The House of Representatives will soon bring a health care reform bill up for a floor vote. All three relevant committees have approved bills containing a public health insurance option. In August, Jacob Hacker explained one of the key differences between those bills (pdf file):

The versions of the House bill approved by the House Ways and Means Committee and  House Education and Labor Committee contain a Medicare tie-in that has two crucial  characteristics:

    1.  Providers participating in Medicare would automatically be considered participating  providers in the new public plan, although they would have the right to opt out.

    2.  Initial payments to providers would be set at Medicare rates plus 5 percent. After  three years, the Secretary of Health and Human Services could adjust rates. But  during the crucial start-up period, the public plan would be able to piggyback on  Medicare’s payment methodology. 17    

     These are good provisions. They would be even better if they included an explicit  protection of providers’ rights to join the public plan. Private plans (at least those that  participate in the exchange) should be prohibited from setting as a condition of participation  in their networks that providers not join the public plan.

     By contrast, the House Energy and Commerce Committee approved the House bill  with amendments that preserve only the first of these two elements. 18 Providers participating  in Medicare would be presumed to participate in the new public plan (but, again, allowed to  opt out). 19 However, rather than setting the rates the public plan would pay providers on the  basis of Medicare rates, the Secretary of Health and Human Services would have to  “negotiate” rates directly with providers. 20 These rates in the aggregate would have to be  between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening  Americans as health care consumers and taxpayers alike. It threatens the viability of the  public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.

Click here to download Hacker’s full report, which includes analysis of the Senate HELP Committee’s bill.

When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won’t bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the “Medicare plus 5 percent” public option.

Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, “lean yes” or “lean no” on the stronger public option. Representative Leonard Boswell (IA-03) is on that list. It’s not clear whether he is undecided or leaning one way or the other. I have sought clarification from his office and will update this post when I hear back.

You know the drill. Boswell needs to hear from as many constituents as possible. The “Medicare plus 5 percent” version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call Boswell’s office rather than e-mail, because phone calls are harder for staffers to ignore. Office contact information:

Washington DC Office

Phone: (202) 225-3806

Fax: (202) 225-5608

Iowa District Office

Phone: (515) 282-1909

Fax: (515) 282-1785

Toll Free Phone: (888) 432-1984

In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change “the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system.” After the jump I’ve posted a joint press release explaining how this deal will affect Medicare reimbursement rates.

UPDATE: Supposedly there are at least 218 votes in the House for the “robust” public option. The deal on Medicare reimbursement rates helped secure some extra votes for the public option. Also, the House bill will strip the insurance industry of its anti-trust exemption.

CORRECTION: Apparently we don’t have 218 votes for the stronger public option after all.

When a bunch of national blogs write about Representative Steve King, you know it’s not for anything that will make Iowans proud. This week was no exception, as King led a group of more than 50 House Republicans demanding that Kevin Jennings resign as the White House official focusing on “safe schools.”

As you might expect, the basis for King’s campaign against Jennings is a canard, but he didn’t stop even after his office was informed that the allegations were false.

Steve Benen, Greg Sargent and Jed Lewison have more on King’s latest embarrassing crusade.

Council Bluffs resident Mike Denklau announced on October 15 that he is running against King in 2010. His official campaign website is here. Although this district leans strongly Republican, it’s important not to leave people like King unchallenged.

A new Iowa poll confirms that Terry Branstad is the toughest challenger for Chet Culver and that next year’s U.S. Senate race could become competitive. Research 2000 surveyed 600 “likely voters who vote regularly in state elections.” The poll was in the field from October 12 through 14, and you’ll find full results and crosstabs here.

Republicans may dismiss this as a “Democratic poll” because it was commissioned by the Daily Kos blog. However, Research 2000 is not a partisan firm, and the sample for this poll included 32 percent Democrats, 31 percent Republicans and 37 percent independents. That’s a smaller advantage for Democrats than the current Iowa voter registration numbers reflect. The proportion of independents in the sample might be a bit high for an off-year election, but that doesn’t necessarily skew against the Republican candidates.

I’ll highlight some of the key findings after the jump.

Senator Chuck Grassley complained this week that he is not being included in negotiations to merge the health care reform bills passed by the Senate Finance Committee and Committee on Health, Education, Labor and Pensions.

Finance Chairman Max Baucus, a Montana Democrat, “assured us that Republicans would be at the table through the process of negotiating a single bill,” Grassley said. “And obviously that’s kind of ruled out now by the fact that I am not a part of a bipartisan agreement.”

Look, the HELP Committee adopted about 160 Republican-proposed amendments to the health care bill during the markup process, yet not a single Republican voted to send that bill out of committee. Then Baucus bent over backwards to include Grassley in negotiations all summer, but he joined all the Finance Committee Republicans except for Olympia Snowe in voting against the health care bill. Why should Grassley have a say in how the HELP and Finance bills are combined?

Now Steve Benen catches Grassley “going around the bend” in his criticism of health care reform:

This week, Grassley appears to have completely lost it, offering at least tacit support for radical “Tenther” theories that insist that health care reform may be unconstitutional.

    “I’m not a lawyer, but let me tell you, I’ve listened to some lawyers speak on this. And you know, it’s a relatively new issue. I don’t think we’ve ever had this issue before of having to buy something. And a lot of constitutional lawyers, saying it is unconstitutional or at least in violation of the 10th Amendment. Now maybe states can do this, but can the federal government? So, I have my doubts.”

This was specifically responding to a question about individual mandates — a measure he’s already endorsed as a good idea that he supports.

Obvious inconsistencies notwithstanding, the notion that health care reform is “in violation of the 10th Amendment” is demonstrably ridiculous. The idea that “a lot of constitutional lawyers” see health care reform as unconstitutional is absurd.

For more details on Grassley’s previous public support for an individual mandate to purchase health insurance, read this post by Benen or this one by Jason Hancock.

Grassley’s misleading and inconsistent comments about health care reform have greatly harmed his reputation with Iowa Democrats and independents this year. It will be interesting to see whether he can repair the damage before next November. I don’t see him getting nearly as large a crossover vote as he has in his previous elections.

“Sources close to [former Governor Terry] Branstad” tell WHO-TV’s Dave Price that Branstad will announce his candidacy for a fifth term as governor this Friday. Whatever the date, it’s obvious Branstad has committed to the race.

Join me after the jump for recent news and unintentional comedy from the Branstad camp. You’ll also find a Bleeding Heartland reader poll at the bottom of this post.

The Senate Finance Committee approved its health care reform bill on a 14-9 vote yesterday, with all Democrats and Republican Olympia Snowe of Maine voting in favor. Ranking Republican Chuck Grassley, a key member of the committee’s “gang of six” negotiators this summer, joined the rest of the Republicans in voting against the bill. Speaking to the Des Moines Register Grassley “said he has no regrets about working with majority Democrats on the committee, only to oppose the bill. Given more time, he might have struck a deal, he said.”

This guy is the perfect picture of a bad-faith negotiator. From the Register:

Grassley said he objects most to provisions in the bill that would require Americans to obtain health insurance. But Grassley also said the bill does too little to block federal money being spent to provide abortions and provide coverage for illegal immigrants.

“Those aren’t the only things, but I think they are the most controversial or the most difficult to deal with,” Grassley told The Des Moines Register.

As Jason Hancock reported for the Iowa Independent last week, Grassley publicly supported the idea of an individual mandate to purchase health insurance this summer. I agree that requiring individuals to purchase insurance is problematic if there is no broad-based public health insurance option (because then the government is just subsidizing private insurers), but of course Grassley opposed the public option too.

In addition, the “gang of six” made changes in the bill before markup to address groundless Republican claims about illegal immigrants. According to PolitiFact, the “Baucus plan explicitly states that no federal funds – whether through tax credits or cost-sharing credits – could be used to pay for abortions (again, except for rape, incest, or the life of the mother).”

Trying to cut deals with Grassley is a waste of time. For more on that point, check out the skipper’s recent diary.

Speaking of Grassley, Cityview’s Civic Skinny thinks he should be worried about a potential race against attorney Roxanne Conlin. When a reporter asked Secretary of Agriculture Tom Vilsack whether his wife, Christie Vilsack, might run against Grassley, he replied, “You should ask her about that.” (UPDATE: Dave Price did ask her and wonders whether she is the mystery candidate.)

As for the health care bill, the Finance Committee and HELP Committee versions have to be merged before a floor vote. It’s imperative that a public option be included in the version sent to the floor, and HELP Committee representative Chris Dodd says he will fight for that. On the other hand, Snowe and a few Democrats, like Blanche Lincoln of Arkansas, might vote against the bill on the floor if it contains a public option. Chris Bowers wrote more at Open Left about the merging process in the House and Senate.

I learned from Sioux City Journal columnist Bret Hayworth that a Democrat has already filed Federal Election Commission paperwork to run against Representative Steve King in Iowa’s fifth Congressional district:

Mike Denklau has eyed the possibility of running in the strong Republican district since early 2009, and after traveling western Iowa recently he decided to go all-in.

On Oct. 15, Denklau will announce his candidacy 55 weeks out from the election in stops here in Sioux City, Council Bluffs and Des Moines. Denklau will turn 27 next month – he was raised in Blue Grass near Davenport and graduated from the University of Iowa with majors in political science and finance. He worked in New York for two banking firms through June 2009, including Lehman Brothers, until moving to Council Bluffs recently.

