Two bills Governor Kim Reynolds signed on May 1 will make advanced testing for breast cancer and other diseases more accessible to Iowans with health insurance coverage.

House File 2489 requires certain types of private health insurance policies to cover supplemental or diagnostic breast examinations such as magnetic resonance imaging (MRI), ultrasound, or contrast-enhanced mammography. House File 2668 requires public and private health insurance to cover biomarker testing for some cancers and other diseases or conditions. Both bills take effect on January 1, 2025.

Henry Jay Karp is the Rabbi Emeritus of Temple Emanuel in Davenport, Iowa, which he served from 1985 to 2017. He is the co-founder and co-convener of One Human Family QCA, a social justice organization.

As some of the Republican presidential hopefuls are talking about cutting Social Security and Medicare benefits for the young, starting in 2031, the underlying issue is far more extensive than the financial woes of these two programs.

Yes, both the Medicare and Social Security programs are in need of serious reform if they are to remain solvent. But there are two major fixes which could do the job: cutting benefits or raising taxes. These presidential candidates choose to cut benefits for future beneficiaries, rather than raising the taxes of our country’s top earners.

That choice reflects a broader ideological problem with the current Republican Party: favoring the interests of the rich and corporations over the interests of the everyday people.

Iowa’s four U.S. House members avoided public comment for days after President Joe Biden and House Speaker Kevin McCarthy agreed on a deal to suspend the debt ceiling until January 2025, in exchange for some federal budget cuts and other policy changes.

But they all fell in line on May 31. Representatives Mariannette Miller-Meeks (IA-01), Ashley Hinson (IA-02), Zach Nunn (IA-03), and Randy Feenstra (IA-04) voted with GOP leadership and the majority of their caucus for the Fiscal Responsibility Act of 2023.

Kay Pence is vice president of the Iowa Alliance for Retired Americans.

Refusing to raise the debt ceiling is like running up your credit card and punishing yourself by refusing to pay the bill.  It ruins your credit score and costs more in the long run. Raising the debt ceiling does not authorize new spending, it authorizes borrowing to pay bills already incurred. Paying bills are obligations not negotiations.

MAGA Republicans want to use the debt ceiling fight to force cuts in future unnamed programs. What they want to cut isn’t exactly secret; we have seen and rejected, most of their proposals before.

Sharon Mayer is a Pella resident and health care advocate.

Rising health care costs are top of mind for many seniors, who often live on fixed incomes and struggle to afford our care. That’s why millions of people forgo critical vaccinations, including for shingles.

Luckily, I was able to get the shot covered by Medicaid. But many aren’t able to afford this important, preventative measure. Thankfully, starting in January, seniors could save hundreds of dollars when getting vaccinated against this painful illness.

Sue Dinsdale leads Health Care For America NOW in Iowa.

This month Medicare and Medicaid celebrate their 57th Anniversary. These two biggest government health insurance programs in the nation were created by President Lyndon B. Johnson and the Democratic-controlled Congress in 1965. Together, they provide coverage and services to more than 150 million people in the United States, including 637,388 Medicare enrollees and 812,017 Medicaid enrollees in Iowa.

Medicaid has been a lifeline and resource for workers, families, state budgets and people of all ages. Whether it’s regular preventive care, prenatal or maternity care for new moms, addiction treatment in the swelling opioid epidemic or rapid response to national crisis like hurricanes, terrorist attacks and epidemics, Medicaid is a fundamental pillar of the American health care system that we all depend on.

Julie Russell-Steuart is a printmaker and activist who chairs the Iowa Democratic Party’s Disability Caucus.

Glenn Hurst is a rural doctor in the small southwestern Iowa town of Minden and a founding member of Indivisble Iowa, whose activism helped elect U.S. Representative Cindy Axne. He faces Abby Finkenauer and Mike Franken in the June 7 Democratic primary for U.S. Senate.

