Friday marked the second anniversary of President Barack Obama signing the Patient Protection and Affordable Care Act, more commonly known as health care reform or “Obamacare.” After the jump I enclose lots of news related to the milestone, including comments from Iowa elected officials and statistics on how certain provisions affect Iowans.

This morning the U.S. Supreme Court is scheduled to start hearing oral arguments regarding the constitutionality of the health care reform law. Governor Terry Branstad signed Iowa on to one of the lawsuits challenging the Affordable Care Act last year. Near the end of this post I’ve included some speculation about how the justices may rule (or punt).

The U.S. Senate voted today to table Republican Senator Roy Blunt’s amendment to repeal a federal regulation on birth-control coverage in employer-provided health care insurance. Iowa’s senators split on party lines.

UPDATE: Added a statement from Tom Harkin below. He argues that the Blunt amendment goes way beyond coverage of contraception and other preventive health services.

Tonight the four remaining Republican candidates for president take the stage in Mesa, Arizona, for the final debate before super Tuesday. CNN will broadcast the debate starting at 7 pm central time. Mitt Romney and Newt Gingrich are under the most pressure to dent Rick Santorum’s momentum. Based on the last few debates, I expect Ron Paul to take more shots at Gingrich and Santorum than at Romney.

Any comments about the GOP presidential race are welcome in this thread. I’ll update the post later.

UPDATE: That debate wasn’t very interesting. Romney seemed to do a little better than Santorum, but I didn’t think anyone was on top form. Paul went after Santorum and mostly left Romney alone. Gingrich absurdly promised $2.50/gallon gasoline. I posted some excerpts from the CNN transcript after the jump.

Candidates love to empathize with struggling middle-class Americans, but middle-income government employees are an easy target for politicians trying to earn their deficit warrior stripes. Today more than a third of U.S. House Democrats voted with nearly all the House Republicans to keep most civilian federal employees’ salaries frozen through 2013. All five Iowans voted for the legislation, even though Democrats Bruce Braley (IA-01), Dave Loebsack (IA-02), and Leonard Boswell (IA-03) have repeatedly said they oppose balancing the budget on the backs of the middle class.

What’s on your mind this weekend, Bleeding Heartland readers? Today is Stephen Hawking’s 70th birthday. The Mirror published 17 things “you need to know” about the renowned physicist. I haven’t read A Brief History of Time or any of Hawking’s other publications for adults, but my kids and I are big fans of the three children’s books he co-wrote with his daughter, Lucy Hawking: George’s Secret Key to the Universe, George’s Cosmic Treasure Hunt, and George and the Big Bang. Highly recommended for children with any interest in science, especially if they are fascinated by space travel or the solar system.

Doctors do not know why Hawking has lived for so many years with amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s disease. He has credited the excellent care he has received through Britain’s National Health Service. In a 2009 editorial against government-run health care, the American conservative publication Investor’s Business Daily claimed that a person with physical handicaps like Hawking’s “wouldn’t have a chance in the UK.”

This is an open thread; all topics welcome. After the jump I’ve posted excerpts from yet another reaction to Stephen Bloom’s harsh commentary on Iowa for The Atlantic monthly. This one is by Peter Feldstein, who co-authored The Oxford Project with Bloom. Bleeding Heartland readers discussed Bloom’s essay a few weeks ago in this thread.  

Only ten Democrats in the U.S. House supported a bill approved last night to extend the payroll tax cut and some unemployment benefits. All three Iowa Democrats crossed party lines to vote for this legislation, which has drawn a rare veto threat from the White House.

UPDATE: Scroll down for Representative Dave Loebsack’s statement on this vote.

SECOND UPDATE: I’ve added a statement from Representative Steve King.

When an elected official wants a certain phrase or point of view to be transmitted in a news story, a spokesperson often has to do the heavy lifting. Governor Terry Branstad’s communications director Tim Albrecht showed this week how pros get the job done while explaining an apparent contradiction in the governor’s stance on the federal health insurance reform law.

Democratic U.S. Representative Leonard Boswell is blasting Republican presidential front-runner Mitt Romney's plan for veterans' health care.

The U.S. House has approved a bill to limit private health insurance coverage of abortion services. All Iowa Democrats opposed the new restrictions, while Republicans supported them.

Few weapons are more effective in politics than well-placed ridicule. Used incompetently, however, political mockery is just cringe-inducing.

