The House of Representatives approved a bill to repeal the insurance industry’s exemption from anti-trust laws today by an overwhelming margin of 406 to 19. All 253 Democrats present were joined by 153 Republicans in voting for H.R. 4626, the Health Insurance Industry Fair Competition Act. Representative Tom Latham of Iowa’s fourth district voted with the majority, but Steve King disgraced the fifth district again by voting no (roll call here).

The anti-trust exemption has helped health insurers to avoid meaningful competition in most markets. Price-fixing is wonderful for corporate profits but doesn’t help consumers obtain affordable insurance coverage. The anti-trust exemption is one reason insurers have been able to jack up premiums by far more than the rate that medical costs are increasing (and many times the overall rate of inflation). Wellmark Blue Cross Blue Shield, which controls about 70 percent of the health insurance market in Iowa, recently announced rate hikes averaging 18 percent for about 80,000 individual policy-holders. Many of those policies (including my family’s) will see premiums go up by 22 percent as of April 1.

How many of King’s constituents will be forced to downgrade their coverage or drop their insurance because of this rate increase? How many Iowa businesses will suffer because their customers have less disposable income to spend on other goods and services? I’ve come to expect outrageous votes from King, but I’m curious to hear how he will justify his vote to keep consumers at the mercy of colluding insurance companies. I will update this post when I see an official statement from him.

A press release from the Democratic Congressional Campaign Committee noted that King has received $53,835 in campaign contributions from the insurance industry. (That number appears to have come from Open Secrets site.) I posted the full text of the release after the jump.

The White House issued a statement yesterday supporting the Health Insurance Industry Fair Competition Act. It’s unfortunate that the the Obama administration didn’t fight to get this provision in the larger health care reform package, but passing it as a stand-alone bill would still be a step forward.

Quite a few Senate Republicans are on record claiming to support repealing the insurance industry’s anti-trust exemption. Senate Majority Harry Reid should bring this bill to a vote as soon as possible. I suspect that if it reaches the floor, Senate Republicans will be as afraid to vote against it as the majority of House Republicans were today.

UPDATE: The Associated Press reports that prospects for this bill “are dim in the Senate.” If that turns out to be correct, it’s yet another reason rank and file Democrats should stop giving to the Democratic Senatorial Campaign Committee.

Meanwhile, David Dayen notes that before the anti-trust exemption bill passed, “there was also a motion to recommit, which would have essentially stopped the bill in its tracks, and 165 Republicans voted for that, along with 5 Democrats.”

Iowa’s own Tom Latham was among the 100-plus Republican cowards who voted for the procedural motion to stop the bill, then for the bill once the blocking attempt had failed.

How does a 15 to 20 percent increase in one of your household’s major expenses sound to you? About 80,000 Iowans (including me) better get used to the idea:

About 80,000 Iowans who buy their own health insurance through Wellmark Blue Cross Blue Shield will pay an average of 18 percent more this year, the largest increase in four years.

The state’s largest health insurer will begin notifying the individual policyholders this week of the increase.

Rising health care costs are driving the premium increases, said Rob Schweers, a Wellmark spokesman. Premium increases, which take effect April 1, range between 10 percent and 25 percent, the company said.

It’s the largest average annual increase since 2006, Wellmark data show.

Last year, Wellmark raised insurance rates for individual policyholders by an average of 9.3 percent.

This year’s increases “are a combination of medical cost inflation and increased usage,” Schweers said. “Also, people are getting sicker as a population. There are more chronic diseases.”

Premiums tend to be more volatile for individual policies than for those bought by employers and other large groups, which can negotiate for lower rates and spread risk among employees and members.

Hey, it could be worse: about 700,000 Anthem Blue Cross customers in California will see an average rate increase of 25 percent in May, and many of those will see their insurance premiums go up 35 to 39 percent. The rate hike cannot be justified by increasing medical costs alone. According to California’s insurance commissioner, medical costs in that state have gone up about 10 to 15 percent.

The U.S. inflation rate in 2009 was about 2.7 percent, by the way. Many people have seen their wages decrease during the recession.

Not many businesses can get away with increasing prices for goods or services by many times the rate of inflation year after year. The health insurance industry is different because most of their customers have no place else to go. In most parts of the country, one or two insurance companies dominate the market. Wellmark controls about 70 percent of the market in Iowa, for instance. Wellmark customers may not be able to find another insurance company willing to cover them, especially if they have any pre-existing conditions.

Aren’t you glad Republicans and cowardly Democrats “saved” us from “government-run” health care in the form of a public health insurance option?

The Des Moines Register’s editorial board cited the insurance premium hikes as evidence that the U.S. needs comprehensive health care reform with a “public option.” I couldn’t agree more, but the events of the past few months give me zero hope that Congress will approve any decent health care legislation.

Eight Democratic senators are urging Majority Leader Harry Reid to include a public option in a new health care bill that could be passed using the Senate’s budget reconciliation rules. Bills passed that way are not subject to a filibuster and can pass with 51 votes, or in this case 50 votes plus Vice President Joe Biden. Some bloggers are asking activists to contact Senate Democrats to get them on board with this effort. If you are so inclined, feel free to contact Senator Tom Harkin’s office. He was a vocal advocate of the public option last year. Frankly, I don’t feel like wasting my time anymore. If 50 Democratic senators were committed to passing a good health care bill through the reconciliation process, Reid would have been working on that option six months ago.

More important, if President Barack Obama had been interested in passing a strong health care bill, he would have been pushing for reconciliation all along instead of cutting backroom deals with industry while his spokesman praised efforts to find a bipartisan compromise in the Senate. It was obvious last summer that Republicans like Chuck Grassley were just stringing out the process with a view to killing reform.