Dr. Hurst has earned our endorsement for his strong experience advocating for people with disabilities and because he is laser focused on improving the lives of the American people in crucial ways.

Sue Dinsdale is the director of Iowa Citizen Action Network and leads the Health Care For America and Lower Drug Prices NOW campaigns in Iowa.

U.S. Senator Chuck Grassley got it right when speaking about efforts to lower prescription costs. He acknowledged the “difficulty of passing something like this in a Republican Congress,” adding, “If we want to reduce drug prices, then we need to do it now.”

For years we’ve been hearing members of Congress promise to tackle rising drug prices without any action. Prescription drugs and the outrageous price of medicine has made reform a top issue that attracts bipartisan support. A recent national poll indicated that 91 percent of voters consider lowering drug prices a very important issue in the upcoming election, ranking it above COVID-19 worries. 

The Hurst for Iowa campaign just received an overwhelming endorsement from Iowa’s leading progressive organization, Iowa Citizens for Community Improvement Action Fund. In the announcement, they stated, “We’re endorsing Glenn because he’s with us on the issues and on challenging business-as-usual politics and the status quo. He shares our belief that real change comes from the ground up, and he has a plan to win and can excite a grassroots base to turn out to the polls on June 7.”

Glenn Hurst is a family physician in southwest Iowa and a Democratic candidate for U.S. Senate.

Several years ago, my wife and I had a friend our family called Grandma Ruth. Ruth was special to us. She was one of the first people we brought my newborn daughter to meet. She had taken a special interest in our kids and was always present for their big events. Often, we would pick her up and bring her to our house for football parties and holidays. She included us in the celebration of her life events as well. She was estranged from her own family and just became part of ours.

I learned a lot from observing how Ruth navigated her world. She had learned how to use senior transportation services to get to doctor appointments as well as to the grocery store or other activities. She knew how to arrange Meals on Wheels and how to keep current with her disability to remain eligible for services she absolutely needed.

A third Democrat joined the race for Iowa’s U.S. Senate seat on July 29. Dr. Glenn Hurst made clear that one issue in particular is driving his campaign.

“I went back to school and became a doctor because I saw a need in the rural communities I love and call home,” Hurst said in a news release. “I’ve had a front-row seat to the tricks insurance companies use to avoid paying for care, drowning providers in paperwork when we should be with our patients. I’m running for the U.S. Senate because Iowans deserve better. We deserve Medicare for All.”

The U.S. House and Senate on December 21 approved a $2.3 trillion package to fund the federal government through September 30, 2021 and provide approximately $900 billion in economic stimulus or relief connected to the coronavirus pandemic.

No one in either chamber had time to read the legislation, which was nearly 5,600 pages long, before voting on it. Statements released by Iowans in Congress, which I’ve enclosed below, highlight many of its key provisions. The unemployment and direct payments to families are clearly insufficient to meet the needs of millions of struggling Americans. Senate Republicans blocked aid to state and local governments, many of which are facing budget shortfalls. President-elect Joe Biden has vowed to push for a much larger economic stimulus package early next year.

The legislation headed to President Donald Trump’s desk includes some long overdue changes, such as new limits on “surprise billing” by health care providers for emergency care and some out-of-network care.

Kay Pence is Vice President of the Iowa Alliance for Retired Americans. -promoted by Laura Belin

U.S. Senator Joni Ernst is no longer working for Iowans. She is working at the behest of President Donald Trump, no matter what he says or does. She has become a puppet to Trump no matter how low he sinks, voting with the president more than 91 percent of the time and following his lead to attack our healthcare and defund Social Security.

The Iowa Alliance for Retired Americans recently invited Ernst and her Democratic challenger Theresa Greenfield to virtual forums celebrating the anniversaries of Medicare and Social Security. I was not surprised when Ernst failed to show up for either forum, because she has such a dismal record on both issues.  