Case in point: the event the Iowa Democratic Party staged yesterday to make fun of Mitt Romney.

The days are getting warmer and longer, early wildflowers are starting to come up, and two of my favorite spring events in Iowa are happening the next two weekends. The Planned Parenthood spring book sale starts this Thursday and continues through Monday at the State Fairgrounds (4H building). This semi-annual sale supports the education and community outreach programs of Planned Parenthood of the Heartland, covering most of Iowa and part of Nebraska. Come Thursday night or Friday for the best selection, Sunday or Monday for the lowest prices.

The sixth annual Natural Living Expo will be held April 2 and 3 at the Polk County Convention Complex in Des Moines. This free event showcases more than 100 natural and/or environmentally friendly Iowa businesses and community organizations. I’ll be helping staff the tables for a couple of non-profits, but I always look forward to browsing during my break times.

Like many in the Bleeding Heartland community, I’m excited to see the new map of Iowa political boundaries, which the Legislative Services Agency will release on March 31. The LSA will hold public meetings around the state on April 4 to discuss the proposed map.

Details on those events and much more are after the jump. As always, please post a comment or send me an e-mail if you know of an event that should be added to this calendar.

The House of Representatives approved a three-week continuing resolution on current-year spending today by a vote of 271 to 158 (roll call). If the Senate does not approve the bill by Friday, the federal government will shut down. The Iowa delegation split the same way as two weeks ago, when the House approved the last continuing resolution. Republican Tom Latham (IA-04) and Democrats Bruce Braley (IA-01), Dave Loebsack (IA-02) and Leonard Boswell (IA-03) all voted for the spending bill. Two weeks ago Steve King (IA-05) was among only six House Republicans to vote against the continuing resolution. Today he had much more company; 54 House Republicans voted against the bill backed by their leaders. The measure would have failed without Democratic support.

That support is eroding as well. Two weeks ago, yes votes outnumbered noes in the House Democratic caucus, but today a majority of House Democrats voted against the continuing resolution. House Minority Whip Steny Hoyer (D-Md.), has said he will not support another continuing resolution after this one. If House and Senate leaders don’t reach a comprehensive agreement on fiscal 2011 spending during the next three weeks, it may become more difficult to avoid a shutdown.

King told ABC News this week he isn’t worried about that outcome:

Rep. Steve King is lobbying his colleagues to take their fight against President Obama’s health care law to a new level: He wants to cut off funding for the law as a condition for keeping other government funds in place.

“We have a leverage point, and it is the funding for the government for the balance of the fiscal year 2011,” King, R-Iowa, told us today on ABC’s “Top Line.” “This is the place to pitch the fight.”

If such a stance brings about a partial government shutdown, it would be Democrats’ fault, King said: “If we shut off the funding to implement Obamacare and the Senate or the president refuses to go along with it, that is their decision, not ours.”

Still, King argued, a shutdown might not be a bad result.

“If essential services keep going, no, it wouldn’t be. And I think that we’d be able to keep essential services going on. You know, the wedge issue is this: Is the president — would he think that his signature issue is more important to him than all the functions of government? That’s the question. And in the end, will American people stand with us, or will they stand with Obamacare?”

In other Congressional news, King is the only Iowan among 81 House Republicans cosponsoring a concurrent resolution that “condemns the Obama administration’s direction that the Department of Justice should discontinue defending the Defense of Marriage Act; and demands that the Department of Justice continue to defend the Defense of Marriage Act in all instances.” King has vowed to seek a funding reduction for the DOJ since President Barack Obama instructed the department not to defend Section 3 of the 1996 Defense of Marriage Act in court.

After the jump I’ve posted Braley’s statement on today’s vote. I will add press releases from the other Iowans in the House if and when I see them.

UPDATE: I see King has introduced a federal official English bill again: “A common language is the most powerful unifying force known throughout history, […] We need to encourage assimilation of all legal immigrants in each generation. A nation divided by language cannot pull together as effectively as a people.” As a state senator, King was the leading advocate of Iowa’s official English bill, which Governor Tom Vilsack signed in 2002. King later sued successfully to stop the Secretary of State’s office from providing voter registration information in languages other than English.

I’ll be interested to see whether the House Republican leadership lets King’s new bill go forward, or whether the same concerns that cost King a subcommittee chairmanship this year sink his efforts to require the federal government to conduct most services in English.