The White House summit that Obama is convening next week looks like nothing more than a photo-op to me. I can’t see what good can come out of that other than PR for the president.

Share any relevant thoughts in this thread.

UPDATE: More than a dozen Senate Democrats have signed on to passing health care reform with a public option through reconciliation.

LATE UPDATE: We received a letter from Wellmark on February 23 informing us that our premiums will go up 22 percent as of April 1, 2010.  

Even before the Bay State debacle, Democrats faced no easy path forward on health care reform. If House Democrats like Bart Stupak, Anthony Weiner and Jerrold Nadler are to be believed, there are not 218 votes in the House for passing the Senate health care bill unchanged. Nor should there be, given the weak state-based exchanges in that bill and an excise tax that will encourage employers to downgrade the coverage they provide. Accepting a promise from the White House that problems will be fixed later would be idiotic. If the president didn’t keep his campaign promises to let Medicare negotiate for lower drug prices or allow re-importation of prescription drugs from Canada, why would he keep any promises made to House Democrats now?

Key labor leaders are calling on Congress to pass a separate bill through the reconciliation process (requiring only 51 votes), while “simultaneously” passing the Senate bill in the House. I don’t know what they have in mind for that separate bill besides fixing some of the problems with the excise tax on expensive health insurance policies.

Ezra Klein would prefer something like what labor is advocating (House swallows Senate bill, hopes for fixes through reconciliation), but the other option he lays out here seems far superior to me:

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that’s it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar.

I would add a few more things to that smaller bill, like the money for primary care clinics that Senator Bernie Sanders has been fighting for.

Democrats could then offer the insurance reforms you can’t pass through reconciliation as regular bills. Will the Republicans dare to vote against allowing re-importation of prescription drugs, or revoking the insurance industry’s anti-trust exemption? Will they dare to vote against banning insurance companies from discriminating because of pre-existing conditions? I don’t think so. We should be able to get 60 votes for all of those reforms and more. If we can’t, everyone will be able to see who stood up for consumers and who voted to protect corporate interests.

The smaller bill wouldn’t solve all of the status quo problems with health care delivery, but neither would the Senate bill. Politically, this course would be less risky as well.

Feel free to tell me why I’m wrong in the comments.

Following up on my review of news from the first half of last year, I’ve posted links to Bleeding Heartland’s coverage of Iowa politics from July through December 2009 after the jump.

Hot topics on this blog during the second half of the year included the governor’s race, the special election in Iowa House district 90, candidates announcing plans to run for the state legislature next year, the growing number of Republicans ready to challenge Representative Leonard Boswell, state budget constraints, and a scandal involving the tax credit for film-making.

Following up on the diary I posted this morning, this post compiles links to Bleeding Heartland’s coverage of national politics from July through December 2009. Health care reform was again the number one topic. I wish there had been a happy ending.

It took me a week longer than I anticipated, but I finally finished compiling links to Bleeding Heartland’s coverage from last year. This post and part 2, coming later today, include stories on national politics, mostly relating to Congress and Barack Obama’s administration. Diaries reviewing Iowa politics in 2009 will come soon.

One thing struck me while compiling this post: on all of the House bills I covered here during 2009, Democrats Leonard Boswell, Bruce Braley and Dave Loebsack voted the same way. That was a big change from 2007 and 2008, when Blue Dog Boswell voted with Republicans and against the majority of the Democratic caucus on many key bills.

No federal policy issue inspired more posts last year than health care reform. Rereading my earlier, guardedly hopeful pieces was depressing in light of the mess the health care reform bill has become. I was never optimistic about getting a strong public health insurance option through Congress, but I thought we had a chance to pass a very good bill. If I had anticipated the magnitude of the Democratic sellout on so many aspects of reform in addition to the public option, I wouldn’t have spent so many hours writing about this issue. I can’t say I wasn’t warned (and warned), though.

Links to stories from January through June 2009 are after the jump. Any thoughts about last year’s political events are welcome in this thread.

Some Republicans are excited about making this year’s Congressional races a referendum on Barack Obama’s policies. I see their point, since Democrats the president has lost some ground with independents, and Republicans benefit from an “enthusiasm gap” right now. The right direction/wrong track numbers are also frightening for Democrats, and the health reform bill is likely to give the GOP good fodder for attacks.

However, Democratic Congressional Campaign Committee chairman Chris Van Hollen told Greg Sargent that he isn’t worried about Republicans nationalizing this year’s House races. (continues after the jump)

Congressman Steve King is the guest on Iowa Public Television’s “Iowa Press” program this week. Unfortunately, it sounds like no one on the panel asked our ACORN-obsessed representative about last week’s Congressional Research Service report, which cleared ACORN of violating any federal regulations during the past five years, or about the federal court ruling that halted a Congressional ban on federal funding for ACORN.

But don’t worry, King served up plenty of nonsensical right-wing talking points yesterday. You can watch the program on Iowa Public TV this weekend, but a few highlights are after the jump.

Assuming the House and the Senate pass whatever health insurance bill comes out of the conference committee, Republicans and Democrats are likely to highlight the reform during next year’s campaigns. Recent polls have shown that most Americans don’t expect action by this Congress to improve the quality of their own health care or reduce its cost. Complicating matters for Democrats, key provisions of the bill won’t take effect until 2013 or 2014, giving Republicans plenty of time to exploit fears about the so-called “government takeover” of health care.

After the jump, Mariannette Miller-Meeks and Senator Chuck Grassley preview messages we’ll hear from GOP candidates across the country, while Senator Tom Harkin summarizes some “immediate benefits” of the health insurance reform.