The U.S. House has fast-tracked a bill responding to the economic challenges created by the novel coronavirus (COVID-19) pandemic. All 223 Democrats present–including Iowa’s Representatives Abby Finkenauer (IA-01), Dave Loebsack (IA-02), and Cindy Axne (IA-03)–voted for the bill shortly before 1:00 am on March 14, joined by 140 Republicans (roll call). U.S. Representative Steve King (IA-04) was one of 40 House Republicans to vote no.

Iowa State University economist Dave Swenson: Of three possible approaches to health policy, only Medicare for All “reduces the damage that the existing system causes and remedies the cumulative policy failures of the past 70 years.” -promoted by Laura Belin

Health care delivery in the U.S. is a market failure and a governmental failure.

The private sector cannot adequately supply all that is demanded because many of those seeking health care cannot pay for what they need. Government systems, while attentive to the needs of the elderly, disabled, poor, and many veterans, nonetheless fail to cover all who require health care, because policies and funding are inadequate.

As a consequence, too little health care is delivered. And too little health care is socially destructive.

State Representative Molly Donahue: “Amy Klobuchar is running to be the president of all the people, not half the people.” -promoted by Laura Belin

Amy Klobuchar isn’t just a smart, funny, gritty, senator from Minnesota who gets things done. She is someone who studies and weighs the pros and cons of policy. She not only knows her own policies in and out, but she also knows the policies of her fellow presidential candidates.

Amy’s one-liners are filled with a wealth of knowledge about how the system works and how to get to where we want to be, while uniting those around her. She has proven her strength is uniting by getting people to work together towards a common cause as a senator, and she has shown time and again that she can stand up to Trump and his policies.

Amy has fought to expand affordable health care options, building on and improving the Affordable Care Act, and working across the aisle to reduce prescription drug prices while allowing Medicare to negotiate with pharmaceutical companies. She wants to end the stigma of mental illness in this country, and to make sure that services are available and affordable for the people in need.

She believes in providing a pathway for citizenship for undocumented workers, and that we must begin to reduce carbon emissions with a plan to achieve net-zero carbon emissions by 2050 while embracing natural gas as a “transition” fuel to help the U.S. move away from foreign oil. She has experience working with agriculture and knows that our farmers and rural communities are at risk because of President Donald Trump’s tariffs. She has a plan to put our rural areas back to work and help farmers be sustainable into the future while protecting the environment.

Amy doesn’t look at things and say they can’t be done. Instead, she asks, how do we get there with everyone, not just part of the country? She is running to be the president of all the people, not half the people.

She is the daughter of a public school teacher, and knows the importance of a public education for a successful future. Amy stands for the people, the workers of America and stresses the importance of the unions to strengthen our work force and continue to build a strong middle class with good jobs, wages, benefits, and safety in the workplace. She supports expanding access to vocational training and other post-secondary education in an affordable way, so students aren’t burdened with insurmountable debt.

Everytown for Gun Safety and Moms Demand Action have praised Amy for her strong stance on gun violence prevention. She jokes she isn’t looking to hurt her uncle, who’s a big hunter. Rather, she supports instituting universal background checks, banning assault rifles, and Extreme Risk Orders, also known as “red flag” laws – which allow law enforcement to remove guns from people they determine to be a threat.

Amy speaks about our allies around the world, and how she will bring them back to the table to stabilize the damage done by the Trump administration. She is a fighter for LGBTQ and women’s rights.

From campaign finance reform to foreign policy, Amy Klobuchar is a great candidate who can win.

I am very happy to announce that I have endorsed Amy Klobuchar for president. She is the person we need to unite this country and to move the country forward. Amy will work across the aisle to pass progressive policy and has what it takes to not only stand up to Trump, but to beat Trump.

She has the work ethic and values that the country wants in a leader, and she will put the people first when she implements the policies and changes for her administration.

Plain and simply, Amy Klobuchar will provide a great future for our kids as president of the United States.

