers will be eligible for the new pools if they have a pre-existing medical condition and have not had insurance for at least six months.

They will pay premiums that parallel rates being offered by commercial insurers to healthy people on the individual market. Many existing high-risk pools charge such high premiums that many people cannot afford the coverage. Today, high-risk pools in 34 states cover only about 200,000 people.

Individuals who sign up for the new pools also will not have to pay more than $5,950 a year out of their pockets for medical care, according to the legislation.

According to this backgrounder posted at Iowa Independent, the new high-risk pool could serve more than ten times the number of people could affect many people not enrolled in Iowa's current high-risk pool:

"This is an opportunity for the state to show whether it is ready to put a critical component of health reform - covering people with pre-existing conditions - on a faster track," said Andrew Cannon, research associate for the nonpartisan Iowa Policy Project and author of a new policy brief on the topic.

Cannon said more than 34,500 Iowans could be eligible for Iowa's existing high-risk pool or a new one the state may create if the state chooses to act now. The federal health-reform legislation allocated $5 billion nationally to states to provide temporary coverage as a bridge to full implementation of health reform, which will require all insurance companies to accept applicants without consideration of a person's medical condition by 2014.

Iowa created its high-risk pool program in 1987, now known as the Health Insurance Plan of Iowa (HIPIowa). It serves 2,732 state residents.

High-risk pools such as HIPIowa are designed to help individuals who do not have health insurance through work, do not qualify for Medicaid and cannot afford or qualify for individual coverage because of a pre-existing medical condition. HIPIowa's premiums are about half as expensive as the standard rate for plans sold on the private market, Cannon said, but in many cases those premiums still exceed potential enrollees' ability to pay.

UPDATE: The Des Moines Register quoted HIPIOWA Executive Director Cecil Bykerk and State Senator Jack Hatch as saying federal funding will allow about 1,000 people to be covered in the new high-risk pool before 2014. That's a small fraction of the number of Iowans who might be eligible for the program, according to the Iowa Policy Project's estimate.

The Des Moines Register quoted Rod Roberts and spokesmen for Terry Branstad and Bob Vander Plaats as saying they oppose participation in this new federal program. I don't know how quickly the new pool will be up and running, but I'd like to see the Republican nominee for governor explain to Iowans with pre-existing conditions why they should have to go without affordable insurance coverage until 2014. Remember, the federal government is subsidizing the cost of operating the new pools.

As of April 30, officials in 28 states had informed the federal Department of Health and Human Services of plans to create new high-risk pools, while officials in at least 15 states had declined to participate for fear that federal funds may be insufficient to cover the operation of these pools until 2014.

Why does Terry Branstad keep talking up Brenna Findley?

by: desmoinesdem

Thu Apr 22, 2010 at 14:22:23 PM CDT

Findley has an unusual resume for an attorney general candidate. A longtime staffer for Representative Steve King, and before that for Iowa statehouse Republicans, Findley hasn't practiced law in some time. According to Cityview's Civic Skinny, Findley doesn't even hold an active license to practice law in Iowa. She doesn't seem to have a firm grasp of the attorney general's job either. Her campaign began with a focus on job creation and has since shifted to the alleged unconstitutional nature of health insurance reform.

But for the purposes of this post, I'm less interested in Findley than in why Branstad talks about her so much. After the jump I explore some possibilities.

Wellmark customers will pay more starting May 1

by: desmoinesdem

Tue Apr 13, 2010 at 10:41:37 AM CDT

[Iowa Insurance Commissioner Susan] Voss said in a memo to Culver that Wellmark's losses supported "the need for the rate increase" based on two separate actuarial analyses conducted by INS Consultants, a Philadelphia actuary. The group also found that the insurance division's rate review process is actuarially "acceptable" and "reasonable" compared with INS's methodology.

Birny Birnbaum, head of the Center for Economic Justice, a nonprofit consumer advocacy group in Texas, said it's unlikely that INS would disagree with the rate increase.

"While INS is technically independent, there is no way the firm would contradict and embarrass the agency which hired the firm," Birnbaum said Monday. "If INS were to contradict the insurance division, it would likely not be hired in the future by the Iowa Insurance Division or any other insurance regulator."

Speaking to the Register, State Representative Janet Petersen touted legislation passed during the 2010 session, which is intended to give consumers more information and warning regarding health insurance premium increases. After the jump I've posted some key points from Senate File 2201 and Senate File 2356.