Hayworth notes that it’s not clear whether Rob Hubler, King’s 2008 opponent, will run again. Although Democrats cannot realistically hope to defeat King in a district with a partisan voter index of R+9, an energetic challenger may help drive up Democratic turnout across the district. There will be several competitive state legislative races in the counties that make up IA-05.

Meanwhile, Craig Robinson reports at The Iowa Republican that Rod Blum of Dubuque is ready to challenge Representative Bruce Braley in the first Congressional district.

Blum has strong eastern Iowa roots. He graduated from Dubuque Senior High School in 1973, earned a bachelor’s degree from Loras College (Finance) in 1977, and received a Masters in Business Administration from Dubuque University in 1989. In 1989, Blum was one of the initial employees of Dubuque-based Eagle Point Software. In just five years, Eagle Point Software went public on NASDAQ and had 325 employees. In 2000, Digital Canal was created as a result of a leveraged buyout of Eagle Point Software. Digital Canal is a leading provider of home building and structural engineering software. Blum was also named the Iowa Entrepreneur of the Year in 1994.

While Blum has never run for elected office before, he has been making his political views known in eastern Iowa since 2001 as the Dubuque Telegraph Herald’s conservative columnist. Blum’s writings for the Telegraph Herald will be helpful for a couple of reasons. First, having a regular column in the local newspaper helps build credibility and name ID. Secondly, writing a political column means that he has well thought out positions on many of the issues facing our country today, something many first time candidates lack.

He’ll need more than conservative ideology and name ID in the Dubuque area to unseat Braley. Robinson notes that Republican Jim Nussle represented IA-01 before the 2006 election, but Nussle’s position as chairman of a House budget subcommittee helped him hang on in a Democratic-leaning district. That’s different from a Republican challenger trying to swim against the tide in a district with a partisan voting index of D+5. Republicans currently hold only two House disticts with that much of a Democratic lean: Delaware’s at-large seat, which the GOP will lose when Mike Castle runs for U.S. Senate next year, and Louisiana’s second district, which was a fluke in 2008 because of the Democratic incumbent’s apparent corruption.

Braley is a rising star and effective legislator with a spot on the House Energy and Commerce Committee. He won re-election with more than 64 percent of the vote in 2008. Even if 2010 turns out to be a Republican year, Braley’s not losing in a district with 35,000 more registered Democrats than Republicans.

To my knowledge, Republican Tom Latham (IA-04) is Iowa’s only incumbent in Congress with no likely challenger yet. Steve Rathje and probably Mariannette Miller-Meeks will run against Dave Loebsack in IA-02, while Dave Funk and Pat Bertroche are challenging Leonard Boswell in IA-03. I don’t expect either of those districts to be competitive in 2010.

Soon after becoming the new chairman of the Senate Committee on Health, Education, Labor and Pensions, Tom Harkin expressed hope that the Senate would approve a food safety bill this year. However, he was less optimistic about that timetable when speaking with a group of Iowans who came to Washington last week to lobby for passage of the bill.

Senate Democrats have not given up on passing health care reform through normal procedures requiring at least 60 votes to overcome a Republican filibuster. The problem is, several conservative Senate Democrats are on record opposing a public health insurance option. Meanwhile, a bill with no public option will have trouble passing the House of Representatives, where the overwhelming majority of the Democratic caucus supports a robust public option tied to Medicare rates.

The obvious political solution is to include some watered-down public option in the bill, giving cover to Progressive Democrats who insist on a public option while placating House Blue Dogs and Senate conservatives who want to protect private insurers’ market share.

The “triggered” public option favored by many industry allies didn’t fly, because most Democrats understand that the trigger would never be pulled. This past week, a new possible compromise emerged:

It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

I consider this idea’s pros and cons after the jump.  

Via the Senate Guru blog I saw that Survey USA released results from its late September poll of 600 adults in Iowa (margin of error 4.1 percent). The survey measured Senator Chuck Grassley’s approval rating at 50 percent. That’s the lowest figure ever for Grassley by this pollster, and you can see from this graph that Grassley’s trendlines are ugly. A full 40 percent of respondents disapprove of Grassley’s performance. His high-profile role in the health care reform debate seems to have hurt his image. Senate Guru notes, “Grassley is also below 50% approval among independents (48%) and self-described moderates (47%).”

The Des Moines Register published a new article Monday on rumors that a well-known and well-funded Democrat will give Grassley “the race of his life.” Speculation seems to be centering on former First Lady Christie Vilsack, who is now executive director of the Iowa Initiative, and prominent attorney Roxanne Conlin, a onetime U.S. Attorney who was the Democratic nominee for governor in 1982.

Other notable findings from Survey USA in September: Senator Tom Harkin is at 44 percent approval and 46 percent disapproval. President Barack Obama’s approve/disapprove numbers in Iowa are now 46/48, but there is a huge gender gap. Among male respondents, 39 percent approve of Obama and 56 disapprove. Among female respondents, 53 percent approve and only 40 percent disapprove.

I was surprised to see that Survey USA didn’t find nearly as much of a gender gap concerning Governor Chet Culver. Culver’s at 41 percent approve/48 percent disapprove overall. Among men and women, 41 percent approve of Culver’s performance. The difference is that 55 percent of men said they disapprove of Culver, versus only 44 percent of women (a full 15 percent of female respondents answered “not sure”). If I were running Culver’s re-election campaign, I would put a high priority on building support among women voters. If a well-known woman makes a serious run at Grassley, that should help boost turnout among women Democrats and leaners.

Incidentally, Swing State Project changed its rating on the Iowa governor’s race from “race to watch” (but safe for the incumbent) to “likely D.” They may revise that rating again if former Governor Terry Branstad enters the campaign.

Survey USA’s Iowa sample in September consisted of 35 percent Democrats, 29 percent Republicans, and 31 percent independents. The sample for their August Iowa poll was quite different: 28 percent Democrats, 34 percent Republicans, and 35 percent independents. That alone could explain why Grassley’s approval rating fell from August to September, while Culver’s rose a bit from his all-time Survey USA low in August.

It’s obviously way too early to predict what proportion of Democrats and Republicans will turn out to vote in Iowa next November. The GOP primary for governor could energize that party’s base or cause lasting divisions. The Democratic base may or may not be excited, depending on what Culver and state legislators accomplish next session and whether Grassley’s race becomes competitive.  Unemployment seems likely to keep rising.  

Share any relevant thoughts in this thread.

All of the health care reform bills under consideration in Congress would prohibit insurance companies from refusing to cover people because of prior health problems. “Guaranteed issue” is the wonky name for this ban on discrimination because of pre-existing conditions. Unfortunately, various economists and health care experts told David Hilzenrath of the Washington Post that “simply banning medical discrimination would not necessarily remove it from the equation […].”

If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.

Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.

And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania’s Wharton School. […]

America’s Health Insurance Plans, a lobbying group for health insurers, has endorsed the idea of guaranteeing individuals access to coverage regardless of their medical history — if that guarantee is part of a larger plan to help the uninsured pay for coverage and bring everyone into the insurance market.

At a more nuts-and-bolts level, AHIP has been trying to shape the legislation in ways that could help insurers attract the healthy and avoid the sick, though it has given other reasons for advancing those positions. In a recent letter to Baucus, AHIP President Karen Ignagni said benefit packages “should give consumers flexible options to meet diverse needs.”

If the final health care reform bill has no public health insurance option, many chronically ill Americans are likely to be left outside the system as insurers find new ways of denying coverage or dropping policy-holders.

Even if the final bill includes a limited public option, cherry-picking by private insurers could set up the public plan for failure. President Obama has endorsed the idea of making the public option available only to people who are currently uninsured, meaning it will serve a disproportionate number of chronically ill people. That will drive up costs of operating the public plan.

I don’t have an answer for this problem, beyond feeling depressed that corporate groups like AHIP have so much sway with Congress. If Americans with prior health issues are still facing discrimination after Obama signs what he claims to be sweeping “health insurance reform,” the political backlash against Democrats could be severe.

UPDATE: MyDD user Bruce Webb wasn’t impressed by Hilzenrath’s article. I’ve posted his rebuttal after the jump.

Representative Tom Latham has enjoyed some nice weekends on the dime of his For America’s Republican Majority PAC, I learned from a must-read piece by Jason Hancock at Iowa Independent.

A golf outing in West Virginia and a weekend getaway to Atlantic City, N.J., are just two of the trips taken this year by U.S. Rep. Tom Latham of Ames that have garnered the attention of campaign finance watchdogs.

That’s because the trips were paid for by Latham’s political action committee and touted as fundraising events, a practice that is legal but that government reform advocates contend turns the PAC into little more than a slush fund designed to skirt campaign finance law.

Go read Hancock’s piece for details on Latham’s fundraising trips to the Trump Taj Mahal Casino Resort in Atlantic City and various high-end golf resorts in West Virginia and California. Latham’s PAC “raised $205,447 during the 2008 election cycle, with almost all of it coming from lobbyists, PACs and corporate leaders.”

A new report by ProPublica explains how leadership PACs function:

Legally, lawmakers are free to spend the leadership PAC money pretty much as they wish.