Editor’s note: Bleeding Heartland welcomes guest posts related to the Iowa caucuses, including but not limited to candidate endorsements. Please read these guidelines and contact Laura Belin if you are interested in writing.

Top image: Senator Amy Klobuchar (left) and State Representative Molly Donahue in Cedar Rapids at a September 1 “climate conversation” event organized by State Senator Rob Hogg. Photo provided by the author and published with permission.

Industry-funded groups have recently spent more than a million dollars on television and online advertising in Iowa opposing Democratic plans to expand access to health insurance.

Some ads primarily focus on single-payer plans (often known as Medicare for All), which more than half a dozen presidential candidates are supporting. But Partnership for America’s Health Care Future has used its hundreds of thousands of dollars in the Des Moines market targeting more modest proposals to offer a “public option” on exchanges selling private health insurance policies.

Many central Iowa Democratic activists were surprised and upset to see Loretta Sieman, a longtime West Des Moines city council member, in one of the partnership’s commercials. Sieman spoke to Bleeding Heartland on September 11 about why she opposes the public option and why she agreed to appear in the ad, now in heavy rotation on YouTube as well as Des Moines broadcast and cable stations.

First disclaimer: I don’t agree with the Democratic National Committee’s debate criteria and encourage Iowans to keep listening to all the presidential candidates.

Second disclaimer: I doubt anything that happens more than four months before anyone votes will significantly affect the battle for the Democratic nomination. As Dan Guild has shown, history tells us more than half of Iowa Democrats who participated in the 2004 and 2008 caucuses decided in the final month.

That said, here are my thoughts on last night’s three-hour debate at Texas Southern University in Houston.

Labor Day traditionally marks the beginning of the most intense phase of campaigning in election years. This holiday is also a good time to review the state of play in races for federal offices in odd-numbered years. Though new candidates could emerge at any time before Iowa’s March 2020 filing deadline–Patty Judge was a late arrival to the Democratic U.S. Senate field in 2016–it’s more typical for federal candidates here to kick off their campaigns by the end of summer the year before the election.

Thanks to Iowa’s non-partisan redistricting system, all four U.S. House races here could be competitive in 2020, and our Senate race is on the map–in contrast to 2016, when Senator Chuck Grassley’s re-election was almost a foregone conclusion.

Bill Witt represented part of Black Hawk County in the Iowa House for ten years and is a well-known advocate for improving health care services and environmental causes. -promoted by Laura Belin

While the big political noise machines have traded barrages in a host of high-profile battles over border security, student debt, the Affordable Care Act, Afghanistan, and more, U.S. Senator Amy Klobuchar has quietly, and with her customary adroitness, slipped around the flanks of the clanking, clattering behemoths and planted her standard on strategic, long-term high ground: the security and health of America’s seniors.

Nineteen presidential candidates had five minutes each to make their case to more than 1,000 activists at the Iowa Democratic Party’s Hall of Fame event in Cedar Rapids on June 9. Most offered at least one really good applause line. Teams of reporters from the Des Moines Register and Iowa Starting Line pulled together some of the memorable parts of each speech here and here.

I decided to focus on how the candidates spoke about health care and women’s ability to access abortion for a couple of reasons. First, while the candidates highlighted a wide range of problems and proposals, almost all of them addressed those topics in some way.

Second, this post represents my gesture toward what media critic Jay Rosen has called the “citizens agenda” approach to covering campaigns. Although I lack survey data to know for sure what Iowa Democrats want the presidential contenders to be talking about, I believe health care and reproductive rights are among the most salient for caucus-goers, because:

Kimberly Graham is the first declared Democratic challenger to U.S. Senator Joni Ernst. Her campaign website is kimberlyforiowa.com, and she’s on Facebook and Twitter @KimberlyforIowa. -promoted by Laura Belin

Our current junior senator ran on a promise to get rid of corruption in Washington and “make ‘em squeal,” but the only people squealing are Iowans harmed by her votes.