These bills contain a lot of good provisions but probably won't solve this particular problem for many Iowans. Wellmark dominates the insurance market in this state. Giving people a few weeks to shop around won't magically allow them to find a better deal. In addition, health insurers can still exclude coverage for pre-existing conditions until 2014. The only real choices Wellmark's individual customers have are: 1) pay a lot more, like my family, or 2) downgrade to a policy that's less comprehensive and/or involves higher out-of-pocket costs for medical care.

Iowa House Republican leader Kraig Paulsen showed his creative side yesterday, finding a way to blame Democrats for Wellmark's rate hikes:

Paulsen pointed out that the Democrat-controlled Legislature has voted in recent years to impose several health insurance mandates, such as coverage of cancer clinical trials and prosthetics.

"It's indisputable that those add to rates. That's just the way it works," he said.

Health insurance mandates drive up costs for Iowans, Paulsen said.

"Mandates aren't necessarily requirements that insurance companies sell something. They're requirements that purchasers buy something," he said.

One legislative proposal would have allowed state-regulated health insurance companies to provide mandate-free coverage "for those who want a less comprehensive product," Paulsen said.

That idea by House Republicans failed, as did a proposal to study allowing out-of-state insurers to offer policies in Iowa, which could help Iowans find cheaper policies, he said.

Come on, Mr. Paulsen, who ever anticipates needing prosthetics someday, or being in a position to benefit from a cancer clinical trial? Anyway, that cancer clinical trial bill passed both the Iowa House and Senate unanimously. Also, allowing out-of-state insurers to sell policies here would spark a "race to the bottom" in terms of consumer protection.

Share any relevant thoughts in the comments.

A person I once knew

by: wahela

Sat Apr 10, 2010 at 20:21:43 PM CDT

I get so frustrated when people start saying things like:  "I wasn't raised to take a handout."   and  "We don't want to be like European countries and get something for nothing."  etc. 

A woman I went to high school with posted on a face book account of a friend (to me, instead of sending it to me) "I do not want to be a European country.  I have no insurance.  But I pay my medical bills by myself,. I wasn't raised to take a handout.  I was raised to pay my own way. I don't want health insurance crammed down my throat.  I do not want something for nothing like all the welfare people.  "  I could have reamed her out,  but out of respect for our friend. I didn't. 

I may be a Social Democrat,  I lean far left.  That right there explains a lot about me and my views.  (or Democratic Socialist, whichever is farthest left, lol).  I have a job.  I pay my way.  I have hospital health insurance which is excellent.  I am willing to pay more in taxes,  more in insurance costs so that everyone that cannot afford it will be covered, and not worry about their health and illnesses.  I can pay more in social security taxes so that social security gets closer to solvent.  I do not mind paying a bit more in taxes every year. 

My town has a deal where everyone in town pays additional property taxes so that every child in the public school system has no fees for books, lockers, uniforms, etc.  Its only about 17 dollars a year on my property tax bill.  I don't have children in school.  The elderly in this town do not have children in school.  We all willingly pay this so children have the advantage of sports, music, book fees, lock fees, uniforms, etc.  And not one person in this town minds doing this. 

 I just do not understand why everyone thinks we are asking for handouts,  something for nothing, free stuff .  I understand I will pay more.  But as a citizen of this country,  it is my privilege and responsibility to pay a little extra so everyone has the advantages that they need to be healthy.  What is so difficult for the right to understand.

Grassley still misleading Iowans on health reform

by: desmoinesdem

Tue Apr 06, 2010 at 17:11:24 PM CDT

Several residents were worried about what would happen to their health care premiums now that the president has signed the health care law. The mandate requiring everyone to purchase health insurance was also a worry.

"It's questionable whether the federal government can require you to buy anything," Grassley said.

One woman asked Grassley if federal funds connected to the health care law could be used to pay for abortions.

Grassley said he believes that the subsidies the poor will receive to purchase insurance could be used to pay for abortion. Democrats believe an executive order signed by President Obama at the insistence of Michigan Democratic Congressman Bart Stupak stops any federal funds from being used for to pay for abortions.

"I think he was sold a bill of goods that an executive order would take care of it," Grassley said. "I am pro-life and that's how I feel about it."

Grassley conveniently failed to mention that he supported a health insurance mandate in 1993, in 2007 and even last summer. He only started questioning the legality of a mandate last fall. Contrary to what he told the Mason City crowd, legal scholars don't think much of the constitutional arguments against health reform. It's also ludicrous for Grassley to charge that federal funds will be used for abortions. On the contrary, Obama's executive order is likely to end all private insurance coverage of abortion, even for women who don't receive a dime in government subsidies.