Lobbyists and lawmakers can — and do — use it to travel together to play golf at Pebble Beach, ride snowmobiles in Montana’s Big Sky Country and go deep-sea fishing in the Florida Keys. The lobbyists don’t pay the costs directly. They contribute to the leadership PAC, which then pays the lawmaker’s resort and travel bills.

Leadership PACs have grown steadily since they began cropping up in the 1970s. What separates them from campaign committees is that lawmakers are supposed to pass along the bulk of the money to other members of their party for their campaigns. That way, lawmakers with leadership PACs can earn their beneficiaries’ support when it comes time to divvy up committee chairmanships and other party leadership posts.

This system helps party leaders spread money to candidates with less money or tighter races. On the other hand, it also fuels the Washington money chase, allocates power in Congress based on fundraising prowess, and encourages lawmakers and lobbyists to mingle socially and recreationally as political money changes hands.

In this tough economy, couldn’t Latham encourage his corporate lobbyist buddies to golf, gamble and spread political money around in Iowa?  

In case you’re wondering whether everyone in Congress does what Latham’s been doing with his PAC, ProPublica’s report has lots more information on hundreds of leadership PACs. But Hancock notes that Iowa’s other members of Congress have used their leadership PAC money for campaign contributions and various expenses, as opposed to trips to high-end casinos and golf resorts.

If you’re an insurance company, that is:

Late in the afternoon [on Wednesday], Sen. Chuck Grassley (Iowa), the top Republican on the committee, requested consideration of the “Grassley F-1 Modified Amendment.” Its goal: eliminate $7 billion a year in fees that the government would charge private health insurance companies, and make up the shortfall by reducing benefits to poor people and legal immigrants.

It was dangerously close to a parody: Republicans demanding that fees be reduced on a profitable industry and shifted to low-income Americans. But Grassley pressed on, unafraid. The fees on the corporations, he said, are a “bad idea” and would undoubtedly result in higher insurance premiums. “I urge my colleagues to vote for my amendment, to strike the fees,” he exhorted.

Sen. Jay Rockefeller (D-W.Va.) recognized the fat target that Grassley had just set up. “I think it’s a ‘message amendment,’ ” he said, suggesting Grassley was sending a symbolic signal to the conservative base. “It certainly takes on legal immigrants and Medicaid in a very sharp way.”

Grassley looked hurt. “You don’t really believe that this is a message amendment, do you?”

Why so cynical, Senator Rockefeller? I take Senator Grassley at his word. He would rather reduce health care coverage for poor people and immigrants (during a recession!) than force a profitable industry to pay higher fees.

I encourage Bob Krause and Tom Fiegen to add this Washington Post story to their Senate campaign websites.

In case anyone is wondering, I still have no idea who the mystery Grassley challenger might be.

UPDATE: Grassley also failed on Wednesday to get the committee to adopt “that would have required beneficiaries of Medicaid and the Children’s Health Insurance Program to show a photo ID in order to enroll.” However, the committee unanimously adopted Grassley’s amendment “that would require members of Congress to get their health insurance through a proposed federal exchange.”

The White House agreement with the pharmaceutical industry, which is reflected in the Senate Finance Committee’s health care bill, is one of the most shameful episodes of the health care reform process. Presidential candidate Barack Obama had promised to “put an end to the game-playing” in Washington, citing in one television ad the deal the pharmaceutical industry wrote into the Medicare prescription drug legislation. Yet in order to bring big Pharma on board with health care reform, the White House “stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion.”

Senator Byron Dorgan of North Dakota says no deal, according to Ryan Grim of the Huffington Post:

A Senate Democratic leader is hoping to blow up the deal reached between the White House, drug makers and Senate Finance Committee Chairman Max Baucus (D-Mont.), by introducing an amendment on the floor to allow prescription drugs to be re-imported from Canada.

It’s one of the simplest ways to reduce health care costs but was ruled out by the agreement, which limits Big Pharma’s contribution to health care reform to $80 billion over ten years.

North Dakota Sen. Byron Dorgan, a member of Democratic leadership, isn’t a party to that bargain. “Senator Dorgan intends to offer an amendment to the health reform bill and his expectation is that it will be one of the first amendments considered,” his spokesman Justin Kitsch told HuffPost in an e-mail. “Prescription drug importation is an immediate way to put downward pressure on health care costs. It has bipartisan support, and has been endorsed by groups such as the National Federation of Independent Businesses and AARP.” […]

Jim Manley, senior communications adviser to Senate Majority Leader Harry Reid (D-Nev.), said that he sees no reason the amendment won’t get a floor vote.

If an amendment on reimporting drugs from Canada gets to the Senate floor, it is hard to see how it fails to pass. Grim notes that a separate bill to allow re-importation of prescription drugs from Canada “has 30 cosponsors, several Republicans among them.” I hope the White House doesn’t start twisting arms to keep that amendment off the Senate floor.

Giving the government the ability to negotiate prescription drug prices would bring costs down even more. Obama should support that reform, since he says he won’t let the health care bill add a dime to the deficit. But apparently, not taking that step was part of the White House deal with drug companies.

Speaking of backroom deals, Alexander Bolton reports for The Hill, citing “senior Democratic aides,” that Reid will “not include legislation repealing antitrust exemptions for the health insurance industry in the healthcare package he will bring to the Senate floor.”

So far the powerful insurance industry has held back waging a full-out battle against Democratic health reform proposals because companies stand to gain tens of millions of new customers. But adding language that would open health insurance companies to prosecution by the Justice Department would provoke a strong counterattack from the industry.

Hey, why take something valuable away from the insurance industry (the ability to fix prices) just because we’re about to hand them a “bonanza” (individual mandate to buy their products)? They might run ads against us.

It is time to replace Reid as Senate majority leader. Since Senate Democrats are unlikely to take that step, I agree with Chris Bowers that Reid losing re-election next year wouldn’t be such a bad thing. Getting a more effective majority leader, like Dick Durbin of Illinois or Chuck Schumer of New York, would make up for losing Reid’s Senate seat.

As expected, the Senate Finance Committee rejected two amendments yesterday that would have added a public health insurance option to the health care reform bill Chairman Max Baucus drafted with a big assist from industry lobbyists. Five Democrats voted with all the committee Republicans against Senator Jay Rockefeller’s amendment, which would have created a national public option tied to Medicare rates. Three Democrats also joined Republicans to vote down Senator Chuck Schumer’s much weaker “national level playing field” public option. CA Berkeley WV liveblogged yesterday’s hearing for Congress Matters.

Senator Chuck Grassley sang the same old song about the “government run plan” forcing private insurance companies out of business. He got a little tripped up when Senator Chuck Schumer asked him for his views on Medicare, though.

“I think that Medicare is part of the social fabric of America just like Social Security is,” Mr. Grassley said. “To say that I support it is not to say that it’s the best system that it could be.”

“But it is a government-run plan,” Mr. Schumer shot back.

Mr. Grassley, a veteran Senate debater, insisted that Medicare did not pose a threat to the private insurance industry. “It’s not easy to undo a Medicare plan without also hurting a lot of private initiatives that are coupled with it,” he said.

Chairman Baucus scored highest on the chutzpah meter, praising the public option even as he refused to support it. Grassley also held out false hope that maybe someday some other bill will accomplish that goal.

Several Senate Democrats, including Tom Harkin, insisted yesterday that they will get some kind of public option into the bill that reaches the Senate floor. After the jump you’ll find lots of links on the battles to come.

I agree that the public option is not dead yet, but for it to survive, President Barack Obama and Senate Majority leader Harry Reid will need to do a lot more than they’ve done so far to lean on the Senate conservadems.  

Iowa Democratic Party chair Michael Kiernan spoke confidently today about a “first-round draft pick” who is ready to run against Senator Chuck Grassley, Kay Henderson reported for Radio Iowa.

“I’m going to tell you here today that Chuck Grassley is going to be in for the race of his life.” […]

“You’re just going to have to wait to find out,” Kiernan said this morning during taping of this weekend’s “Iowa Press” program.  “We want to wait ’til, obviously, after Terry Branstad announced his candidacy for governor.”

Kiernan isn’t revealing the characteristics this phantom candidate may have either. “I’ll just wait for the announcement,” Kiernan said.  “You will be impressed.” […]

“I’m here to tell you today that it will be the toughest race that Chuck Grassley has faced since John Culver,” Kiernan said.

Grassley defeated Senator John Culver (Governor Chet Culver’s father) in the 1980 Reagan landslide.

Speaking to reporters after today’s taping, Kiernan said the big-name challenger is “100 percent committed” to this race.

Your guess is as good as mine. A retired politician? Christie Vilsack? A celebrity in a non-political field? Someone from the business world? (Retired Principal Financial Group CEO Barry Griswell has ruled out running, as has Fred Hubbell, the incoming interim director of the Iowa Department of Economic Development.)

Grassley’s approval rating has fallen this year, but it’ll take a lot to convince me that we can defeat him. He’s still got a strong brand name and 30 years of constituent service behind him.