Senators approved the health care reform bill 60-39 as Vice President Joe Biden presided over the Senate’s first Christmas Eve session in at least four and a half decades. It was the expected party-line vote, with Republican Jim Bunning absent.

More updates and reaction to this vote to follow.

Yesterday Tom Harkin asked for unanimous consent to move up the final health care vote to make it easier for some members to spend Christmas with their families, but Republican David Vitter of Louisiana said no.

Speaking of health care maneuvering, Joe Lieberman’s brand has taken a hit this month. It’s no mystery why. As Nate Silver observed here and here, being at the center of the health care reform debate tends to bring senators’ approval ratings down.

Recent polls have shown Chuck Grassley still above 50 percent approval, but with far less support than he has enjoyed for most of his career. He has already been running some positive television ads, but I don’t think he’ll be able to get his numbers back up to the 70 percent range by next year’s election. Nevertheless, Grassley’s Democratic challenger will need to make a broad-based case against him, because his double-dealing on health care reform won’t be the focus of news coverage next fall.

After this morning’s health reform vote, the Senate moved on to raise the debt ceiling. Retiring Republican George Voinovich of Ohio voted yes, making up for the no vote by Democrat Evan Bayh of Indiana.

UPDATE: On Tuesday Chris Bowers previewed some of the key fights coming up as House and Senate members reconcile their bills in conference.

From a statement Richard Trumka of the AFL-CIO released today:

SECOND UPDATE: This chart at the Washington Post site shows how each senator voted, how much he or she has received in campaign contributions from the health industry, and what percent of that state’s residents lack health insurance.

Oh no! Representative Leonard Boswell must be quaking in his boots now that the National Republican Campaign Committee is running this robocall against him in Iowa’s third district:

“Leonard Boswell spent 2009 helping liberal Speaker Nancy Pelosi push a massive government takeover of health care, a cap-and-trade energy bill that will increase costs for Iowa workers, and a massive $787 billion pork-laden spending bill that he called a stimulus but that has not helped the Iowa economy. Tell him your New Year’s resolution is to watch his votes in 2010 to make sure he is voting for Iowa families, not the liberal agenda of the Democrat party leaders in Washington.”

For years, Republicans have trotted out versions of this script against Boswell: blah blah blah Nancy Pelosi blah blah blah liberal agenda blah blah blah Democrat Party. It hasn’t resonated before, so why would it work now?

Specifically, I don’t think they will get far running against the stimulus package. Even in a weak economy, Boswell will be able to point to dozens of programs from the stimulus bill that benefited Iowa families. He has brought money to the district through several other bills passed this year as well. The Republican alternative, passing no stimulus and freezing federal spending, would have made the recession far worse.

The health care bill doesn’t even contain a weak public insurance option, let alone a “government takeover.” I don’t dispute that there will be plenty for the Republicans to attack in that bill, but Boswell will be able to point to items that benefit Iowans, such as new Medicare reimbursement rates to benefit low-volume hospitals (including Grinnell Regional Medical Center and Skiff Medical Center in Newton).

Boswell fought for concessions in the climate change bill that weakened the bill from my perspective but will be touted by his campaign as protecting sectors of the Iowa economy. Anyway, many people’s utility bills are lower this winter because the recession has brought down natural gas prices.

It’s fine with me if the NRCC wants to drain its coffers by funding robocalls like this around the country. I doubt they will scare Boswell into retirement or succeed in branding him as a Washington liberal.

Last night the U.S. Senate voted 60 to 40 to move forward with debate on the health insurance reform bill. All senators who caucus with Democrats voted for cloture, and all Republicans voted against. The breakthrough came on Saturday, when Senate Majority Leader Harry Reid secured Senator Ben Nelson’s support with extra money for Medicaid in Nebraska and new language on abortion.

At Daily Kos mcjoan published a good summary of what’s in the latest version of the bill.

Reid reportedly promised Nelson a “limited conference” on this bill, meaning that very few changes will be made to the Senate version. However, it’s far from clear that the House of Representatives will approve the Senate’s compromise. About two dozen House Democrats plan to vote against health care reform no matter what, meaning that it will only take 15-20 more no votes to prevent supporters from reaching 218 in the House.

Bart Stupak, lead sponsor of the amendment restricting abortion coverage in the House bill, has been working with Republicans against the Senate’s abortion language. Meanwhile, the leaders of the House pro-choice caucus have suggested the Senate language may be unconstitutional.

Even before Reid struck the final deal with Nelson, Representative Bruce Braley told the Des Moines Register, “I think the real test is going to be at the conference committee and if it doesn’t improve significantly, I think health care reform is very remote based on what I’m hearing in the House.”

Senator Tom Harkin has done several media appearances in recent days defending the Senate compromise. He seems especially pleased with the Medicaid deal for Nebraska:

The federal government is paying for the entire Medicaid expansion through 2017 for every state.

“In 2017, as you know, when we have to start phasing back from 100 percent, and going down to 98 percent, they are going to say, ‘Wait, there is one state that stays at 100?’ And every governor in the country is going to say, ‘Why doesn’t our state stay there?’” Harkin said. “When you look at it, I thought well, god, good, it is going to be the impetus for all the states to stay at 100 percent. So he might have done all of us a favor.”

Ezra Klein has posted some amazing spin this morning about how the Senate bill is “not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.” Sorry, no. Obama campaigned on a health care plan that would control costs and include a public insurance option, drug re-importation, and letting Medicare negotiate for lower drug prices. Obama campaigned against an individual mandate to purchase insurance and an excise tax on insurance benefits.