Grassley is smart enough not to call health insurance reform "socialist", but when someone in the Mason City audience asked about the government taking stock in General Motors and some large banks, Grassley drew applause by saying, "If you're listed in the Yellow Pages, I guess the president thinks that the government ought to nationalize you."

As far as I can tell, Grassley is no longer claiming that health insurance reform will let the government "pull the plug on grandma." A poll taken in late February found that a majority of Iowans think Grassley "embarrassed" our state by making that allegation last summer. In the same poll, only 42 percent of respondents said Grassley should be re-elected. The poll results were released this week; Iowa Independent analyzed the results here, and Senate Guru did the same in this guest post at Bleeding Heartland.

The Senate race still looks like Grassley's to lose, but Iowans are aware that the senator stretched the truth about end-of-life counseling. We need to call him out on his other distortions too, like his claims about student loan reform. According to Grassley's pretzel logic, ending big federal subsidies to banks will somehow impose a "tax" on students.

I encourage all Iowa Democrats to get involved in supporting one of Grassley's challengers: Roxanne Conlin, Tom Fiegen and Bob Krause.

IA-Sen: Grassley Embarrasses Majority of Iowans; Less Than Half Would Re-Elect

by: Senate Guru

Tue Apr 06, 2010 at 10:32:54 AM CDT

New polling by Research 2000 finds that Republican Chuck Grassley is far more vulnerable than the conventional wisdom gives him (dis)credit for.

When asked if Grassley should be re-elected, only 42% said re-elect, while 31% said it was time for someone new, and 27% were not sure.  (Remember, being unsure about an incumbent of twenty-nine years bodes poorly for the incumbent.)  Among independents, only 39% said re-elect.  Not too hot.

The money question of the poll was:

When Senator Chuck Grassley says President Obama and Democrats would QUOTE "pull the plug on grandma" UNQUOTE do you think that does Iowa proud in Congress or embarrasses Iowa?

By more than a 2-to-1 margin (53% to 26%), Iowans responded that Grassley's comments embarrassed them rather than made them proud.  Among independents, the embarrass-proud ratio was an overwhelming 61-21.  Research 2000 broke down the responses by Congressional district.  Outside of right-wing radical Steve King's 5th Congressional district (which saw a 30-51 embarrass-proud ratio), every other district was overwhelmingly embarrassed by Grassley's remarks.  The other four Congressional districts ranged from 53-64% embarrassed while only 19-24% proud.

Very interestingly, while only 35% of respondents favored the Senate version of the health care reform bill, while 56% opposed it, 62% of respondents favored a public option (a 2-to-1 margin over the 31% of respondents that opposed a public option); and, moreover, by more than a 3-to-1 margin, Iowans want Democratic Senator Tom Harkin to fight harder for a public option and would respect him more if he did.

The message from these numbers is clear: Iowans are open to voting for an alternative to Republican Chuck Grassley, would support a public option (and many who opposed health care reform in Iowa simply feel that it didn't go far enough), and were embarrassed by Grassley's dishonest kowtowing to the teabaggers with his "pull the plug on grandma" routine.

The Iowa Independent reminds us:

The "pull the plug on grandma" statement, which was part of the death panel meme Pulitzer Prize winning Web site PolitiFact named its "Lie of the Year," dogged Grassley throughout the last few months of 2009 and was cited by at least one of the three Democrats vying to unseat him as the reason for entering the race.

Grassley's own numbers must be telling him that his lies could constitute a politically fatal flub given how freaked out he got over the discussion of his comments and how he tripped over himself backpedaling:

By the end of the year, though, Grassley was blaming media reports for his association with the death panels meme. In a letter to a constituent forwarded to The Iowa Independent, Grassley said some "commentators" took his comments and twisted them as saying that health care reform would establish death panels.

"I said no such thing," Grassley said. "As I said then, putting end-of-life consultations alongside cost containment and government-run health care causes legitimate concern."

Who was that Democrat who cited Grassley's comments as a reason for entering the race?  Attorney and Democratic former gubernatorial nominee Roxanne Conlin.  She got into the race in late 2009, so this past quarter's fundraising report will be the first test of her campaign's financial viability.  Word is, she's a fairly prodigious fundraiser.