For months, White House officials and Senate leaders praised the “gang of six” negotiations toward a bipartisan deal on health care reform, even as other observers doubted the Republicans in that group were negotiating in good faith. At the beginning of the summer recess in August, Senator Jay Rockefeller (who was shut out of the deal-making) warned:

Changes to the bill have been frustrating, Sen. Jay Rockefeller (D-W.V.) told reporters at a press conference, particularly given that the Republicans — Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine — are, in his opinion, just stalling for time.

“You just watch as the bill diminishes in its scope, in its coverage, in its ferocity to try to attack the problem. I don’t know where it will come out,” Rockefeller said. “My own personal view is that those three Republicans won’t be there to vote it out of committee when it comes right down to it, so that this all will have been a three-or-four-month delay game, which is exactly what the Republicans want.”

No Republicans stood with Senate Finance Committee Chairman Max Baucus last week as he finally unveiled what David Waldman described as “a plan that amounts to capitulating to every Republican demand, and then adding a heaping pile of political suicide on top of it.” The bill is in markup this week, and CA Berkeley WV has been blogging the Senate Finance Committee meetings for Congress Matters (day one, day two and day three).

Where does ranking Finance Committee member Grassley stand after Baucus bent over backwards to keep negotiating with him all summer? After the jump I’ve posted the relevant portion of a transcript from Grassley’s September 24 telephone news conference with Iowa reporters. The short version is, he’s against the bill because:

1. The individual mandate to buy health insurance amounts to “[q]uite a steep tax for people that maybe don’t pay a tax.”

2. Democrats supposedly were “not willing to go far enough” on enforcement to make sure illegal immigrants wouldn’t be covered.

3. Democrats supposedly “weren’t willing to go far enough to make sure that the subsidy through the tax credit was not used to finance abortions.”

4. You shouldn’t be “increasing taxes and cutting Medicare” when “we’re in depression.”

I told Iowa Republicans not to worry about Grassley voting for any health care reform bill. Senate Democrats should reject the concessions Baucus made to win GOP votes that are now off the table.

The Republican polling firm Rasmussen Reports surveyed 500 “likely voters” in Iowa on September 22 and came up with bad numbers for Governor Chet Culver. Former Governor Terry Branstad leads Culver by 54 percent to 34 percent, and Bob Vander Plaats leads Culver by 43 percent to 39 percent. Culver’s approval rating is 43 percent, with 53 percent of respondents disapproving of the job he is doing.

Topline results and favorability ratings are here. Culver was viewed very or somewhat favorably by 43 percent of respondents and viewed very or somewhat unfavorably by 50 percent. Branstad’s favorability was 64 percent, and his unfavorable numbers were just 29 percent. Vander Plaats was viewed favorably by 45 percent and unfavorably by 30 percent.

These numbers will encourage Branstad, who appears likely to seek his old job again. He has said he’ll decide by October, and I’ve heard rumors that Branstad will announce his candidacy very soon (September 28 according to one person, October 3 according to someone else). I believe that the numbers we see for Branstad this month will be his high water mark, since no one has campaigned against him for 15 years.

Vander Plaats will surely cite the Rasmussen poll as proof that he can beat Culver. The whole “draft Branstad” movement grew out of fears that Vander Plaats could not win a general election.

As a rule, Rasmussen polls tend to come in with somewhat better numbers for Republican candidates and worse numbers for Democrats. Go to Pollster.com and click on almost any national or state-level race to compare recent results from different pollsters.

The recent Selzer Iowa poll for the Des Moines Register found much better numbers for Culver (50 percent approve, 39 percent disapprove). Selzer polled 803 Iowans over a three-day period (3.5 percent margin of error), while Rasmussen polled 500 “likely voters” on a single day (4.5 percent margin of error). Selzer did not poll Culver against Branstad or any other Republican.

I am seeking further information about the likely voter screen Rasmussen used, as well as the proportion of Democrats, Republicans and no-party voters in the sample. I will update this post if I receive more details. If any Rasmussen premium subscriber is reading, feel free to post a comment here or e-mail me at desmoinesdem AT yahoo.com.

The same Rasmussen poll shows Senator Chuck Grassley leading Democrat Bob Krause 56 percent to 30 percent. Chase Martyn looks at the trendlines and concludes that Grassley could become vulnerable next year. In my opinion, Grassley is still well outside the danger zone for an incumbent despite his falling approval numbers.

Click here for Rasmussen’s results on how Iowans view President Obama, the economy and health care reform proposals.

UPDATE: The commenters at Swing State Project trust Selzer a lot more than Rasmussen. One person pointed out that in late July, Rasmussen found Senator Barbara Boxer of California leading Republican Carly Fiorina by just four points (45-41), while a few weeks later Research 2000 found Boxer leading Fiorina 52-31. It appears that Rasmussen’s likely voter screen produces a sample skewed a bit toward Republicans.

It would have been helpful if the Des Moines Register’s recent poll had asked respondents about Culver and Branstad and Vander Plaats. Craig Robinson is wrong to imply that the Register might have asked those questions and decided to cover up the results. The Register published the full questionnaire from its recent poll. Some pollsters don’t think head to head matchups are useful this far out from an election.

On Tuesday the U.S. House of Representatives passed the Unemployment Compensation Extension Act of 2009, which “would extend unemployment insurance benefits by 13 weeks in states that have jobless rates above 8.5 percent.” 27 states and the District of Columbia have unemployment rates exceeding that level.

The bill easily passed by a vote of 331 to 83, but as you can see from the roll call, Iowa’s House delegation was divided in an unusual way. Representatives Bruce Braley (IA-01) and Leonard Boswell (IA-03) were among the 17 Democrats who voted against the bill. They opposed it because unemployed Iowans would be ineligible for the extended benefits. Although our state has the eighth-lowest unemployment rate in the country, we also have pockets of higher unemployment, especially in rural areas.

After the jump I’ve posted statements released by Braley and Boswell on this bill. Boswell noted that four counties in the third Congressional districts have unemployment rates above 9 percent. Braley noted, “When you’re unemployed, it doesn’t matter to you what your state’s unemployment rate is.  What matters is that you need to support your family.”

Representative Dave Loebsack (IA-02) did not vote yesterday, because he was meeting with Fema Administrator Craig Fugate and various state and local officials in Cedar Rapids to discuss flood recovery efforts. I contacted his office for comment on the unemployment bill. His spokesperson Sabrina Siddiqui told me that Loebsack had serious concerns about the way Iowans were excluded from the extended unemployment benefits, adding that Loebsack is working with House leaders to address the needs of unemployed Iowans in future legislation.

Extending unemployment benefits during a severe recession is good policy, not only to help struggling families, but because spending on unemployment benefits has a very high economic stimulus “bang for the buck.” That said, it’s unfair to penalize unemployed Iowans for the fact that our state is faring better than many others on the jobs front.

Iowa’s Republicans in the U.S. House were also divided on this bill, with Tom Latham (IA-04) voting yes and Steve King (IA-05) voting no.

The House of Representatives passed the Student Aid and Fiscal Responsibility Act on Thursday on a mostly party-line vote of 253 to 171 (roll call here). Iowa Democrats Bruce Braley, Dave Loebsack and Leonard Boswell all voted for the bill, while Republicans Tom Latham and Steve King voted against it.

Click here to download a pdf file containing the House Education and Labor Committee’s estimates on how many students in each Congressional district will be able to receive Pell Grants during the 2010/2011 academic year under this reform. The estimate is 16,355 students in Iowa’s fourth district (Latham) and 16,301 students in Iowa’s fifth district (King).

Overall, just four Democrats voted against the bill: Allen Boyd (FL-02), Paul Kanjorski (PA-11), Stephanie Herseth-Sandlin (SD-AL), and Mike McMahon (NY-13). Six Republicans voted for the bill: Vern Buchanan (FL-13), Joseph Cao (LA-02), Timothy Johnson (IL-15), Tom Petri (WI-06), Todd Platts (PA-19), and Ileana Ros-Lehtinen (FL-18). At Congress Matters, David Waldman posted details about the amendments proposed to this bill and which ones passed yesterday.

A press release from the Democratic Congressional Campaign Committee included these bullet points about the bill:

*The Student Aid and Fiscal Responsibility Act is the largest single federal investment in higher education in American history and will also be used to pay down the national debt (H.R. 3221, #719, 9/17/09)

*The measure will make federal student lending more efficient through a variety of reforms that will save the federal government $87 billion. Of those savings, $77 billion will be invested toward making college more affordable and $10 billion will be used to pay down the national debt.

*These savings will be achieved through a number of reforms including:

*Converting federal lending to the Direct Loan Program.

*Establishing a competitive bidding process, allowing the U.S. Department of Education to select lenders based on how well they serve borrowers.

*Allowing non-profit organizations to continue servicing student loans.

*This measure will increase the amount of Pell Grants in 2010 and 2011, lower the interest rates of federally subsidized student loans, expand the Perkins Loan program, and streamline the application form for financial aid.

Senate HELP Committee Chairman Tom Harkin is committed to passing student loan reforms this year.

UPDATE: Like Latham and King, all the House Republicans from Kentucky voted against this bill, and I agree with RDemocrat’s assessment at the Hillbilly Report:

I think this once again properly demonstrates the hypocrisy of Kentucky Republicans and the Republican Party as a whole. They constantly lecture us on spending, but they care little about money being wasted as long as it is being wasted on corporate welfare. When presented with a chance to both save money, and help working poor children afford college, they would rather waste that $80 billion.