SECOND UPDATE: King’s statement is now after the jump. Politifact provides more context on the $105 billion figure King mentions here.

U.S. District Court Judge Roger Vinson struck down last year’s health insurance reform law yesterday, backing the lawsuit filed by Florida’s attorney general and joined by 25 other states. Vinson’s 78-page opinion can be read in full here. David Kopel summarized the key points at the Volokh Conspiracy blog:

1. The 26 states lose on the argument that the mandate for drastically increased state spending under Medicaid is unconstitutional. State participation in Medicaid always has been voluntary, and remains so. […]

2. The plaintiffs win on the individual mandate. The individuals plaintiffs, and the National Federation of Independent Businesses have standing to challenge the mandate. So do Utah and Idaho, at the least, because of state statutes forbidding health insurance mandates. According to original meaning, “commerce” was trade. Citation to Randy Barnett. Even the modern precedents require “activity” as a predicate for commerce clause regulation.[…]

3. Necessary & proper does not save the mandate. […]

4. The mandate is not severable from the health control act. Defendants themselves have argued forcefully that the mandate is absolutely essential to the entire regulatory scheme. There is no severability clause. The mandate is tightly integrated into the entire act. […]

6. The entire act is declared void. […] Of course the 11th Circuit might grant a stay, and Judge Vinson might also do so, but as of right now, there is no stay.

The White House immediately made clear that the federal government will continue to implement the Affordable Care Act. I would be shocked if the U.S. Court of Appeals doesn’t grant a stay of Vinson’s ruling, especially since two other U.S. district court judges ruled last year that the individual mandate is constitutional. Vinson’s ruling went further than U.S. District Court Judge Henry Hudson’s decision in December, which struck down the federal requirement that individuals purchase health insurance but let the rest of the law stand. Click here for links to numerous reactions to Vinson’s ruling. Legal analyst Ilya Somin finds the judge’s reasoning persuasive, while Orin Kerr argues that Vinson erred by going against precedent (Supreme court case law). Dave Weigel explains how Congressional Democrats failed to include a standard severability clause in this legislation. Brian Beutler notes that U.S. Supreme Court Chief Justice John Roberts (one of the most conservative members of the high court) recently struck down a single provision of a law that lacked a severability clause.

Representative Steve King (IA-05), a champion of efforts to repeal health insurance reform, was jubilant about yesterday’s news: “Many of us opposed ObamaCare in part because of our oath to the Constitution. Any member who had reservations should now be empowered to vote with those of us who will cut off all funding to ObamaCare starting with the continuing resolution.” The full text of King’s press release is after the jump.

Iowa State Senator Jack Hatch blasted Vinson’s “blatant judicial overreach” and expressed confidence that courts will ultimately uphold the federal law. Hatch chairs the Working Group of State Legislators for Health Reform and joined more than 70 state lawmakers who filed a “friend of the court” brief in the Florida case supporting the constitutionality of the law. The full press release from Progressive States Network and the Working Group of State Legislators for Health Reform is after the jump.

Senators Tom Harkin and Chuck Grassley didn’t release any statement on Vinson’s ruling, which surprised me, since both quickly reacted to Hudson’s ruling against the individual mandate in December. Yesterday Harkin publicized the first in a series of Senate HELP Committee hearings about “the tangible, positive impact that [health insurance] reform is having on Americans’ lives.”

Governor Terry Branstad joined the plaintiffs in the Florida lawsuit two weeks ago (disregarding Iowa Attorney General Tom Miller’s opinion). I was surprised not to see any statement from the Branstad administration on Judge Vinson’s ruling yesterday. I will update this post with further Iowa reaction as it becomes available.

UPDATE: Through the governor’s Twitter account, Branstad’s communications director Tim Albrecht said released this statement:

“This health care law is clearly not sustainable nor is it affordable for the long-term. I believe it would be appropriate for both parties to start over and advance a plan that is more workable.”

When I asked how questions about whether the law is sustainable or affordable related to the constitutional matters at hand (judge rejecting argument against Medicaid expansion but accepting case against individual mandate), Albrecht added, “The governor continues to believe the individual mandate is unconstitutional.” To my knowledge, Branstad has not publicly acknowledged that a few years ago he supported a state mandate to purchase health insurance.