On top of that, Grassley has handed her the issue and according message frames on which to run.  Notably to me, Conlin has five grandchildren.  In other words, she is a grandma.  I think it would be powerfully resonant for Conlin to put out an ad highlighting Grassley's "pull the plug on grandma" comments that embarrassed a majority of Iowans and to close the ad (while talking to the camera, surrounded by her five grandchildren) with the line, "I'm Roxanne Conlin, and I approved this message because I'm a grandma and I'm embarrassed that Chuck Grassley is talking about pulling the plug on me."

Keep a close eye on IA-Sen; I'm expecting a competitive race that will surprise the traditional media.

Sebelius warns insurers against excluding sick kids

by: desmoinesdem

Tue Mar 30, 2010 at 10:00:41 AM CDT

Health and Human Services Secretary Kathleen Sebelius wrote to the head of the insurance industry's lobbying arm yesterday warning against efforts to continue to deny coverage to children with pre-existing conditions. Excerpt from the letter, which you can download as a pdf file at Greg Sargent's blog:

Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition. Leaders in Congress have reaffirmed this in recent days in the attached statement. To ensure that there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term "pre-existing condition exclusion" applies to both a child's access to a plan and to his or her benefits once he or she is in the plan. These regulations will further confirm that beginning in September, 2010:

*Children with pre-existing conditions may not be denied access to their parents' health insurance plan;

*Insurance companies will no longer be allowed to insure a child, but exclude treatments for that child's pre-existing condition.

I urge you to share this information with your members and to help ensure that they cease any attempt to deny coverage to some of the youngest and most vulnerable Americans.

A spokesperson for House Speaker Nancy Pelosi sent Sargent the following statement:

The intent of Congress to end discrimination against children was crystal clear, and as the House chairs said last week, the fact that insurance companies would even try to deny children coverage exemplifies why the health reform legislation was so vital. Secretary Sebelius isn't going to let insurance companies discriminate against children, and no one in the industry should think otherwise.

Let's hope this works. I wouldn't be surprised to see insurance companies challenge the new regulations in court. They must have been counting on that loophole to save them money during the next few years.

UPDATE: David Dayen is probably right about the insurance companies' motives here:

You can pretty much figure out AHIP's game here. With no restrictions on cost until 2014, the industry can raise their premium prices almost at will. Even the bad publicity suffered from that 39% rate hike of Anthem Blue Cross [of California] plan has not stopped that scheduled increase from taking effect in May. And when outrage is expressed by families facing double-digit rate hikes, AHIP will clear their throats and blame the pre-existing condition exclusion for children, forcing the poor insurance companies to take on a sicker risk pool and raise prices to survive.

Except covering kids is fairly cheap to begin with. And the universe of kids with a pre-existing condition who aren't covered through SCHIP, Medicaid, or an employer plan is extremely small. So by making a big issue of this, AHIP potentially sets up large rate hikes in the 2010-2014 period that aren't at all justified.

Founding Father signed health insurance mandate into law

by: desmoinesdem

Mon Mar 29, 2010 at 09:22:19 AM CDT

It turns out that precedent for a health insurance mandate is much older than the 1930s Supreme Court rulings on the Commerce Clause. Thanks to Paul J. O'Rourke for the history lesson:

In July, 1798, Congress passed, and President John Adams signed into law "An Act for the Relief of Sick and Disabled Seamen," authorizing the creation of a marine hospital service, and mandating privately employed sailors to purchase healthcare insurance.

This legislation also created America's first payroll tax, as a ship's owner was required to deduct 20 cents from each sailor's monthly pay and forward those receipts to the service, which in turn provided injured sailors hospital care. Failure to pay or account properly was discouraged by requiring a law violating owner or ship's captain to pay a 100 dollar fine.

This historical fact demolishes claims of "unprecedented" and "The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty..."

Perhaps these somewhat incompetent attorneys general might wish to amend their lawsuits to conform to the 1798 precedent, and demand that the mandate and fines be linked to implementing a federal single payer healthcare insurance plan.

O'Rourke posted the full text of the 1798 legislation as well.

I'm not one to claim American's "Founding Fathers" could do no wrong; after all, President Adams also signed the Sedition Act, which violated the First Amendment. But Republican "strict constructionists" say we should interpret the constitution only as 18th-century Americans would have understood it. Some claim judges should cite only 18th-century sources when interpreting the constitution. Well, Congress enacted and the president signed a health insurance mandate less than a decade after the U.S. Constitution went into effect.