My name is Kimberly Graham. I’m running for the United States Senate. Here’s who I am, who I’m running for, and why:

Matt Sinovic is the executive director of Progress Iowa. -promoted by Laura Belin

This week, the Trump administration released its proposed budget for fiscal year 2020, which revives a call to repeal the Affordable Care Act and lays out massive cuts to Medicaid, Medicare, and the Department of Health and Human Services. The administration’s budget reveals just how steadfast it remains in trying to take away Americans’ health care.

Here are five things you need to know about Trump’s Health Care Sabotage Budget:

Nancy Pelosi won an important U.S. House Democratic caucus vote on November 28, and all three Iowans who will be part of the majority next year backed her for speaker.

U.S. Senator Chuck Grassley told reporters today that he will lead the Senate Finance Committee in the new Congress. The current chair, Senator Orrin Hatch, is retiring. Grassley’s official website notes,

Senator Grassley calls this committee the quality of life committee because of the committee’s jurisdiction, which includes all tax matters, health care, Social Security; Medicare, Medicaid, social services, unemployment compensation, tariffs and international trade. Legislation acted on by the Committee on Finance raises virtually all federal revenue, and expenditures authorized by this committee represent as much as two-thirds of the federal budget.

With just seven weeks remaining before election day, “No Republican organization has put money toward TV ads that could benefit” U.S. Representative Rod Blum in Iowa’s first Congressional district, Barbara Rodriguez and Brianne Pfannenstiel reported for the Des Moines Register on September 17. Their analysis of television air time data from Kantar Media showed that groups supporting Democratic challenger Abby Finkenauer “have spent or reserved more than $1.2 million for airing political ads” in IA-01. Blum’s campaign has placed $129,000 in television ad buys, and no GOP-aligned groups have indicated plans to advertise in the district.

In many battleground Congressional races, candidates run mostly positive tv ads, while outside groups pay for the hatchet jobs. That normal division of labor won’t be available to Blum. He will have to cover the cost of any negative ads about Finkenauer from his own campaign funds, leaving less money to make an case for himself on the air.

“We need to use every tool we have to reclaim our country,” U.S. Senator Jeff Merkley told me during his latest visit to Des Moines. “We are at the verge of a tipping point, and maybe we’re almost past it, in which the power of the mega-wealthy is so profound that we can’t tip the balance back in to we the people.”

The senator from Oregon spent much of Labor Day weekend in central Iowa supporting Democratic candidates for the state legislature. His fifth trip here since the 2016 election won’t be his last: he will be a featured speaker at the Polk County Steak Fry later this month. During our September 2 interview, I asked Merkley about the most important matters pending in the U.S. Senate, prospects for Democrats in November, and his possible presidential candidacy.

First-person accounts of political events are always fun to read. Thanks to Susie Olesen, a semi-retired former teacher and school administrator in southwest Iowa, for this write-up. -promoted by desmoinesdem

Senator Joni Ernst’s July 6 town hall at the high school auditorium in Shenandoah (Page County) was a well-attended, civil meeting. People who wanted to participate filled out a slip of paper, which were drawn out of a glass jar to determine who would be able to ask questions. Ernst sat at a table in front of the room.

A newly-formed political non-profit sent two mass mailings to Iowa Democrats this week in support of Eddie Mauro, one of three candidates seeking the nomination in the third Congressional district. The website and Facebook page for Iowans for a Progressive Tomorrow do not indicate who is funding the effort, nor has the group filed 24-hour independent expenditure reports with the Federal Election Commission. UPDATE: The group belatedly submitted reports; added details below.