Roughly 46,000 Iowans who buy individual health insurance policies through Wellmark Blue Cross/Blue Shield will face an average rate hike of 8.5 percent this year, instead of the 11 percent Wellmark requested. State Insurance Commissioner Susan Voss announced on Friday that she had approved a smaller rate increase, in part because of reviews conducted by two actuaries who said Wellmark’s request was excessive. A law enacted in 2010 required an independent actuarial review whenever an insurer’s proposed premium hike exceeds the medical inflation rate.

According to the Des Moines Register, Voss said in a January 28 press release

that her department would look into whether the company has appropriate levels of reserves. She said the department also would examine how Wellmark’s dominant position in the Iowa market affects Iowans.

“We’ve heard the concerns of Wellmark’s customers,” Voss said.

“We think the time is right for a careful professional analysis of these two additional areas. We gained valuable insights from the extended review just completed that allowed us to arrive at the appropriate level of permitted rate increase. Learning more facts on these points will be useful in future considerations of rate adjustments.”

Wellmark has a near-monopoly on the individual health insurance market in Iowa. The company is the provider for more than 70 percent of Iowans who purchase their own health insurance.  

Tom Latham (IA-04) is Iowa’s longest-serving current member of the House of Representatives, but he has kept a low profile for most of his 16 years in Congress. You don’t see him on television or hear him on the radio nearly as often as his Republican colleague Steve King (IA-05). According to statistical analysis by the GovTrack website, Latham is a rank-and-file Republican who has sponsored few major bills.  

Last Friday, Latham stepped out of character to introduce broad-ranging health care reform legislation. A few thoughts about the substance and strategy behind this move are after the jump.

The House of Representatives passed a bill today on “Repealing the Job-Killing Health Care Law Act” by a vote of 245 to 189. Iowa’s delegation split along the usual party lines: Democrats Bruce Braley (IA-01), Dave Loebsack (IA-02), and Leonard Boswell (IA-03), who voted for the Affordable Care and Patient Protection Act last year, voted against repeal. Republicans Tom Latham (IA-04) and Steve King (IA-05) voted against health insurance reform last year and for repealing it. King was delighted: “100% of my language to repeal 100% of ObamaCare just passed the House with 100% Republican support = 100% great day 4 the USA!” Press releases from Braley, Loebsack, Boswell, Latham and King are after the jump. Latham’s statement mentions the main points of the “replacement health care legislation” House Republicans are drafting.

Various groups and politicians have issued statements warning that many Americans will be hurt by repealing the health insurance reform. I’ve posted a few of those after the jump too, but I wouldn’t lose any sleep worrying about that just now. Repeal is a dead letter at least through 2012 and could advance in 2013 only if Republicans capture the U.S. Senate and defeat President Barack Obama.

I found it interesting that only three House Democrats voted for today’s repeal bill, even though 13 current members of the Democratic caucus voted against health insurance reform in the last Congress. Good whipping by Nancy Pelosi and Steny Hoyer, or recognition that popular support for repeal may be declining?

Here in Iowa, Governor Terry Branstad announced on January 18 that he joined the state of Florida’s lawsuit challenging the constitutionality of health insurance reform:

“I am signing on to this suit as the governor on behalf of the people of Iowa, because I believe Iowa taxpayers deserve to be heard on this critical matter,” Branstad said in a statement. “As we begin constructing our five-year budget, there is no doubt that the current federal health care law will shackle Iowa taxpayers for billions in unfunded mandates.”

The suit challenges the individual mandate of the health care reform law, as well as the expansion of Medicaid, the state-federal health insurance program for low-income people, said Branstad spokesman Tim Albrecht.

Branstad’s action is purely symbolic. The case will be litigated no matter how many states sign on as plaintiffs, and if the law is ruled unconstitutional, all states will be affected, not just those that joined the suit. Though I’m not an attorney, it seems that a whole lot of federal laws would have been struck down over the years if unfunded mandates really were unconstitutional.

Legal experts disagree over whether the Commerce clause gives Congress the power to require individuals to purchase health insurance reform.

Politically, Branstad’s opposition to health insurance mandates will boost his standing with the Republican base. They don’t really mind “activist judges,” and they won’t remember that Branstad advocated for a mandate to purchase health insurance as recently as 2007. (He explained why here.) The governor’s legal counsel, Brenna Findley, made the case against the individual mandate a central argument in her campaign against Attorney General Tom Miller last year. Miller supports the federal health insurance reform and has said the law is “heavily on the side of constitutionality.”