Senator Jay Rockefeller was excluded from the bipartisan group of Finance Committee members who worked on the bill Chairman Max Baucus unveiled on Wednesday, so he spent part of his summer vacation researching the fake public option favored by some “gang of six” members. He reported on his findings in an open letter to Baucus and ranking member Chuck Grassley. You should click through and read Rockefeller’s whole letter, but here are some excerpts:

“First, there has been no significant research into consumer co-ops as a model for the broad expansion of health insurance. What we do know, however, is that this model was tried in the early part of the 20th century and largely failed. As the USDA states in its response letter, ‘Government support for the cooperative approach to delivering universal health care was reduced during [World War II] and terminated afterward.’ This is a dying business model for health insurance. Moving forward with health insurance cooperatives would expose Americans, who are hoping for a better health care system, to a health care model that has already been tried and largely failed in the vast majority of the country.

“Second, there is a lack of consistent data about the total number of consumer health insurance cooperatives in existence today, and there have been no analyses of the impact of existing health insurance cooperatives on consumers.

“Third, all of the consumer health insurance cooperatives identified by the [U.S. Department of Agriculture] and [National Cooperative Business Association] operate and function just like private health insurance companies. Therefore, it is unclear how expanding consumer health insurance cooperatives would actually achieve greater affordability for consumers or bring about greater competition in the private market…

The Congressional Budget Office doesn’t expect the co-ops to affect the cost of the Baucus bill:

(The proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the specifications, they seem unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments.)

The failure of co-ops to provide competition in Iowa bears out the CBO’s expectations:

In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Wellmark Blue Cross and Blue Shield collects about 70 percent of the premiums paid in the private insurance market in Iowa and South Dakota.

It’s past time for President Obama to stop sending out White House staff and cabinet secretaries to signal that Obama might accept cooperatives as an alternative to a public health insurance option.

Here’s hoping that even in the absence of presidential leadership, Rockefeller can get strong amendments attached to the Baucus bill or make sure it never gets out of the Senate Finance Committee.

In his latest e-mail blast to constituents, Senator Tom Harkin touches on his priorities as the new chairman of the Senate Committee on Health, Education, Labor and Pensions. One point he mentioned hasn’t been on my radar screen this year:

The full agenda of the Committee will focus on reforming federal student loan programs so that we can stop subsidizing private banks and instead focus on loans that the federal government can make more cheaply.  We can save $87 billion over 10 years in that effort, and use that money to increase Pell grants for low- and middle- income college bound students, and to fund other important education initiatives.  

I had forgotten about President Barack Obama’s effort to reform the student loan system:

His plan is to do away with a system in which the Federal Government subsidizes banks and other private finance companies like Sallie Mae to lend money to students. The Administration essentially wants to cut such companies out of the game and run the system itself. Democrats claim the move will save $87 billion over 10 years, which can be used for a laundry list of education priorities, including increasing the maximum amount of Pell Grants, expanding Perkins Loans and investing in community colleges and other programs. […]

Educational institutions currently have two ways to offer federal loans to students. In the Federal Family Education Loan (FFEL, pronounced “fell”) program, the government pays subsidies to banks and lenders to dole out money to borrowers and reimburses companies up to 97% of the cost of any loan that is not paid back. The second way is the direct-loan program, created in 1993 as an alternate option, in which the government cuts out the middle man, lends money directly and gets all the profits. If the Student Aid and Fiscal Responsibility Act (SAFRA) passes both houses of Congress, the approximately 4,500 colleges and universities that are currently signed up for FFEL will have to abandon the program and start using the direct-loan option by July 1, 2010.

Directing federal money toward programs that help needy students, such as Pell Grants, makes a lot more sense than subsidizing private banks to make student loans.

Finding 60 votes in the Senate for this proposal will be challenging, however. This is one banking bailout Republicans will fight hard to protect, and according to Time magazine, at least one Democrat (Ben Nelson of Nebraska) opposes the plan too. If this bill passes, it will probably be through the budget reconciliation process, which requires only 51 votes in the Senate.

Health care reform is sure to take up a lot of Harkin’s time this fall, but I’m glad the HELP chairman will also focus on other bills that could change many lives for the better. Even if the health care project falls apart in the Senate, Harkin could accomplish a lot this year if he gets the student loan bill through and brokers a good compromise on the Employee Free Choice Act.

I see only one downside to Harkin becoming the HELP chairman, and that’s Senator Blanche Lincoln of Arkansas taking over the Agriculture Committee. Jill Richardson has been on this case at La Vida Locavore. I recommend reading her posts on industry lobbyists who used to work for Lincoln, Lincoln’s strong support for corporate ag interests such as Arkansas-based Tyson Foods, and Lincoln’s positions on trade, the climate change bill, and the Clean Water Act.

BruceMcF breaks it down for you:

So: (1) Public Choice

“No Taxation without Representation”. Every single person facing an individual mandate must be provided with the choice of a publicly administered plan. Otherwise the government is forcing the citizen to pay without the elected representatives of the citizen controlling the spending.

You want to put a trigger on the public option. Fine, except the exact same trigger applies to the individual mandate.

You want to restrict access to the public option to some smaller group? Fine, except the same restriction applies to the individual mandate.

The system is not politically legitimate if it requires payment to for-profit commercial corporations.

(2) Robust

It cannot be lumbered down with any restrictions not faced by private insurers.

State by state public options? Really? You are really prepared to restrict the corporations to firms with no commercial activity across state lines? If they are free standing state by state public options, it has to be state by state for profit corporations. Oh, not allowing [United Healthcare] into the exchanges defeats the purpose of lining private pockets at the public expense? Yeah, kind of thought so.

BruceMcF has long been one of my favorite transportation bloggers and has written great stuff on health care reform too, including Axelrod: Government by Consent of the Corporation. His home blog is Burning the Midnight Oil, but he frequently cross-posts his work at Progressive Blue, Daily Kos, My Left Wing, Docudharma, and the Hillbilly Report.

Speaking of real and fake public options, Timothy Noah explains “the sorry history” of triggers enacted by Congress, and slinkerwink has suggestions and talking points to use when contacting House Progressives about health care reform. I still think it’s worth urging Populist Caucus members as well as Progressives to insist on a real, not fake or triggered, public option in the final health care bill.

Bruce Braley (IA-01) leads the Populist Caucus, and Dave Loebsack (IA-02) and Leonard Boswell (IA-03) both belong to the caucus. All of them have advocated for the public option, but to my knowledge none has pledge to vote down any bill that lacks a public option.

For those interested in the nitty gritty of legislative wrangling, David Waldman ponders what might happen if the Senate Finance Committee members can’t agree and consequently fail to report out a health care bill.

Senator Tom Harkin told a crowd of nearly 2,000 people today that health care reform including a public health insurance option will pass before this Christmas. Speaking at his 32nd Annual Steak Fry in Indianola, Harkin joked,

“This is my kind of town-hall meeting,” […] because he didn’t see any Republicans standing up to say, “Keep your government hands off my Medicare.”

Harkin and event headliner Al Franken predicted that health care reform would pass with some Republican votes, which seems unlikely if the final version of the bill contains a public option. Republican Senator Olympia Snowe of Maine has been the focus of White House courting on health care, but she opposes a public option, apparently because it has the potential to provide lower-cost health insurance.

The Senate Committee on Health, Education, Labor and Pensions passed a bill this summer containing a public option, but according to one critic, the HELP bill’s public option is anything but robust:

the actual provisions in the HELP Committee bill call for numerous “community health insurance options,” not the single “Medicare-like” plan promised by “public option” advocates. That means the individual “options” will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these “community options” will almost certainly be run by insurance companies.

The public option in the bill that cleared the House Energy and Commerce Committee, HR 3200, is also weak in several respects.

President Barack Obama met with 17 relatively conservative Democratic senators on Thursday, reinforcing many people’s fears that he was ready to discard the public option. The same day, Harkin assured the Progressive Populist blog that 51 votes can be found in the Senate for a bill with a public option.

So what about all the hubub about the Blue Dogs and/or Progressives opting out if the bill doesn’t meet their liking? Harkin said don’t put too much stock in those statements.

“Look, around here people are always jockeying for power. That’s all this is,” Harkin said.

The only chance of making this bill stronger, in my opinion, is getting a large bloc of House Democrats to draw a line in the sand. If you live in Iowa’s first, second or third Congressional districts, please contact Bruce Braley, Dave Loebsack or Leonard Boswell to urge them not to accept any bill containing a “trigger” (which is guaranteed to fail) or some other fake public health insurance option. Organizing for America has a new petition out if you prefer that method of generating an e-mail to your member of Congress.

UPDATE: Don’t miss John Deeth’s entertaining liveblog from this event, with lots of photos. Braley and Loebsack praised Boswell for standing up for a public option (unlike many Blue Dogs).

From Chase Martyn’s write-up at Iowa Independent:

Boswell and fellow Democratic U.S. Reps. Bruce Braley and Dave Loebsack also expressed optimism that a final bill would include measures to reform medicare reimbursement rates. Medicare currently pays doctors in rural states like Iowa less than what doctors in densely populated states receive for the same procedures.