Across the United States, trans health care is an unstable patchwork of “islands.” Nowhere is this more evident than in Midwest states like Iowa and Indiana. -promoted by desmoinesdem

Jeff Cox sees one gubernatorial contender best positioned to help Democrats become the majority party again. Bleeding Heartland welcomes guest posts advocating for candidates in competitive Democratic primaries. Please read these guidelines before writing. -promoted by desmoinesdem

There is only one word to use when surveying the damage the Republicans are doing to Iowa and America: depressing. We need to keep our eye on the ball, though, and avoid being diverted into competitive name-calling with Republicans. We need to elect Democrats until we regain a majority at every level of government. In the present crisis, any Democratic victory is a win, no matter how awful the Democrat.

In addition to issuing an “all hands on deck” call to elect Democrats, we should also have a discussion about how we got into this mess of being a minority party at every level of government. We could do worse than look back to a period of history when Democrats were the natural party of government, the half century beginning in 1932.

Voters in Iowa’s first district favor an unnamed Democrat over two-term Representative Rod Blum by 51 percent to 43 percent, according to a new survey by Public Policy Polling. Respondents in the same survey opposed the tax bill U.S. House Republicans approved last month by a 50 percent to 44 percent margin.

The Not One Penny coalition, formed in August to oppose any tax cuts “for millionaires, billionaires and wealthy corporations,” commissioned the survey in IA-01 and five other Congressional districts. The group has also launched a new round of television commercials targeting Blum and Representative David Young in Iowa’s third district. Not One Penny previously ran television commercials in August in IA-01, IA-03, and six other Republican-held House districts.

Meanwhile, the End Citizens United political action committee confirmed yesterday that Blum is among the “Big Money 20” Congressional Republicans it will target in 2018.

U.S. Senators Chuck Grassley and Joni Ernst joined all but one of their Republican colleagues to approve a $1.5 trillion tax cut and health care policy overhaul late last night. Whereas Ernst had told Iowans, “I look forward to carefully reviewing tax reform legislation in the Senate,” the final vote “came after Senate Republicans frantically rewrote the multi-trillion dollar legislation behind closed doors to win over several final holdouts,” Politico reported.

To all the Democrats who want to hear directly from each contender in the Iowa governor’s race before deciding how to vote next June: this post’s for you.

Since Bleeding Heartland published seven pitches for gubernatorial candidates from a major party event this summer, Todd Prichard has left the race and Ross Wilburn has joined the field.

All seven Democrats running for governor appeared at the Progress Iowa Corn Feed in Des Moines on September 10, speaking in the following order: Cathy Glasson, Fred Hubbell, John Norris, Ross Wilburn, Jon Neiderbach, Andy McGuire, and Nate Boulton. I enclose below the audio clips, for those who like to hear a candidate’s speaking style. I’ve also transcribed every speech in full, for those who would rather read than listen.

As a bonus, you can find a sound file of Brent Roske’s speech to the Progress Iowa event at the end of this post. With his focus on single-payer health care and water quality, Roske should be running in the Democratic primary. Instead, he plans to qualify for the general election ballot as an independent candidate, a path that can only help Republicans by splitting the progressive vote.

Ruth Thompson shares her remarks from the Our Lives on the Line health care rally in Des Moines on July 29. She has previously described how the Affordable Care Act saved her daughter from potentially severe medical complications and crushing debt. -promoted by desmoinesdem

I’m a person with lived experience with disability and I’m the vice-chair pro-tem of the Disability Caucus of the Iowa Democratic Party, I serve on the board of the Central Iowa Center for Independent Living and a very active member of the Polk County Democrats.

I’m speaking as a representative of those groups and as an individual who cares about health care.

An Iowan with in-depth knowledge of the health care sector looks at lesser-known benefits that could be lost if Congress replaces the Affordable Care Act. -promoted by desmoinesdem

The debate on Republican efforts to repeal and replace the 2010 health care reform law has focused on the provision of health care and the repeal of some taxes. In particular, attention has been directed at the effort to reduce Medicaid coverage.

What isn’t being discussed: the Affordable Care Act (ACA) included many provisions aimed at addressing serious issues in the health care system, such as quality, safety, and workforce shortages. None of those can be found in the House-approved American Health Care Act (AHCA) or the Better Care Reconciliation Act (BCRA), proposed by Senate Republican leaders.