Thousands of Wellmark Blue Cross/Blue Shield customers learned late last year that their health insurance premiums would go up by 11 percent in 2011. Yesterday state Insurance Commissioner Susan Voss received reports from two actuaries who found that rate hike to be too steep:

Close to 46,000 Iowa policyholders under age 65 will see an increase in their base premium rate of 10.8 percent, effective April 1, 2011, if approved. Another 3,000 basic and standard policyholders will receive an increase of 11.3 percent. Approximately 2,500 Blue Transitions policyholders will receive an increase of 15 percent.

The company raised rates by 18 percent in May of 2010. […]

Lewis & Ellis Inc., of Overland Park, Kan., said Wellmark’s proposed rate increase is too high. They recommend a 7.5 percent instead of the proposed 10.8 percent increase.

The Insurance division’s in-house actuary is recommending a 9 percent increase.

Tom Alger with the Iowa Insurance Division said the reports will weigh heavily in Voss’ decision about whether Wellmark will get the rate increase it wants.

Voss also presided over a public hearing yesterday, at which an attorney for Wellmark defended the rate hike, and some customers asked Voss to reject the insurer’s proposal. But a rate increase of 7 percent or 9.5 percent would still be unaffordable for many customers, and there are other problems too:

State Rep. Janet Petersen, who last year pushed legislation requiring the hearings and the independent actuarial review, called the recommendations a small victory.

The Des Moines Democrat noted that even if Wellmark is denied permission to raise its base rates as much as it wants, it still can impose big increases for people who shift into new categories, including as they age.

For individuals and families who buy their own health insurance, Wellmark has a virtual monopoly in Iowa. Giving Americans the option of buying into Medicare would not instantly make health insurance affordable, but it might constrain the excessive rate increases from companies like Wellmark.

U.S. District Court Judge Henry Hudson ruled today that the individual mandate to purchase health insurance is unconstitutional. The mandate, scheduled to go into effect in 2014, is a key provision in the Patient Protection and Affordability Act, which President Barack Obama signed in March. The mandate creates a guaranteed increased market for private insurers in exchange for new regulations, such as ending discrimination based on pre-existing conditions. Most of the two dozen lawsuits filed against the federal health insurance reform law have challenged the individual mandate. Judges dismissed several of those cases earlier this year, but Virginia Attorney General Ken Cuccinelli found a somewhat sympathetic ear in Judge Hudson, who wrote, “No specifically constitutional authority exists to mandate the purchase of health insurance. […] Salutatory goals and creative drafting have never been sufficient to offset an absence of enumerated powers.”

Hudson arguably should have recused himself from this case, since he owns a significant share in the Republican consulting firm Campaign Solutions, Inc. That firm has worked against health care reform and for various Republicans, including Cuccinelli. But in fairness to Hudson, he rejected the plaintiff’s call to strike down the entire health insurance reform law, or to issue an injunction against implementing that law. In any event, legal challenges to the mandate are bound to work their way up to the U.S. Supreme Court one way or another. (The Justice Department will appeal Hudson’s ruling.)

Senator Chuck Grassley’s office released this statement:

As Ranking Member of the Senate Committee on Finance, in 2008 and 2009, Senator Grassley participated in the bipartisan effort for health care reform that could secure support across the political spectrum.  In September 2009, that effort was thwarted by Democratic leaders in Washington.  From 2007 through 2009, there was a rigorous debate over the individual mandate.  President Obama staunchly opposed it as a candidate for President.  The concerns he raised then became more clear as the reform debate unfolded, including enforcement.  Health insurance companies lobbied for the mandate, which drives billions of tax dollars in new subsidies directly to them.

Senator Grassley’s comment:

“The nonpartisan Congressional Research Service called requiring people to buy a good or service or be penalized a ‘novel issue,’ and now a federal court has ruled it unconstitutional.  The ruling is likely to be appealed, but it’s a clear signal that the constitutionality of the law, which was moved through Congress with a lot of controversy and partisanship, isn’t as certain as its supporters have argued.”