Those of you still making excuses for Obama should listen to what Senator Russ Feingold said yesterday:

“I’ve been fighting all year for a strong public option to compete with the insurance industry and bring health care spending down,” Feingold said Sunday in a statement. “Unfortunately, the lack of support from the administration made keeping the public option in the bill an uphill struggle.”

Republican Senator Olympia Snowe was about as unprincipled and two-faced during this process as White House officials were. She voted for the Senate Finance Committee’s bill in October and had suggested her main objection to Reid’s compromise was the inclusion of a public health insurance option. Yet Snowe remained opposed to the bill even after the public option was removed last week. Because of her stance, Reid cut the deal with Nelson. The supposedly pro-choice Snowe could have prevented the restrictions on abortion coverage from getting into the bill if she had signed on instead.

Speaking of Republicans, the Iowa Republican posted this rant by TEApublican: “Nebraska And Huckabee Respond To Ben ‘Benedict’ Nelson’s Christmas Senate Sellout.” If you click over, be prepared to encounter mixed metaphors and misunderstandings about what this “reform” does. Still, the rant is a good reminder of how Republicans will still scream about government takeovers even though corporate interests got everything they wanted out of the bill.

I’m likely to ignore future e-mails from MoveOn.org Political Action after reading the last two appeals they’ve sent me. They are raising money off the health care reform battle while absolving President Obama from blame for the pitiful state of the Senate bill.

Excerpts from the MoveOn.Org appeals and some commentary are after the jump.

Democratic strategists who are counting on a bounce from passing fake health care “reform” won’t be comforted by the latest poll numbers. Highlights are after the jump.

I have had it with e-mail blasts like the one I got over the weekend from J.B. Poersch of the Democratic Senatorial Campaign Committee:

Republicans tried every trick in the book to block us, but Senate Democrats scored important health care reform wins in the past two weeks. We passed the Mikulski Amendment, to make sure every woman gets crucial cancer screenings. And we defeated the Senate’s version of the Stupak Amendment – one of the biggest attacks on choice in a generation.

But these wins didn’t faze the Republicans. A lot of what they are doing to kill the Senate’s bill isn’t making the headlines – but that doesn’t make it any less insidious. We’ve pulled together facts on their latest heinous tactics in our new Obstruction Report.

Nate Silver thinks that thinks any Democrat who opposes it is “batflippin’ crazy.” He posts a chart showing how a family of four earning $54,000 a year would get much more in subsidies if the bill goes through than if no bill passes.

I discuss a few problems with the bill and Silver’s analysis after the jump.

White House Chief of Staff Rahm Emanuel told Senate Majority Leader Harry Reid to give in to all of Joe Lieberman’s demands.

So Reid did. We have a “health insurance reform” bill with no public option, no trigger, no Medicare buy-in. And it will probably continue to get worse from here.

There is no point in pretending that President Obama wanted any comprehensive bill to pass. There was zero pressure on Lieberman to cave, no talk of using the budget reconciliation process–only pressure on Reid to give Lieberman everything.

Emanuel didn’t just leave it to Reid to find a solution. Emanuel specifically suggested Reid give Lieberman the concessions he seeks on issues like the Medicare buy-in and triggers.

“It was all about ‘do what you’ve got to do to get it done. Drop whatever you’ve got to drop to get it done,” the aide said. All of Emanuel’s prescriptions, the source said, were aimed at appeasing Lieberman–not twisting his arm.

Organizing for America will get a rude awakening when they try to round up canvassers and phone bankers. All the volunteers and donors and voters who brought Obama where he is turned out to be less important than one senator from Connecticut who campaigned for John McCain.

Yes, you early Obama supporters out there have every right to be furious. My candidate before the caucuses turned out to be a jerk in his personal life, but he was right to warn against replacing “a group of corporate Republicans with a group of corporate Democrats.”

UPDATE: Darcy Burner explains why the Senate bill is worse than doing nothing on health care.

The Constitution does not contain a supermajority requirement for ordinary legislation to pass the Senate, but the filibuster has evolved into a means to kill any bill unless 60 senators support it.

The current use of the filibuster is not “traditional.” This memo from December 1964 shows that no one imagined Medicare would need more than a simple majority in the Senate. There was no expectation that Lyndon Johnson’s reform efforts would fail if Medicare couldn’t command a filibuster-proof majority.

Senator Tom Harkin tried to change Senate rules on the filibuster in 1995, and the Burlington Hawk Eye reports that he may try again, “Given what he sees as the abuse of power by a couple members of his own party whom he said are threatening to join the minority party if their every demand is not met.”

UPDATE: Proposed excise tax on insurance looking like a very bad idea too.

One key goal of “health insurance reform” was to prohibit insurance companies from limiting how many dollars they would spend on a patient’s care during a year. This makes sense if you want to eliminate medical bankruptcies, which are unknown in most of the developed world.

But the merged Senate health care bill gives insurance companies an out.

Last night a group of Senate Democrats reached some kind of compromise on the health care reform bill. Senator Tom Harkin “told reporters he didn’t like the agreement but would support it to the hilt” in order to get a bill through the Senate. Reports on the nature of the compromise varied, but Talking Points Memo seems to have the most details:

If this trade-off carries the day, the opt out public option is gone. […]

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed–contingent upon CBO analysis–to a Medicare buy in.

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

Those unspecified insurance regulations might refer to this:

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

The health care bill approved by the House would require insurers to spend 85 percent of premium income on providing benefits. Upping that to 90 percent is even better; my concern is that if enforcement is left to state insurance commissioners, evasion will be widespread.

Chris Bowers is excited about three “meaningful concessions” Senate progressives received in exchange for dropping the (already weak) public option.