So, in addition to reducing (or eliminating) coverage for poor people and individuals with illnesses, the Republican bill would be a step backward in terms of efforts to improve the health care system, which accounts for 17 percent of our gross domestic product.

Iowa’s Senators Chuck Grassley and Joni Ernst say they are “continuing to carefully look through the revised health care discussion draft” released by Senate Republican leaders last week. Iowans who have called the senators’ offices are likewise hearing from staffers that Grassley and Ernst have not decided whether to support the GOP alternative to the Affordable Care Act.

I suspect Iowa’s senators would rubber-stamp any GOP “health care” bill Majority Leader Mitch McConnell brings to the floor, for several reasons:

• None of the Washington-based reporters on this beat include Grassley or Ernst on their lists of Republican senators who may not support the bill.

• Reports speculating about special deals GOP Senate leaders may offer to lock down votes don’t refer to any additional spending geared toward Iowa.

• Neither Grassley nor Ernst made time to meet with Iowa hospital leaders who lobbied against the bill on a trip to Washington last week.

• Neither Grassley nor Ernst has bucked the party line on any important Senate vote that I can recall.

For now, let’s take Iowa’s senators at their word: they are still undecided and seeking input from constituents. If Grassley and Ernst intend to keep promises they’ve been making on health care policy, they need not spend any more time deliberating. They have ample reasons to vote against the Orwellian-named Better Care Reconciliation Act (BCRA).

Non-partisan analysis indicates that if this bill becomes law, tens of millions of Americans–including hundreds of thousands of Iowans–will have worse health insurance coverage or no coverage at all.

With the exhausting battles of the 2017 legislative session behind us, Iowa Democrats can turn their attention to the most pressing task ahead. Next year’s gubernatorial election will likely determine whether Republicans retain unchecked power to impose their will on Iowans, or whether some balance returns to the statehouse.

A record number of Democrats may run for governor in 2018. Today Bleeding Heartland begins a series of in-depth looks at the possible contenders.

John Norris moved back to Iowa with his wife Jackie Norris and their three sons last year, after nearly six years in Washington and two in Rome, Italy. He has been touching base with potential supporters for several weeks and expects to decide sometime in May whether to become a candidate for governor. His “concern about the direction the state’s going” is not in question. Rather, Norris is gauging the response he gets from activists and community leaders he has known for many years, and whether he can raise the resources “to make this a go.”

In a lengthy interview earlier this month, Norris discussed the changes he sees in Iowa, the issues he’s most passionate about, and why he has “something significantly different to offer” from others in the field, who largely agree on public policy. The native of Red Oak in Montgomery County (which happens to be Senator Joni Ernst’s home town too) also shared his perspective on why Democrats have lost ground among Iowa’s rural and small-town voters, and what they can do to reverse that trend.

Among the U.S. political developments I never would have predicted: the Republican-controlled Congress was unable to repeal the Affordable Care Act under a president ready to sign the bill into law. After canceling a planned floor vote today on the American Health Care Act, House Speaker Paul Ryan acknowledged, “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”

In the depths of my despair after the November election, I felt sure that the Affordable Care Act would be history by now, and Congress would be well on the way to privatizing Medicare.

Among the many reasons Republicans failed to draft a coherent health care alternative and could not coalesce around the half-baked American Health Care Act, the most important is this:

A little more than two weeks after House Republicans released their alternative to the Affordable Care Act, U.S. Representative Rod Blum (IA-01) announced on Twitter that he will not support the American Health Care Act. According to Blum, the bill “doesn’t do enough to lower premiums for hardworking Americans. I’m a ‘no’ on current version – need to drive down actual costs!” Speaking to The Hill the same day, he added, “We need real competition driving prices down. We don’t need the government telling us what should be in an insurance policy. The government has a role to play. We need to help people who need the help.” Blum had previously said directly and through staff that he was studying the bill.