I don't expect these facts to affect Republican rhetoric about health insurance reform. Thankfully, Iowa Attorney General Tom Miller is not wasting our state's money on this frivolous lawsuit. So far I haven't heard any Republicans demand his impeachment, as some GOP legislators are doing in Georgia.

Will Iowans buy Grassley's balancing act on health reform?

by: desmoinesdem

Sat Mar 27, 2010 at 09:07:38 AM CDT

Senator Chuck Grassley is taking a more nuanced approach. As the ranking Republican on the Senate Finance Committee, he played a prominent role in crafting the bill. Now he is taking credit for a few aspects of the new law while drawing attention to a populist-sounding provision left out by Democrats.

After the House passed the Senate's heath insurance reform on Sunday, most Iowa Republicans condemned the effort in broad terms. In contrast, Grassley released an oddly specific statement about an amendment he planned to offer to the bill containing "fixes" to health insurance reform. Grassley called for the president, White House staff and senior Congressional staff to be covered under the new health insurance system. As expected, Senate Democrats voted against all Republican amendments to the reconciliation bill, hoping to avoid another House vote on the legislation. That prompted this press release from Grassley's office: "Senate approves unfair double standard by rejecting Grassley amendment to apply health care reforms to White House and all of Congress." (Not every failed amendment offered by Grassley leads to a press release. I don't recall his office drawing attention to one he offered in October, which would have cut benefits for poor people and legal immigrants in order to save private health insurers $7 billion a year.)

Grassley got some media play this week for his "double standard" framing, but a different statement from his office attracted far more attention. That release noted, "The health care legislation signed into law yesterday includes provisions Grassley co-authored to impose standards for the tax exemption of charitable hospitals for the first time."

Anyone following this issue knows that Grassley delayed the Senate Finance Committee's work on the health reform bill for several months, pretending to seek compromise while fundraising on a promise to defeat Obamacare and spreading false claims about what the bill would permit. Grassley then voted against the bill in the Senate Finance Committee and on the Senate floor.

Political blogs quickly publicized Grassley's effort to brag about good things in a bill he tried to stop. The senator was even featured in a segment on Rachel Maddow's MSNBC program: "Republicans farcically flustered by health reform's passage". Two of the Iowa Democrats running for U.S. Senate seized on Grassley's hypocrisy as well. I posted a press release from Tom Fiegen and a memo from Roxanne Conlin's campaign after the jump.

Grassley's balancing act on health reform makes some political sense. He doesn't need to play to the crowd that despises Obamacare, because the filing deadline for federal candidates in Iowa passed earlier this month. It's too late for a conservative to mount a primary challenge against the five-term incumbent.

Meanwhile, the news media have reported many details about the new law this week, and some of the provisions are likely to be quite popular. Why should Grassley loudly condemn a law that gives tax credits to small businesses, closes the Medicare "donut hole" and lets young adults be covered on their parents' insurance policies? If he's trying to impress swing voters, he's better off railing against the "double standard" of Washington elitists.  

On the other hand, swing voters might be repelled to see Grassley claim credit for reforms after he tried to "pull the plug" on health insurance reform. The senator defended himself as follows:

"So overall even though it's got a lot of good things in it, even a lot of things that I wrote, even a lot of things that I thought up myself to help health care delivery, the bad outweighs the good, it's just that simple."

When the Democratic Senatorial Campaign Committee slammed Grassley's posturing, Grassley's office responded that DSCC Chairman Bob Menendez has also taken credit for provisions in bills he voted against. We've heard similar "two wrongs make a right" arguments from Grassley before. It doesn't sound statesmanlike to me.

What do you think, Bleeding Heartland readers?

Next Up: A Climate Bill

by: Heather TaylorMiesle NRDC Action Fund

Fri Mar 26, 2010 at 13:59:49 PM CDT

Student loan reform is change we can believe in

by: desmoinesdem

Fri Mar 26, 2010 at 10:36:08 AM CDT

Just a couple of months ago, student loan reform appeared endangered because of Republican obstruction and corporate-friendly Democrats who didn't want to cut student loan companies like Sallie Mae out of the equation. In early February, the New York Times reported on the extensive lobbying campaign against this bill. (One of the key lobbyists for the banks was Jamie Gorelick, a familiar name from Bill Clinton's administration.)