I mentioned on Labor Day that I haven’t heard much lately about Senator Tom Harkin’s efforts to reach a compromise on the Employee Free Choice Act. The EFCA is one of the top legislative priorities for organized labor and needs 60 votes in the Senate to overcome a Republican filibuster. Several Democrats who supported the bill in 2007, knowing that President Bush would veto it, either oppose the bill or have dodged the question this year.

Harkin has been the lead Senate negotiator on EFCA and is replacing the late Senator Ted Kennedy as chairman of the Committee on Health, Education, Labor and Pensions. Speaking to the American Rights at Work group yesterday, Harkin said he had 60 votes lined up behind a compromise this summer:

“As of July, I can tell you this openly and I know the press is all here but we had worked out a pretty good agreement. […]”

Harkin said prominent labor leaders were on board with the deal, including AFL-CIO President John Sweeney and Andy Stern, president of the Service Employees International Union.

“That’s when we needed 60 votes and that’s when I called to get Sen. Kennedy down because we needed him for three days. That’s when Dr. [Lawrence] Horowitz told me that he couldn’t make it,” Harkin said.

The Hill’s Kevin Bogardus reported that Harkin refused to specify the terms of the compromise deal:

“I will not say because it was closely held, it never leaked out and it still hasn’t,” Harkin said. “I took it off the front-burner and put it on the back-burner so it is still on warm, OK?”

In May Harkin suggested that the “card check” provision might be dropped from the bill in favor of other changes to labor election procedures. He did not say anything about binding arbitration, which is also an important part of the EFCA.

If Massachusetts law is changed to allow Governor Deval Patrick to appoint a temporary replacement for Kennedy, then Harkin may be able to revive this compromise and pass the EFCA this fall. Democratic leaders in the House agreed earlier this year not to bring the EFCA up for a vote until the measure had passed the Senate. Getting the bill through the House should not be difficult, even if a substantial number of Blue Dog Democrats vote no.

Last year all five Iowa incumbents in the House of Representatives were re-elected by double-digit margins. The main challengers failed to win even 40 percent of the vote against Democrats Bruce Braley (IA-01) and Dave Loebsack (IA-02), as well as Republicans Tom Latham (IA-04) and Steve King (IA-05).

I’ve long assumed that none of Iowa’s Congressional districts would be competitive in 2010. Although Republicans have put Leonard Boswell (IA-03) on their long list of House targets, several other analysts share my view that Boswell is safe for next year. To my knowledge, the only declared candidates against Boswell are the little-known Dave Funk and Pat Bertroche. Boswell’s 1996 opponent Mike Mahaffey is thinking it over too.

Isaac Wood and Larry Sabato released new House race rankings, and they included IA-03 among 47 Democratic-held districts that are “likely” to remain Democratic:

The “likely” category is reserved for those competitive races where one party has a distinct advantage over the other. Most of these races feature either strong challengers or weak incumbents, but not a combination of the two that would warrant a more competitive designation. Consider these races as a watch list which could turn into heated battle with a single misstep by an incumbent or positive fundraising report.

I could see Iowa’s third district becoming competitive, but only if the economy is in terrible shape next fall and Republicans fund a well-known candidate with a base in Polk County (the population center of the district).

I question Wood and Sabato’s decision to put Loebsack’s district in the “likely” category as well. So far right-winger Steve Rathje is definitely running against Loebsack (he narrowly lost the 2008 GOP primary for U.S. Senate). Mariannette Miller-Meeks is also considering a rematch. She’s an impressive woman, but I frankly can’t imagine this district becoming competitive in 2010. IA-02 has much stronger Democratic voting performance than IA-03, which tracks closely with the nationwide vote in presidential elections.

Share any thoughts or predictions in this thread.

President Barack Obama goes before Congress this evening to urge passage of health care reform this year. I will update this post later when the prepared text of the speech becomes available. White House officials say Obama will make the case for a public health insurance option, but it sounds as if he will still leave the door open for Congress to take a different approach. That doesn’t look like a strong negotiating position to me.

Various polling firms will survey people who watch Obama’s speech tonight. Mark Blumenthal of Pollster.com discusses the methodology of instant reaction polls and gives a few reasons for you to be skeptical of their findings.

Speaking of polls, I was disappointed to learn from Greg Sargent that a recent White House memo omitted results from polls showing strong nationwide support for a public health insurance option. (Multiple polls earlier this summer also found majorities in favor of a public option. In fact, Republican pollster Rasmussen has found that support for health care reform drops sharply if there is no public option.

Still, expect to hear Republicans demagogue against government-run “Obamacare.” Yesterday The Iowa Republican blog hyped a new poll from the Winston Group showing that a plurality of Iowans oppose “Obama’s plan” for health care (whatever that is). I wasn’t surprised to read that the head of the Winston Group

has served as a strategic advisor to Senate and House Republican leadership for the past 10 years. He was formerly the Director of Planning for Speaker of the House Newt Gingrich, and advises center-right political parties throughout Europe. Additionally Winston was a senior fellow at the Heritage Foundation where he did statistical policy and econometric modeling. He has served in a senior staff role to four RNC Chairmen.

Gee, I’m shocked that the Winston Group would produce a poll indicating that Obama’s plan is unpopular.

The president’s support has declined quite a bit among Democrats and independents recently. The obvious way for him to turn this situation around is to get behind a real health care reform package that doesn’t give away the store to corporate interests.

Speaking of giving away the store, Senate Finance Committee Chairman Max Baucus finally made his health care plan public this week. Turns out K Street lobbyists had the draft before Baucus showed it to fellow senators or White House officials. Also, a Baucus staffer who used to work for WellPoint is the author of the document.

Ezra Klein thinks the Baucus plan isn’t as bad as you may have heard, but Chris Bowers explains why it is very, very bad. I’m keeping my fingers crossed that Chuck Todd and Andrea Mitchell are correct, and the White House is sick of dealing with Baucus. But like Bowers, I am skeptical that Obama would push for any law encountering objections from the major industry it affects. Consequently, I have no confidence in Obama to reject the Baucus approach outright.

Post any thoughts about the president’s speech or health care reform in this thread.

UPDATE: The full text of the speech as prepared is after the jump. I didn’t watch, but I did read the speech and I am very disappointed. He made a big deal about the moral case for reform, then defended the public option by saying don’t worry, hardly anyone will sign up for it. The only veto threat he made was, “I will not sign a plan that adds one dime to our deficits – either now or in the future.”

If we did health care reform right, we would save money and not add to the deficit. But on principle, I reject the idea that providing universal health care at reasonable cost is not worth doing if it adds to the deficit. Obama doesn’t mind expanding our commitment in Afghanistan, providing an open-ended bailout to Wall Street, extending most of the Bush tax cuts and any number of other things that add to the federal deficit. But for some reason, health care reform isn’t as important. Pathetic.

Corrupt Democrats will make sure that no real public option remains in the bill, which will drive up the cost, allowing Republicans to complain that Obama is breaking his promise not to add to the deficit. To keep costs down, Congress will probably reduce the subsidies available to citizens who will be forced to purchase private insurance. Huge bonanza for insurance companies, nothing to keep costs down, political suicide for the Democratic Party.

I don’t care what the instant reaction polls say; in my view this speech was a failure.

Senator Ted Kennedy’s death left a vacancy as chair of the Senate Committee on Health, Education, Labor and Pensions. I had assumed that Senator Chris Dodd of Connecticut, who is looking vulnerable going into his re-election campaign, would jump at the chance to become the HELP committee chairman, but surprisingly, he prefers to remain chairman of the Senate Banking Committee. Paul Kane reports for the Washington Post,

Dodd’s decision leaves the chairmanship of the Health, Education, Labor and Pensions Committee to Sen. Tom Harkin (D-Iowa), who follows Dodd in seniority. Multiple sources in the Harkin orbit, requesting anonymity to discuss internal deliberations, said that he is certain to take over the HELP committee.

Harkin is currently chairman of the Agriculture Committee and would have to give up that position. He would likely be replaced at Agriculture by Sen. Blanche Lincoln (D-Ark.), who faces a difficult reelection bid in 2010. Other Democrats are more senior than her on the Agriculture Committee, but they hold more prestigious chairmanships already.

Leaving the chairman’s position at Agriculture means Harkin will have less influence over the drafting of the next farm bill. On the other hand, the HELP Committee deals with a range of extremely important issues.

I have contacted Senator Harkin’s office seeking confirmation of this report, and I’ll update this post when I hear back from his staff.

UPDATE: Harkin will replace Kennedy as HELP chairman. His statement is after the jump, along with a statement from Iowa Democratic Party chair Michael Kiernan.

UPDATE: Two professional negotiators, Jerome a Paris and BenGoshi, discuss Obama’s negotiating strategy on health care reform.

Let’s say I’m trying to sell my house, and I have an interested buyer. I could tell the buyer one of two things:

1. The minimum offer I’ll consider for this house is $300,000.

2. This house is worth at least $300,000. Compared to the house down the street that went for $280,000, this house has an extra bedroom and a fully remodeled kitchen. In fact, my house has a bigger yard and more closet space than one in the neighborhood that sold for $310,000. Also, we just added more insulation in the attic and installed triple-pane windows, so you’ll spend less on utility bills than you would in a different house this size. Plus, this house is within walking distance of a good elementary school. But the bottom line is, my mortgage is expensive, and I need to sell my house this month. If you can’t pay me $300,000, I’m willing to consider another fair offer.