Like all other House Republicans, Blum has voted multiple times for “Obamacare” repeal bills that would have done nothing “to lower premiums for hardworking Americans,” let alone “drive down actual costs.” However, the stakes are higher now that a GOP-controlled Senate and Republican president might enact new health care legislation. I don’t know what kind of plan Blum is envisioning, but there is no magic wand Congress can wave to “help people who need the help” without the government setting minimum standards for health coverage and regulating the market in other ways.

Blum belongs to the House Freedom Caucus. Although that group has not taken an official stand against the AHCA, some of its prominent members are on various “whip counts” of Republicans opposing the bill. Since no Democrats are backing a plan that would leave millions uninsured and drive up costs for millions more, House leaders can’t spare more than 21 GOP members in any floor vote on their health care bill. Some Congress-watchers have already counted more defectors than that.

Representative Steve King (IA-04) was among the first House Republicans to come out against the AHCA. He supports “rip it out by the roots” repeal of “Obamacare” instead. I doubt the amendments unveiled this week to satisfy House conservatives will change his mind. UPDATE: A staffer told the Des Moines Register’s Jason Noble on March 22 that King is “undecided–leaning no” on the bill. SECOND UPDATE: White House spokesperson Sean Spicer announced that King will support the bill. Seeking confirmation. A member of the House whip team told Jonathan Martin of the New York Times that King “went from no to yes in the WH [White House] today after assurances about Senate tweaks.” UPDATE: King released a video statement explaining his decision to support the AHCA. He’s still committed to repealing Obamacare. He hopes Republicans will strip “essential health benefits” out of the bill, paving the way for other measures he wants, like health savings accounts and selling insurance across state lines. He said he told President Donald Trump in a White House meeting today that he worked very hard for total repeal of the Affordable Care Act, but that legislation won’t be brought up this year, because leaders don’t think they can get the votes. He said he had a “firm commitment” from Senate Majority Leader Mitch McConnell for a manger’s amendment to strip out “mandates” and “essential health benefits” from the House bill. King views this bill as the “best chance” for the “closest thing” to total repeal of Obamacare in the current political environment. He later tweeted that he and Trump had negotiated “the best possible improvement on ObamaCare Repeal.”

Representative David Young (IA-03) has repeatedly said he is studying the bill and the Congressional Budget Office analysis of its impact. Young’s staff have told constituents this week that he is still undecided. I consider him likely to vote yes if the bill comes to the floor–which may never happen, if leaders conclude they don’t have the votes. For what it’s worth, The Hill’s whip count put Young in the “leaning/likely no” camp because he said on March 15, “I want to make sure it is something that works in the end for all Americans, and that it would pass if it gets over to the Senate.” Several GOP senators have said the AHCA will not pass the upper chamber. UPDATE: Young announced in a March 22 statement, “While the American Health Care Act, legislation to repeal and replace Obamacare, is a very good start, it does not yet get it right and therefore I cannot support it in its’ [sic] present form.” I’ve added his whole press release below.

Neither of Iowa’s U.S. senators have clarified how they would vote on the Republican bill. Senator Chuck Grassley has made conflicting statements, telling House members the bill must be changed so that insurance premiums don’t skyrocket for older people not yet eligible for Medicare. On the other hand, Grassley has said Republicans can’t afford to miss what could be their only opportunity to keep six years of promises. Senator Joni Ernst said at town-hall meetings in Cedar Rapids and Des Moines on March 17 that she is studying the AHCA’s potential impact on Iowans and insurance premiums. I hate to break it to her: no alternative plan will magically make cheap insurance widely available while maintaining guaranteed coverage for people for pre-existing conditions and letting children stay on their parents insurance through age 26.

UPDATE: Forgot to mention that the Iowa Hospital Association estimates between 200,000 and 250,000 Iowans would lose their insurance coverage under the Republican plan. More on that story below.