Scott Brown's victory in the Massachusetts Senate election made it even less likely that Democrats could round up 60 votes to overcome a filibuster of student loan reform.

Fortunately, Senator Tom Harkin and other strong supporters of this reform were able to get the measure included in the budget reconciliation bill that was primarily a vehicle for passing "fixes" to health insurance reform. Not only is student loan reform a good idea in itself, I agree with Jon Walker that adding it to the health reform improved the political prospects for getting the reconciliation bill through the Senate. Democrats from several states were said to be balking on the student loan reforms, but only three senators who caucus with Democrats were willing to vote no on yesterday's reconciliation bill.

This reform is scaled back somewhat from the original proposal, which would have saved $87 billion over 10 years and passed the House of Representatives last September on a mostly party-line vote. The original proposal would have provided larger increases in Pell grant funding, because it was budget neutral. In order to be included in the budget reconciliation measure (and therefore not subject to a Republican filibuster in the Senate), the student loan reform had to reduce the deficit. But that compromise was well worth making in order to move to direct lending by the government.

Regarding health insurance reform, financial regulation and many other issues, I'm one of those "cynics and naysayers" President Obama decried in yesterday's speech in Iowa City. But this student loan reform is a big step in the right direction, and the Democrats in the White House and Congress who kept pushing for it deserve credit.

Someone is robocalling on Boswell's health reform vote

by: desmoinesdem

Thu Mar 25, 2010 at 19:16:02 PM CDT

The first question was whether Leonard Boswell's vote for health care reform makes you more or less likely to vote for him. (This person responded "less likely" in an attempt to give the "correct" answer and hear more from the call.) The voice then asked two questions for "statistical purposes," about the respondent's gender and party affiliation. After the party ID question, the voice said thanks and ended the call without saying who paid for the call. The Bleeding Heartland reader says that he pressed *69, and a phone number with a 202 area code (Washington, DC) came up, but when he tried to dial that number he couldn't get through--it didn't ring.

Republicans believe Boswell is vulnerable this year, and seven candidates are competing in the GOP primary to represent Iowa's third district (partisan voting index D+1).

I would like to hear from other Bleeding Heartland readers who received these robocalls. Was any phone number provided at the end of the call? Was any information given about who paid for the call?

I wonder whether answering that Boswell's vote makes you "more likely" to vote for him would lead to the respondent getting a bunch of push-poll questions portraying health insurance reform in an awful light. I also wonder whether constituents of Bruce Braley (IA-01) or Dave Loebsack (IA-02) are receiving similar calls.

Please post any relevant comments in this thread or e-mail me confidentially: desmoinesdem AT yahoo.com.

UPDATE: Another Bleeding Heartland reader e-mailed me to report getting the same call on Boswell. This person answered "more likely" to the first question and got the same two follow-up questions "for statistical purposes." So this sounds like a voter ID call, not a push-poll.  

Senate passes reconciliation bill 56-43 (updated with House passage)

by: desmoinesdem

Thu Mar 25, 2010 at 14:23:07 PM CDT

I assume the House will have the votes to pass the amended reconciliation bill. In theory, House Democrats could try to add a public health insurance option, but that would require another vote in the Senate. I think leadership wants to declare victory on this issue and move on.

Speaking of health insurance reform, it turns out the bill Obama just signed had a loophole that will allow insurers to keep denying coverage to children with pre-existing conditions until 2014. Health and Human Services Secretary Kathleen Sebelius claims this can be fixed through rule-making, but we'll see. I suspect insurance companies will be able to work around most of the supposedly tough regulations in the new law. They are guaranteed more than 30 million new customers and face no new competition.

UPDATE: It wasn't nearly as suspenseful as Sunday's vote, but the House of Representatives passed the revised budget reconciliation bill Thursday evening by a vote of 220-207 (roll call). Just as on Sunday, all three Iowa Democrats in the House (Bruce Braley, Dave Loebsack, and Leonard Boswell) voted for the bill, while Republicans Tom Latham and Steve King voted against it.

Here's your laugh for the day: MSNBC's Chris Matthews still thinks he was right and Representative Alan Grayson was wrong about whether changes to the health care bill could be passed using the budget reconciliation process.

Obama in Iowa City and events coming up this weekend (updated)

by: desmoinesdem

Thu Mar 25, 2010 at 09:57:26 AM CDT

I hope some Bleeding Heartland readers will post comments or a diary about today's presidential visit.