Which message is more likely to get me the offer I want: the one justifying my asking price, or the one making clear that I won’t settle for less?

Over at the Campaign Diaries blog, Taniel wrote a good post on Thursday debunking the “unsubstantiated myth” of a pending primary challenge against Senator Chuck Grassley. Bill “crazier than Steve King” Salier got this speculation going in the spring, when many among the religious right were disappointed by Grassley’s reaction to the Iowa Supreme Court’s Varnum v Brien ruling.

This summer, Grassley continued to disappoint the right by negotiating with other Senate Finance Committee members on health care reform. State Representative Kent Sorenson wrote an open letter to Grassley, pleading with him to provide “principled and bold leadership”. Sorenson’s letter is the most-viewed post ever published on The Iowa Republican blog, where Craig Robinson warned last month,

The longer Sen. Grassley strings along Iowa Republicans, the more difficult his re-election effort may become. At the beginning of the year, it would have been absurd to suggest that Sen. Grassley could face a legitimate primary challenge. Now, with each and every passing day that Grassley flirts with supporting some version of health care reform, the possibility of a primary challenge grows.

Grassley’s conservative critics are misguided in the sense that the senator has done more to block health care reform than move it along. If not for Grassley and the rest of the Finance Committee “gang of six,” Democrats might have been able to get the bill through the Senate this summer.

Still, the disappointment with Grassley is real. The trouble is, you can’t defeat an incumbent just by being mad, and as Taniel points out, no Republican appears likely to run against Grassley in next year’s primary. Salier has ruled himself out, as has Sorenson (though I wish Sorenson would run for Senate, giving Iowa Democrats an open seat target in House district 74).

Social conservatives are likely to focus on the governor’s race between now and June 2010. Bob Vander Plaats will officially announce his candidacy on Labor Day and will need all the help he can get from the religious right if former Governor Terry Branstad gets back into politics. Yesterday Vander Plaats promised to give homeschooling parents and those whose children attend private schools more influence over education policy. If the GOP primary comes down to Vander Plaats against Branstad, education is sure to become an issue, since some Republicans feel Branstad didn’t do enough to fight the teacher’s union or oppose sex education. The Network of Iowa Christian Home Educators is large and well-organized.

Some Iowa legislative districts may also be targeted by social conservatives, if there is an open GOP primary or a Republican incumbent deemed to be doing too little to advance the religious right’s causes. The Iowa GOP is in a bit of a bind; party strategists understand that they should emphasize economic issues, but some social conservatives become angry when Republicans say too little about abortion or same-sex marriage. We saw this dynamic play out in the recent House district 90 special election. Although Republican candidate Stephen Burgmeier toed the line on the so-called “pro-family” agenda, two conservatives ran against him because he wasn’t emphasizing their issues. The two minor candidates received 282 votes combined, while Burgmeier lost to Democrat Curt Hanson by 107 votes.

You can run a statehouse campaign on a shoestring, while taking on Grassley in a GOP primary would be a very expensive hopeless cause. The religious right may give other establishment Republicans headaches next year, but Grassley is home free.

Not to be a wet blanket after yesterday’s great special election victory, but the latest Pew Research Center poll should set off some alarm bells at the DCCC and DSCC:

Americans are extremely displeased with Congress, and there are already some signs that this could take a toll on the Democrats in the 2010 midterm elections. Currently, 37% express a favorable opinion of Congress, while 52% hold an unfavorable view. Positive opinions of Congress have declined by 13 points since April and are now at one of their lowest points in more than two decades of Pew Research Center surveys.

At the same time, intentions to vote Democratic in the next midterm election are markedly lower than they have been over the past four years. Voters are about evenly divided when asked how they would vote if the election for Congress were being held today: 45% say they would vote for a Democratic candidate in their district, or lean Democratic, while 44% say they would vote for a Republican or lean Republican. At about this point four years ago, Democrats led in the generic congressional ballot by 52% to 40% and went on to win a majority of the popular vote and regain control of Congress the following November.

Meanwhile, the Research 2000 polling for Daily Kos finds the Democratic lead on the generic Congressional ballot down to 6 points, with Democratic intensity “lagging badly”:

With Independents potentially sitting this next election out (as the numbers hint at), we’re in bad shape in a base election. Core Republicans are engaged and solidly home. Democratic constituencies are wavering (look at those African American numbers). The only key Democratic constituency to have moved more Democratic are young voters — from +30 Democratic to +37, but only because they are abandoning Republicans at a bigger rate than Democrats. And even those gains are threatened by the (non) geniuses in DC seriously contemplating a health care mandate without cost controls (like the public option).

At current rates, any 2010 losses would not stem from any resurgence in conservative ideology — Republicans are simply not making any significant gains anywhere — but in a loss of confidence in Democrats. There’s a way to change that dynamic — deliver on the promises made the last two election cycles. Failure to do that would make cynics out of too many idealistic political newcomers, while turning off base activists who do the hard on-the-ground work of winning elections.

But why deliver on campaign promises when President Obama can score points with the Beltway wizards by backing away from a strong public health insurance option?

I’m not saying next year’s elections will be determined solely by whether the Democrats deliver on health care reform. The condition of the economy will obviously play an important role too. But Obama has less control over the economic recovery than he has over whether he sells out the Democratic base. The correct choice is clear, especially when you consider that a stronger public health insurance option would make it easier to pass the bill through the budget reconciliation process in the Senate.

The Bean Walker, Iowa’s copycat version of The Drudge Report, was thrilled to link to the latest approval numbers from Survey USA yesterday:

Iowa

Pres. Obama: 45 / 51

Sen. Grassley: 54 / 34

Sen. Harkin: 49 / 38

Gov. Culver: 36 / 51

This statewide poll of 600 adults was conducted on August 26 and 27 and is said to have a margin of error of 4 percent. It’s the first time any pollster has found the president below 50 percent approval in Iowa, and the first time any pollster has found the governor’s approval in the 30s. For more details about various demographic groups in this poll, you can find Culver’s chart here, charts on Harkin and Grassley here, and Obama’s chart here.

Looking at Survey USA’s trendlines for Culver since he took office, I noticed that Culver’s disapproval number is basically unchanged this summer, but his approval number has dropped significantly from 42 percent in June and 44 percent in July to 36 percent in late August.

Before anyone panics, remember that Survey USA’s approval numbers for Culver tend to run low compared to other pollsters. In early July, the poll commissioned by The Iowa Republican blog found Culver’s approve/disapprove numbers to be 53 percent/41 percent. Later the same month, Hill Research Consultants’ poll for the Iowa First Foundation found Culver’s favorability at 52 percent. (The Iowa First Foundation did not release the governor’s approval number from that poll, but you better believe they would have if the number had been in the 30s or even the low 40s.) Meanwhile, Survey USA pegged Culver’s approval at 44 percent on July 20.

Survey USA’s numbers for Obama, Harkin and Grassley are also noticeably down in the latest poll. Obama is at a record low in Iowa. Grassley’s approval of 54 percent is the lowest Survey USA has found in at least four years. I couldn’t find a similar graph for Harkin’s numbers, but it’s been a long time since I can remember seeing his approval rating below 50.

Of course, it’s possible that the recession and the health care debate have affected Iowans’ view of all political leaders. Still, I would like to see these numbers confirmed by some other pollster. Even with the best sampling techniques, approximately 1 in 20 polls is wrong just by chance (“wrong” meaning that the true state of public opinion lies outside the margin of error for that poll). Right now this poll looks like an outlier.

I also agree with Steve Singiser that if Culver were this unpopular in Iowa, Democrat Curt Hanson probably would not have won yesterday’s special election in House district 90 (a swing district). The Republicans ran at least two television ads linking Hanson to Culver (see here and here).

I’m looking forward to the next Selzer and Associates poll for the Des Moines Register, which probably will come later this month or in early October.

Share any relevant thoughts in this thread.

UPDATE: Hubbell told Iowa Independent he’s not interested in running against Grassley.

The Progressive Change Campaign Committee and Democracy for America have produced a new television commercial, which asks which side Chuck Grassley is on:

Click here to donate to help keep this ad on the air in Iowa and Washington, DC.

Speaking of which side Grassley’s on, Monday’s Des Moines Register reports on our senior senator’s massive campaign contributions from health industry interest groups. Thomas Beaumont’s story was based on numbers compiled by Maplight.org.

Meanwhile, Representative Bruce Braley confirmed on Friday that he is running for re-election in Iowa’s first Congressional district. I consider him highly likely to run for U.S. Senate when one of our current senators retires.

Rumors persist that a prominent Democrat will join Bob Krause and Tom Fiegen in challenging Grassley next year. Al Swearengen of The Iowa Republican blog speculates that Fred Hubbell is the mystery candidate. Hubbell currently chairs the Iowa Power Fund Board. From his official bio:

Fred S. Hubbell was a member of the Executive Board and Chairman of Insurance and Asset Management Americas for ING Group. Mr. Hubbell retired from ING Group’s Executive Board effective April 25, 2006. Mr. Hubbell was formerly Chairman, President and Chief Executive Officer of Equitable of Iowa Companies, an insurance holding company, serving in his position as Chairman from May 1993 to October 1997, and as President and Chief Executive Officer from May 1989 to October 1997.