I’m off the bus, however, unless further details come to light about very good provisions buried in this compromise. This bill creates millions more customers for private insurers but doesn’t give Americans enough choices, doesn’t create a government plan to keep private insurers honest, and therefore is unlikely to reduce costs or solve the various problems of our current health care delivery system.

In the good news column, last night the Senate tabled (killed) Ben Nelson’s abortion amendment modeled on the Stupak language in the House health care bill. The vote was 54-45, with seven Democrats from conservative states voting with all but two Republicans (roll call here). Harkin voted to table this amendment, like most Democrats, while Chuck Grassley was on the other side.

UPDATE: Can any Obama fans defend this kind of action from his administration?

A proposal to enable the importation of cheaper prescription drugs could endanger the U.S. medicine supply and would be difficult to implement, the Food and Drug Administration said Tuesday. […]

But the Obama administration’s declaration on the eve of the vote could derail the amendment despite the fact that Obama co-sponsored Dorgan’s drug imports bill while a member of the Senate and that White House Chief of Staff Rahm Emanuel was a vocal proponent of the House version of the bill when he served as a member of the lower chamber.

Feel the hope and change!

SECOND UDPATE: The compromise still may not be enough for Joe Lieberman. They shouldn’t have given up on using the budget reconciliation process to pass a better bill with 51 votes.

Many Iowans will be leaving work or school early today, or perhaps not going in at all, as the season’s first big winter blast rolls in. Here’s plenty of reading to keep you busy if you are stuck at home.

Global news first: The United National Climate Change Conference in Copenhagen opened yesterday. To follow news from the proceedings, I’m reading the team of Mother Jones bloggers in Copenhagen. The Open Left blog will also post regular updates from Natasha Chart and Friends of the Earth staff who are on the ground. If you prefer a mainstream media perspective, check out The Climate Pool on Facebook, which is a collaboration among major news organizations.

Also on Monday, Environmental Protection Agency Administrator Lisa Jackson signed off on two findings that will pave the way to regulate carbon dioxide emissions under the Clean Air Act. This action follows from a 2007 U.S. Supreme Court ruling in Massachusetts v. EPA. More background and details can be found on the EPA’s site. Environment Iowa explains the significance of the EPA’s action here. An expert panel surveyed by Grist disagreed on whether the EPA’s “endangerment finding” would affect the Copenhagen talks.

The most important reason I oppose the current draft bills on climate change kicking around Congress is that they would revoke the EPA’s authority to regulate carbon dioxide. Chris Bowers explains why that would be disastrous here.

Uganda is considering a horrific law that would subject homosexuals to long prison terms or even the death penalty. One Iowa is collecting signatures on a petition to Senator Chuck Grassley, asking him to speak out against this law. Grassley’s never going to be a gay rights advocate, but he should agree that criminalizing homosexuality is wrong. Grassley is involved with “The Family,” which is connected to the proposed bill in Uganda.

On the economic front, President Obama is expected to announce plans to use about $200 billion allocated for the Wall Street bailout to fund a jobs bill Congress will consider soon.. The Hill previewed some of the measures that may end up in that bill.

Some economists who met with Governor Chet Culver yesterday think Iowa has already reached the bottom of this recession. I hope they are right, but either way, policy-makers should listen to their ideas for reforming Iowa’s budget process. I’ll write a separate post on this important development soon. Here is the short take:

The state could base its spending on a multi-year average, such as the previous three years, or five years or seven years, said Jon Muller, president of Muller Consulting Inc., a public policy and business development consulting firm based in Des Moines.

“The way it’s always worked, when times are really good, we increase spending and we cut taxes,” Muller said. “And when times are bad, there’s pressure to increase taxes and decrease spending. And that all happens when the demand for government is at its highest,” Muller said.

The multi-year idea would flip, he said.

“In good times you would be squirreling money at way a little at a time. And in bad times, you could continue to increase spending to service the growing demands of a recession.”

It would require state lawmakers to not touch the reserves, even in times of plenty. But it would also reduce the need to tap into reserves just to get by during rainy days, the advisers said.

Regarding budget cuts, the Newton Independent reports here on a “plan to reorganize the Iowa Department of Human Services operations under two deputy directors, six rather than nine divisions, five rather than eight service areas, more part-time offices and the elimination of 78 currently vacant positions” (hat tip to Iowa Independent). Click this link for more details about the proposed restructuring.

On the political front, John Deeth analyzes possible changes the Democratic National Committee is considering for the presidential nomination process. Jerome Armstrong had a good idea the DNC won’t implement: ban caucuses everywhere but Iowa. No other state derives the party-building benefits of caucuses, but just about every state that uses caucuses for presidential selection has lower voter participation than would occur in a primary.

I haven’t written much on health care reform lately, because recent developments are so depressing. Our best hope was using the budget reconciliation process to pass a strong bill in the Senate with 51 votes (or 50 plus Joe Biden). Now that Senate Majority Leader Harry Reid has taken reconciliation off the table, we’re left with a variety of bad compromises to get to 60 votes in the Senate. I am not convinced the final product will be any improvement over the status quo. It will certainly be worse for millions of Americans required to buy overpriced private health insurance. If there’s a quicker way to neutralize the Democrats’ advantage with young voters, I don’t know what it is.

Speaking of health care reform, Steve Benen wrote a good piece about Grassley’s latest grandstanding on the issue.

Speaking of things that are depressing, John Lennon was shot dead 29 years ago today.  Daily Kos user noweasels remembers him and that night. Although Paul’s always been my favorite Beatle, I love a lot of John’s work too. Here’s one of his all-time best:

Share any relevant thoughts or your own favorite Lennon songs in the comments.