UPDATE: Scroll down for the full text of Obama's remarks in Iowa City, as prepared. What he said about children with pre-existing conditions being able to get insurance coverage this year isn't accurate, unfortunately.

I'm excited about a couple of other great events for progressives this weekend. Planned Parenthood of the Heartland (formerly known as Planned Parenthood of Greater Iowa) holds its spring book sale from March 25-29 in the 4-H building at the State Fairgrounds. It costs $10 to get in on opening night, but admission is free for the rest of the weekend. You will find a huge selection of books in almost every category you can imagine, as well as some CDs, DVDs, comic books and posters. Mr. desmoinesdem and I always find some wonderful out-of-print children's books. Click here for opening hours and more details. Proceeds from the book sale support Planned Parenthood's education programs in Iowa and Nebraska.

Another free event worth checking out this weekend is the Natural Living Expo at the Polk County Convention Center in downtown Des Moines Saturday from 10-6 and Sunday from 11-4. About 150 local businesses and non-profit organizations will be represented at the expo, including Iowa farmers, green home remodelers, and cloth diaper sellers. Francis Thicke's campaign for secretary of agriculture and Iowa's Water and Land Legacy will have booths too. Click here for a list of vendors, free lectures and panel discussions. If you have children, bring them along, because they may enjoy the storytelling, art and activities like hula-hooping and yo-yos in the kids' area. I'll be helping out a couple of non-profits at the expo, so I may see you if you stop by, but I won't be wearing my "desmoinesdem" hat.

More events coming up this weekend are listed after the jump.

Rasmussen poll finds little change in Senate race

by: desmoinesdem

Wed Mar 24, 2010 at 11:48:41 AM CDT

Senator Chuck Grassley still leads all his Democratic challengers, with no statistically significant change in his lead since Rasmussen's last Iowa poll in February. He leads Roxanne Conlin 55 percent to 36 percent (the February numbers were 53-36). Grassley leads Bob Krause 57-31 (55-33 in February), and he leads Tom Fiegen 57-28 (56-28 in February).

Instead of asking respondents whether they approved of Grassley's work in the Senate, Rasmussen asked whether they had a favorable or unfavorable impression of the senator. He was at 66 percent very or somewhat favorable, 31 percent very or somewhat unfavorable. (The latest Selzer poll for the Des Moines Register measured Grassley's approval at 54 percent, but favorability numbers can often run ahead of approval numbers.)

Clearly the Senate race is still Grassley's to lose, but he's not likely to be re-elected with the huge margins he's had in the past. There is also plenty of time for the race to tighten up if Grassley makes big mistakes. As Senate Guru reminded us in this diary, the current fundraising quarter ends March 31. I encourage Democrats to get involved and support one of Grassley's challengers. Here are links to donate to the Conlin campaign, the Fiegen campaign and the Krause campaign.

Other notable findings from the latest Rasmussen poll: President Barack Obama's approve/disapprove numbers were 50/49, but Governor Chet Culver is still in negative territory at 41 percent approve/57 disapprove. About 45 percent of respondents said they favored "the health care reform plan proposed by President Obama and the congressional Democrats," while 53 percent said they opposed it. Remember, this poll was in the field before Congress gave final approval to the bill Obama signed yesterday. I am curious to see future polling on the issue. A quickie USA Today/Gallup nationwide poll released yesterday was the first in a long time to show net positive approval for health care reform: 49 percent of respondents said it was a "good thing" that Congress passed the bill over the weekend, while 40 percent said it was a "bad thing."

Iowa Republicans, make up your minds about "activist judges"

by: desmoinesdem

Tue Mar 23, 2010 at 07:16:12 AM CDT

"We need to send a message to the Iowa Supreme Court that they are accountable to the people of Iowa," said Roberts, who has made restoring the role of the people in state government a centerpiece of his campaign. "The problem with judicial activism is that it thwarts the will of the legislature and of the people of Iowa."

Now that Congress has approved a health insurance reform bill Republicans don't like, some GOP politicians have decided judicial activism isn't so bad after all. Gubernatorial candidate Bob Vander Plaats pledged to "invoke the Constitution's 10th Amendment to protect Iowans from new federal mandates" on health care. Rod Roberts followed Vander Plaats' lead:

Roberts said that if the federal government passes a nationalized health care plan that conflicts with the Roberts Amendment, as governor he will file a lawsuit in federal court against President Obama to have the plan struck down as a violation of Iowans' Tenth Amendment rights. The Tenth Amendment to the U.S. Constitution provides that powers not delegated to the federal government (such as the regulation of health insurance) are reserved for the states.