Charlotte Hubbell, Fred Hubbell’s wife, serves on the Environmental Protection Commission.

Trish Nelson of Blog for Iowa forwarded to me a job listing from Democracy for America. They are hiring “public option field organizers” in 12 states, including Iowa. This is a short-term position but does include health benefits. You can apply here. I’ve posted the full listing after the jump.

Click here to see the list of 64 House Democrats who have promised to vote against any health care reform bill that does not include a public health insurance option. Click here to donate to Democracy for America.

House Energy and Commerce Committee Chairman Henry Waxman is ready to shine a light on the health insurance industry’s business practices, according to this piece by Bill Boyarsky at Truthdig:

Waxman has already begun by demanding that major insurance companies reveal how much they pay top executives and board members and, most important, the size of their profits from selling policies. […]

I asked Waxman whether he expected the insurance companies to reply to his letters. “Oh yes,” he said. “When we write letters, we expect to get answers.” And what was his purpose in seeking the information? At first, he was reluctant to discuss the investigation. Finally, he gave a guarded reply: that many folks perhaps take too benign a view of private insurance companies. […]

The letters from Waxman and his colleague, Bart Stupak, chairman of the House Oversight and Investigations Subcommittee, went to every major insurance company, ranging from Aetna to Wellpoint. The lawmakers want to know the pay, stock options, perks, incentives, and retirement and other financial information of executives earning more than $500,000 a year. They are curious about the cost of promotional junkets. They are seeking disclosure of premiums, revenue, claims payments and sales expenses for health insurance policies. This includes sales to employers, individuals and the government. Interestingly, while insurance companies rail against the federal government, they earn money from participating in a number of federal programs, such as Medicare.

David Mizner has more on why this is important.

Speaking of insurance industry practices, Froma Harrop of the Providence Journal wrote a powerful column last week on the “death panel” her late husband faced from their insurance company, United Healthcare, after he was diagnosed with liver cancer.

A United Healthcare subsidiary owns the Lewin Group, which has been putting out so-called “non-partisan” research to discredit the idea of a public health insurance option.

The Congressional Democrats fighting for a strong health care reform bill need as much help as they can get, with the insurance industry increasingly confident that they will get the bill of their dreams: a mandate for all Americans to buy health insurance, with no public option to compete with private insurers that dominate most markets.

We should all agree on how stupid it would be to let insurance companies “reap a financial windfall” from reform, when so many of our current problems stem from those companies’ high overhead costs and bad-faith business practices. If cost containment is an important goal of health care reform, we’re not going to get there by requiring people to buy overpriced private insurance.

The political fallout would be just as disastrous. Like David Waldman says,

If I’m uninsured or poorly insured, and the answer coming out of Congress is that I now have to buy crappy insurance from some private company that has no plan to actually help me pay for my health care without raking me over the coals, then I’ve gone into this fight an ardent supporter of strong reform, and come out a teabagger.

Digby warned in this excellent post that selling out the Democratic base on health care could fuel a movement comparable to the one that delivered nearly 3 million votes for Ralph Nader in 2000. Glenn Greenwald added more thoughts on the political calculations here.

The alternative to this scenario is not complicated.

Senator Chuck Grassley already has two likely Democratic opponents (Bob Krause and Tom Fiegen), but rumors persist that a better-known Iowa Democrat is thinking seriously about this race.

I still don’t buy the rumors that Representative Bruce Braley will take on this challenge, even though Braley sharply criticized Grassley in a guest piece for the Huffington Post on Friday. With Grassley’s approval ratings still outside the danger zone for an incumbent, I would hate to see Braley give up a safe House seat and a good committee assignment to run in 2010. He is young enough to wait until either Grassley or Harkin retires.

Whether or not Braley intends to run for Senate next year, he could raise his profile and support by promising to work as hard to keep a strong public option in the health care reform bill as Grassley is working to keep one out. (Progressive activists have now raised nearly $400,000 for House Democrats who promise not to vote for any health care bill lacking a strong public option.) A joint statement on behalf of Braley’s Populist Caucus would do even more to bolster Braley’s reputation as a fighter for a strong health care reform bill.

Other names being floated on various blogs include former first lady Christie Vilsack, Des Moines Mayor Frank Cownie, Lieutenant Governor Patty Judge, Attorney General Tom Miller, and Mike Blouin, a former member of Congress who headed the state Department of Economic Development when Tom Vilsack was governor. Blouin narrowly lost the 2006 gubernatorial primary to Chet Culver, so he has recent experience campaigning statewide. On several issues Blouin and I are as far apart as any two Democrats could be, but I thought displacedyankdem made a strong case for him:

Even if he’s not in the very highest tier of candidates (Vilsack, Miller, and Braley), he is:

a)several tiers higher than Grassley’s past 3 opponents

b)likely to automatically get at least 35% and likely 40% of the vote (somewhere between 7 and 12 points higher than the last 3)

c)a strong enough candidate to take advantage if there is a Macaca moment a la Jim Webb 2006

d)likely to tie down millions of dollars in GOP money

e)risk free in that he’s not giving up an office

f)just young enough to be on the edge of viability (maybe I’m making too much out of the seniority thing)

Since running against Grassley will be an uphill battle, I would like Democrats to nominate someone who doesn’t have to give up a current elected position.

On a related note, Grassley is still playing rope-a-dope with the White House, this morning backing down on his ridiculous comments about pulling the plug on grandma. I hope key people in the Obama administration finally understand that nothing is to be gained by seeking a compromise with Grassley. The Senate Finance Committee “gang of six” is taking two weeks off from negotiating, probably because delays help Republican efforts to defeat health care reform.

Share any thoughts about Grassley or the 2010 Senate race in this thread.

Most of the Iowans in Congress have health care town-hall meetings scheduled during the remainder of the summer recess. Some of these have been moved to larger venues because of high expected turnout. It’s important for supporters of strong health care reform not to let the loudest voices on the other side drown out debate. Senator Chuck Grassley has cited town-hall protesters as a reason for scaling back reform efforts.

If you live in the first, second or third districts, it’s especially important for you to make your voice heard. Representatives Bruce Braley, Dave Loebsack and Leonard Boswell have all signed on to support Health Care for America Now’s core principles for health care reform. They all belong to the House Populist Caucus, which stands for six key issues, including “Providing affordable, accessible, quality health care for all Americans.”

But so far Braley, Loebsack and Boswell are not among the 57 House Democrats identified by Blue America PAC (or 64 House Democrats according to Democracy for America) who have said they will not vote for any health care reform bill lacking a robust public option.

Please tell Iowa’s Democratic representatives that the majority of Americans support a public-run health care plan to compete with private insurers. Tell them that cooperatives are not a substitute for a real public option, and anyway, health care co-ops have already failed to provide competition in Iowa.

Also urge them not to let the White House buy them off with “inducements, like more money for favored projects”. Fellow Iowa blogger 2laneIA got it right in this diary:

Thanks, but no thanks for that bridge to nowhere.  

We have a bridge that needs repair in our community.  It would take about $350,000.  I am happy to keep driving a different road to avoid it if we all get access to affordable health care instead.  Any Democrat who trades his or her vote to keep the public option in return for a bridge, a day care center, or a highway expansion, should be publicly embarrassed.  […]

While you are calling congressional public option supporters to thank them, tell them you don’t want any bridges if it means you don’t get affordable access to health care.  You could also mention that if they vote for a bill without the public option, you will want to know what they got from the White House in return.

If you attend any health-care town-halls, please consider posting a diary here about your experience, like hei and iowademocrat did last week.

Final note: it would be great for some prominent Iowan to steal this idea from Terry McAuliffe and offer to host a fundraiser for the first Iowa representative in Congress who pledges not to vote for any health care bill without a public option.

Event details are after the jump.

UPDATE: John Deeth posted a good liveblog of Loebsack’s town-hall in Iowa City on Saturday. Wingnuts in the crowd apparently can’t decide if health care reform is socialism or fascism.

SECOND UPDATE: Trish Nelson wrote up the same Loebsack town-hall at Blog for Iowa.

I wasn’t living in Iowa during the 1990s, so I had never heard about this episode before reading today’s New York Times:

Hopes for co-ops may also be tempered by the experience of Iowa, home to Senator Charles E. Grassley, the senior Republican on the Finance Committee, which is trying to hash out a bipartisan health care proposal.

In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Wellmark Blue Cross and Blue Shield collects about 70 percent of the premiums paid in the private insurance market in Iowa and South Dakota.

To become established, a new market entrant would have to offer lower prices or better services, Ms. Voss said, adding: “Wellmark has a huge advantage. They already have contracts with practically every doctor in the state.”

I am shocked, shocked to learn that senators hauling in huge money from the insurance industry want to scuttle plans for a public health insurance option in favor of cooperatives that would not provide any meaningful competition in the marketplace.

House and Senate Democrats need to stand firm against a fake public option. Contact your members of Congress, Stand With Dr. Dean or sign up with Health Care for America Now to advocate for a real public option.