Developing a line of attack he has used before, Republican gubernatorial candidate Bob Vander Plaats asserted yesterday that Terry Branstad’s past support for Democratic Senator Ben Nelson of Nebraska makes Branstad partly responsible for any health care reform bill Congress passes this year.  

From the Vander Plaats campaign press release of November 23:

“Ben Nelson gave Senate Democratic Leader Harry Reid the vote he needed to get the 60 votes to steamroll Republican opposition. It means the Democrats will be able to proceed with legislation that will effectively destroy our private health care system while saddling businesses and working families with hundreds of billions of dollars in new taxes and limiting our access to care,” said Vander Plaats, who is seeking the 2010 Iowa Republican gubernatorial nomination. “Whatever happens from here on out, Terry Branstad is going to have to accept some responsibility because he was a very active supporter of Ben Nelson in his first campaign for the Senate.”

A few thoughts on this line of attack are after the jump.

I’m heading to the Iowa Democratic Party’s Jefferson-Jackson Dinner. I won’t be blogging there, but I will update this post with some highlights when I get home.

If you’d like to watch online, the IDP will be livestreaming the proceedings here, beginning at 6:30 pm central.

Senator Tom Harkin has taped a video greeting for the event, because he’s in Washington as the Senate begins to debate the health care reform bill. Democrats have all 60 votes they need to bring the bill to the floor, but several members of the caucus have not ruled out backing a Republican filibuster before the final vote. I won’t be supporting the Democratic Senatorial Campaign Committee this cycle, because I don’t want a penny going to a dishonest tool like Blanche Lincoln. She’s probably going to lose anyway.

In addition to any comments about health care reform or the JJ Dinner, please consider this an open thread for anything that’s on your mind this weekend.

For comic relief: in the middle of this afternoon’s Senate proceedings, Chuck Grassley tweeted,

Can somebody tell me why Wall st Journal no longer list Des Moines in its weather cities list. Iowa still exists

UPDATE: I hadn’t been to the JJ dinner in a few years and had a great time. Iowa House Majority Leader Kevin McCarthy and Iowa Senate Majority Leader Mike Gronstal were making fun of each other when the bucket was passed around for extra donations.

McCarthy: What’s the difference between God and a state senator? God doesn’t think he’s a state senator.

Gronstal: What’s the difference between House representatives and boy scouts? Boy scouts have adult supervision.

Speakers: Bruce Braley, Leonard Boswell, Patty Judge, Chet Culver, and Tom Harkin’s recorded video before Biden. (Dave Loebsack is out of the country.)

Huge ovation shortly after 8 pm when IDP chair Michael Kiernan came on stage to announce that the U.S. Senate defeated a filibuster of the motion to bring the health care reform bill to the floor, 60-39. Harkin promised in his video that they will get a health care reform bill bassed before the end of the year, and it will contain a public health insurance option.

Biden gave a great speech, with plenty of jokes, Irish poetry, quiet moments and a few lines that got the crowd on their feet. He apologized for being a little late; he had been on the phone with some unnamed senators whose votes he had helped sway on health care reform.

I had to leave right after Biden’s speech, so I missed the after-party, where U.S. Senate candidates Bob Krause, Roxanne Conlin and Tom Fiegen were set to speak. If you were there, post a comment or a diary to let us know how those speeches were.

SECOND UPDATE: After the jump I’ve posted Kiernan’s remarks and excerpts from Culver’s speech.

FINAL UPDATE: The Iowa Democratic Party posted a slideshow from the event here.  

I’m looking forward to the Iowa Democratic Party’s Jefferson-Jackson dinner this weekend. It will be live-streamed for those who can’t be there in person. The Iowa branch of Organizing for America is having a grand opening on Saturday as well, right before the JJ dinner.

Details for those and other events are after the jump. Post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know if something I’ve left out.

Linn County Dems: Don’t forget that November 24 is the special election in Iowa House district 33.

One more “save the date”: the Culver-Judge campaign’s holiday party will be on Saturday, December 5 at the Val-Air Ballroom in West Des Moines from 7:30 pm to 11:00 pm. Tickets are just $35 for an individual, $10 for students and $50 for a family. Call 515-244-5151 or go to www.chetculver.com for more information.

Health Care for America NOW and the American Federation of State, County and Municipal Employees are running television ads this week thanking 20 Democrats in relatively tough districts who voted for the House health care reform bill last Saturday. If you live in the Des Moines viewing area, you may have seen this commercial about Congressman Leonard Boswell:

Corporate-funded conservative groups have targeted Boswell in negative ads this year because of his vote for the climate-change bill in June. Ads attacking the health care reform project (many funded by insurance industry fronts or the Chamber of Commerce) have been plentiful this summer and fall too. It makes sense for reform advocates to thank Boswell, as Iowa Republicans are gearing up to challenge him with State Senator Brad Zaun or some other well-known figure.  

In other health care reform news, Tom Harkin is among the Senate Democrats trying to keep the "Stupak amendment" language on abortion out of the Senate's version of health care reform. He's absolutely right that some people pushing amendments are trying to kill the bill rather than make it better. A lot of questions have been raised about whether defeating the bill was Representative Bart Stupak's main goal. Since 1992, Stupak has been involved with the fundamentalist Christian "Family" group and has lived in their house on C Street in Washington.  

Stupak claims that as many as 40 House Democrats would reject health care reform without his amendment, but yesterday House Whip James Clyburn said the Stupak amendment only gained 10 votes for the bill. Meanwhile, more than 40 House liberals are threatening to vote down the final bill out of conference if it contains the Stupak language.  