Gubernatorial candidate Terry Branstad also supported the idea of using the courts to nullify the will of Congress: "Given the massive scope and effect of this [health insurance reform] bill, it is likely that various provisions will be challenged in the courts. Those challenges are both timely and appropriate."

Any constitutional lawyer can tell you that the U.S. Supreme Court has long affirmed the power of Congress to regulate interstate commerce. Law professor Mark Hall explains in detail here why constitutional arguments against an individual mandate to purchase health insurance are wrong. As for the broader 10th amendment claim that the constitution doesn't empower the federal government to regulate health insurance, Hall notes, "Congress has ample power and precedent through the Constitution's 'Commerce Clause' to regulate just about any aspect of the national economy."

Conservative legal scholar Eugene Volokh likewise does not find the constitutional arguments against health insurance reform convincing:

While I agree that the recent commerce clause cases hold that Congress may not regulate noneconomic activity, as such, they also state that Congress may reach otherwise unregulable conduct as part of an overarching regulatory scheme, where the regulation of such conduct is necessary and proper to the success of such scheme. In this case, the overall scheme would involve the regulation of "commerce" as the Supreme Court has defined it for several decades, as it would involve the regulation of health care markets. And the success of such a regulatory scheme would depend upon requiring all to participate. (Among other things, if health care reform requires insurers to issue insurance to all comers, and prohibits refusals for pre-existing conditions, then a mandate is necessary to prevent opportunistic behavior by individuals who simply wait to purchase insurance until they get sick.)

The U.S. Supreme Court could overrule the will of Congress on health insurance reform only by reversing several decades of precedent about the definition of commerce. That's textbook "judicial activism," but it's ok with some Iowa Republicans if it achieves the political end they are seeking.

By the way, Vander Plaats claims that as governor, he could issue an executive order halting same-sex marriages in Iowa. I wonder if he also thinks President Barack Obama could issue an executive order overturning a possible Supreme Court ruling against health insurance reform.

UPDATE: Kevin Drum considers prospects for a lawsuit challenging the individual mandate to buy health insurance. He makes the same point about Congressional authority to regulate interstate commerce and adds,

What's more, the penalties for not buying insurance are tax penalties, and if anything, Congress has even wider scope in the tax area than in the commerce area. The Supreme Court has frequently ruled that Congress can pass tax laws that essentially force people to do things that Congress doesn't have the direct power to require.

[...]here's the thing: if the Supreme Court decided to overturn decades of precedent and strike down the mandate even though Kevin Drum says they shouldn't (hard to imagine, I know), the insurance industry will go ballistic. If they're required to cover all comers, even those with expensive pre-existing conditions, then they have to have a mandate in order to get all the healthy people into the insurance pool too. So they would argue very persuasively that unless Congress figures out a fix, they'll drive private insurers out of business in short order. And that, in turn, will almost certainly be enough incentive for both Democrats and Republicans to find a way to enforce a mandate by other means. If necessary, there are ways to rewrite the rules so that people aren't literally required to get insurance, but are incentivized so strongly that nearly everyone will do it. As an example, Congress might pass a law making state Medicaid funding dependent on states passing laws requiring residents to buy insurance. Dependent funding is something Congress does routinely, and states don't have any constitutional issues when it comes to requiring residents to buy insurance. They all do it with auto insurance and Massachusetts does it with health insurance.

Like Drum, I view these proposed legal challenges as Republican posturing rather than a serious threat to nullify the law Obama signed this morning.

Iowa reaction to health insurance reform bill passing

by: desmoinesdem

Mon Mar 22, 2010 at 16:45:27 PM CDT

The president is coming to Iowa City this Thursday to promote the health insurance reform bill:

Iowa City was where candidate Obama announced his health-care plan before the 2008 caucuses, when he was in a scrap with Hillary Clinton and John Edwards for the party's presidential nomination.

A White House official said today the president will be in the state to "discuss how health insurance reform will lower costs for small businesses and American families and give them more control over their health care."

I'll be curious to see the public polling on this issue in Iowa. A new nationwide CNN poll released today showed that 39 percent of respondents support the Senate bill just approved by the House. Some 43 percent oppose the bill because it is "too liberal," while 13 percent oppose the bill because it is "not liberal enough." In other words, more than half the respondents either support the bill or (like me) feel it doesn't go far enough.