Final note: MyDD user Bruce Webb wrote an interesting piece about what he views as "the most important and overlooked sentence" in the House health care reform bill:  

Most of the criticism of HR3962 coming from the left revolves around the belief that the House bill has no premium and so no profit controls, that it in effect delivers millions of Americans into the hands of insurance companies who can continue to raise premiums at will while denying care by managing the risk pool in favor of those unlikely to make claims. This just is not true, not if the provision in this one sentence is properly implemented. In a stroke it guts the entire current business model of the insurance companies, based as it is on predation and selective coverage, and replaces it with a model where you can only make money by extending coverage to the widest range of customers and or delivering that coverage in a more efficient way.

 Like they say, go read the whole thing.
 

After many hours of debate, the House of Representatives approved HR 2962, the Affordable Health Care for America Act tonight by a vote of 220-215. In a nice touch, Representative John Dingell (MI-15) presided over the chamber today. He was one of the architects of the original Medicare bill.

President Barack Obama went to the Capitol this morning to urge House Democrats to pass the bill. But as you can see from the roll call, 39 Democrats voted no. All of Iowa’s Democrats voted “aye.” Only one House Republican voted for the bill (Joseph Cao, representing the heavily Democratic LA-02).

I am upset that no House Progressives were allowed to offer amendments today, but Bart Stupak (MI-01) was able to further restrict women’s access to abortion services. His amendment is a very bad deal for women. I’m with Angry Mouse: this is not okay.

The Stupak amendment passed 240-194, gaining 64 Democratic votes (roll call here). That’s almost a quarter of the House Democrats. An embarrassing number of Democrats who aren’t even in the Blue Dog caucus voted for it. As Natasha Chart tweeted tonight, the Stupak amendment is exactly the kind of thing a Democratic majority was supposed to stop from coming to the floor. The DCCC won’t get a dime from me this cycle.

Supposedly Obama told progressives this morning he will try to have the Stupak provision removed from the bill in conference. I would bet money against that happening. I expect to see bipartisan movement to include a similar clause in the Senate health care bill.

According to Jane Hamsher, the AFL-CIO may cut off contributions to Democrats who vote against health care reform. Again, I would bet money against this happening, but some Blue Dogs would have trouble funding their re-election campaigns without support from organized labor.

Speaking of Blue Dogs, I want to give special credit to Leonard Boswell (IA-03) tonight. Unlike most of his fellow Blue Dogs, he voted no on the Stupak amendment and yes on passing the bill.

Bruce Braley (IA-01) noted tonight that we hear a lot of Republican talk about medical liability, but not one word about medical safety.

Also worth noting: the future of the State Children’s Health Insurance Program is uncertain. As fairleft2 notes in this diary, the House bill moves children either to Medicaid or into private plans. It’s not clear whether this provision could pass the Senate.

Meanwhile, a new poll from Virginia suggests opposing the public health insurance option was disastrous for Democratic gubernatorial candidate Creigh Deeds.

Share your own health care reform thoughts in this thread.

UPDATE: Jacob Hacker, “godfather” of the public health insurance option, thinks the House bill is worth supporting. Whether the public option can survive a House/Senate conference committee is another question. A few days ago the Stupak amendment was considered a “poison pill” that would doom the health care reform effort, but last night House Progressives almost all voted for the bill even after the Stupak amendment passed. I think that signals the death of the “progressive block” strategy for demanding a public option in the final version of health care reform.

Representative Steve King (IA-05) enjoyed Thursday’s “House call” rally against health care reform so much that he organized another rally at the Capitol today to “kill the bill.” Unfortunately for fellow Republicans, King and several other wingnuts blew off a House Judiciary Committee hearing on Thursday. In their absence, several Republican amendments to the PATRIOT Act reauthorization bill failed to pass:

Those votes took place, a committee staffer confirmed, between noon and two — the very time when Republican lawmakers were rallying the Tea Party troops on the Capitol steps.

One measure, offered by Rep. Lamar Smith of Texas, the ranking Republican on the committee, would have extended the “lone wolf” provisions of the Act, which would allow the FBI to surveil or search foreign nationals even if it can’t be shown that the person is an agent of a foreign power. Many believe that had this been in effect before 9/11, the FBI might have caught Zacarias Moussaoui. And Republicans had said that extending the lone wolf provision this time around was crucial to protecting national security. Even some Democrats supported the measure, giving it a good chance of passage. But it failed by a single vote, 15-15. Reps. King and Gohmert were absent.

Another measure, offered by Rep. Dan Lundgren (R-CA), failed by a vote of 11 to 8. Reps. King, Gohmert, Jordan, and Poe were all missing.

And a third, brought by Rep. Tom Rooney (R-FL), which would have bolstered the ability of local law enforcement to use a device that records phone numbers from a particular phone, failed by 12 to 10, with King, Gohmert, Jordan, Poe, and Franks all absent. (A subsequent amendment that did essentially the same thing later passed, it’s worth noting.)

Several other members of both parties missed some of these votes as well, but there’s no evidence they were Tea Partying.

I guess King likes preaching to the converted more than doing his job.

UPDATE: In fairness to King, he is apparently missing his son’s wedding today in order to be in Washington for the health care debate.

The Quad-City Times reports today that Roxanne Conlin is “in the midst of putting together a [U.S. Senate] campaign” and will file papers with the Federal Election Commission next week. She seems to have hired at least one campaign staffer already; the newspaper quotes Mark Daley as Conlin’s spokesman.

I expect Conlin to raise large sums of money quickly once she has formed a campaign committee, but she has a ways to go to become competitive with Senator Chuck Grassley. He had $4.4 million cash on hand at the end of the third quarter, and there will be plenty more where that came from. During this election cycle alone, Grassley has raised more than $1.6 million in individual contributions and $1.9 million from political action committees. Health care and insurance interests have generously supported him:

Iowa Sen. Chuck Grassley (R) has raised $154,350 in campaign donations in the 3rd quarter of 2009 from health care interests, including $43,590 from health insurance interests, according to research conducted by the campaign finance watchdog Public Campaign Action Fund. Grassley serves as the ranking Republican on the Senate Finance Committee, which voted out a health care reform bill earlier this year.

Over his career, Grassley has raised at least $3.3 million from the health care and insurance industries during his time in Washington, according to the Center for Responsive Politics.

“Sen. Grassley was showered with health industry contributions while the Finance Committee was meeting to discuss health care legislation,” said David Donnelly, national programs director for Public Campaign Action Fund. “Insurance PACs and executives wanted Grassley to oppose health care reform, and that’s what they got.”

Last week Cityview’s Civic Skinny expressed doubts that Conlin can raise $10 million without taking any money from lobbyists or PACs. $10 million might be a tall order, but Conlin has plenty of major donor contacts around the country, not to mention potential support from small donors who got fed up with Grassley this summer. Conlin probably won’t be able to match Grassley dollar for dollar, but she certainly will raise enough to stage a credible statewide campaign.

Conservative activists gathered in Washington yesterday to protest Democratic-backed health care reform proposals. As usual, right-wingers are completely wrong about the substance of the bills, crying “socialism” when the real problem is not enough government-backed competition for private insurers. Former House Majority Leader Dick Armey, a key figure in the “tea party” movement, claims to believe that “The largest empirical problem we have in health care today is too many people are too overinsured.”

Anyway, when ill-informed right-wingers are causing a spectacle inside the beltway, you can count on finding Representative Steve King (IA-05) nearby. Hey, it’s been almost three weeks since national media last paid attention to his unfounded allegations.

So King gets on MSNBC yesterday and falsely claims that the House Democrats’ bill would cancel every private insurance contract in America. You can watch the clip on the Iowa Democratic Party’s site.

Not only do the Democratic bills not void private insurance contracts, they prevent Americans covered by private insurance from choosing a public health insurance option.

Politifact should add this gem to their fact-checking page on King. I noticed that Representative Michele Bachmann (MN-06) is way ahead of him in terms of the number of “false” and “pants on fire” claims subjected to Politifact’s Truth-o-meter, but it shouldn’t take long for King to catch up.

By the way, I recommend watching the video of Mike Stark’s brief interview with King outside the Capitol, recorded a few days ago. King doesn’t know how many uninsured people live in his district (approximately 83,000), and he doesn’t know how many bankruptcies in his district are related to medical costs (about 700 last year), but he does know that “my people want freedom” from health care reform.

Senate HELP Committee Chairman Tom Harkin told reporters yesterday that he does not expect Senator Joe Lieberman to join a Republican filibuster to block the health care reform bill. He also hinted that Lieberman has a lot to lose by sinking this bill.

Good news, part 1: Senate Majority Leader Harry Reid announced yesterday that the health care bill he’ll bring up on the Senate floor will have a public health insurance option. That means opponents of the public option will have to try to strip out the measure with amendments on the Senate floor. They don’t have 60 votes to do that.

Good news, part 2: at yesterday’s press conference, Reid “definitively stated that a trigger bill wouldn’t get a [Congressional Budget Office] score – effectively taking it off the table as a legislative option.” The insurance industry and its allies in Congress, including Republican Senator Olympia Snowe, have pushed the “trigger” idea because it would virtually guarantee that the public option would never go into effect.

Bad news, part 1: Reid’s compromise would allow states to opt out of the public health insurance option, and limits participation in the public plan in many other ways too.

Bad news, part 2: At crunch time, President Barack Obama did nothing to help progressives fighting to strengthen the health care bill. On the contrary, he urged Reid to drop the public option in favor of a “trigger.”

More thoughts on that betrayal are after the jump.

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.

For uninsured homo sapiens, not so much.

Meteor Blades brought to my attention a surreal editorial from the Colorado Springs Gazette about a silverback lowland gorilla who needed medical care.

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.

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.

Breastfed babies can be long and lean, short and fat, or anywhere in between. But I never heard of an insurance company citing a breastfeeding infant’s “obesity” as a pre-existing condition before reading this story from the Denver Post:

By the numbers, [four-month-old] Alex [Lange] is in the 99th percentile for height and weight for babies his age. Insurers don’t take babies above the 95th percentile, no matter how healthy they are otherwise. […]

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

” ‘Your baby is too fat,’ she told me,” Bernie said.

Up until then, the Langes had been happy with Alex’s healthy appetite and prodigious weight gain. His pediatrician had never mentioned any weight concerns about the baby they call their “happy little chunky monkey.” […]

“I’m not going to withhold food to get him down below that number of 95,” Kelli Lange said. “I’m not going to have him screaming because he’s hungry.”

Good call, Mrs. Lange. There is “no evidence to support ‘dieting’ or substituting other foods or liquids for human milk to reduce weight gain.”

It’s outrageous for an insurance company to use Alex’s weight at four months of age as an excuse to deny coverage. Not that exclusions for other “pre-existing conditions” (such as a benign heart murmur that a child would grow out of without treatment) are any more defensible.

Also, the Lange family wouldn’t have been shopping around for new coverage if their previous carrier hadn’t raised their rates by 40 percent after Alex was born. I remember our insurance premiums went up quite a bit after our second child was born, but I don’t think it was by that much. Then again, they went up 10 percent last year even without any new babies or health problems in our family.

Share any relevant thoughts in this thread.

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.  

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.

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.