Hmmm, something seems to be missing from that statement. Oh, now I remember: Grassley supported an individual health insurance mandate in 1993 and 2007, and said in June 2009 that “there is a bipartisan consensus [in Congress] to have individual mandates.”

Senator Tom Harkin, a key author of the health insurance reform law, didn’t think much of the judge’s reasoning:

“On the merits, the Virginia Attorney General’s suit is clearly wrong.  When people seek medical care without health insurance and don’t pay for it, they aren’t ‘opting out’ of the health care market.  Instead, it adds more than $1,000 per year to the premiums of American families who act responsibly by having coverage.  This clearly affects interstate commerce and is thus within Congress’ power to regulate.  

“Two federal courts in Michigan and Virginia have already dismissed similar cases, and the Virginia court should have followed their lead.  I’m confident that the appellate courts and the Supreme Court will find the Affordable Care Act constitutional and in doing so, ensure that Americans keep crucial new protections against the unfair practices of insurance companies.”

I will update this post as other Iowa politicians comment on Hudson’s ruling.

UPDATE: From Representative Steve King, a leading Republican advocate of repealing the health insurance reform:

“With Judge Hanson’s decision, a federal court has now ruled in accordance with what I have always said – Obamacare’s requirement that Americans purchase health insurance or pay a fine is unconstitutional. Obamacare’s ‘individual mandate’ always restd on the absurd premise that the Commerce Clause empowered the federal government to regulate Americans’ decisions not to engage in commercial activity… With the ‘individual mandate’ that lies at the heart of the legislation ruled unconstitutional, the badly-flawed Obamacare law is now completely dysfunctional, further accelerating the need for Congress to repeal it.”

Governor-elect Terry Branstad hasn’t commented on this lawsuit, but he announced today that Brenna Findley will be his legal counsel. Findley was King’s chief of staff for seven years before running unsuccessfully for Iowa attorney general. She made challenging health insurance reform (specifically the individual mandate) a major issue in her campaign. Branstad promoted her candidacy at virtually every campaign stop and appeared in one of Findley’s television commercials.  

Representative Steve King’s never had trouble calling attention to himself, even as a not very powerful member of the House minority. With Republicans in charge of the House beginning in January, King’s national profile will rise further as chairman of the House Judiciary Committee’s subcommittee on immigration. One of his top priorities will be moving a bill to restrict birthright citizenship.  

With so many Democratic incumbents around the country endangered this year, U.S. Senate candidate Roxanne Conlin hasn’t received much campaign assistance from Democratic organizations outside Iowa or their allies. That changed this week when the advocacy groups Democracy for America and Progressive Campaign Change Committee started running a 60-second television commercial targeting Republican Senator Chuck Grassley.

Unfortunately, the ad fails to make a persuasive case against sending Grassley back to Washington.

Follow me after the jump to watch the new commercial, along with more Grassley and Conlin campaign ads.

I figured Republican Mariannette Miller-Meeks was too conservative to have a chance against Representative Dave Loebsack in Iowa’s second Congressional district. Loebsack represents the most Democratic-leaning House district in the state (partisan index D+7), and Miller-Meeks failed to reach the 40 percent mark in 2008. But I was wrong. Plenty of House incumbents who cruised two years ago are in tough races now, and many signs point to a highly competitive rematch in IA-02.

It’s been too long since Bleeding Heartland last checked in on this race. Television commercials for Miller-Meeks and Loebsack are after the jump, as well as highlights from this week’s debate between the candidates.

No Republican in Congress has been more vocal about repealing “Obamacare” than Representative Steve King. He has tried to make undoing everything in the health insurance reform law the top priority for Republicans. Speaking to the Spencer Daily Reporter’s Gabe Licht in August, King asserted:

“I think we’ve lurched to the left so hard that we’re nearly off the cliff into the abyss of socialism … We should keep in mind so many things I think should be undone.”

Topping that list for King is what he calls nationalization of health care.

“When I say nationalization, I mean under the ownership, management or control of the federal government,” he said. “Now our skin and everything inside it has been nationalized by ‘Obamacare.’”

That may sound like an extreme interpretation of a law that gave health insurance industry interests almost everything they wanted, but remember, we’re talking about Steve King. He has derided the State Children’s Health Insurance Program (which pays for kids’ medical care but doesn’t dictate where they must receive it) as Socialized Clinton style Hillarycare for Illegals and their Parents.

Imagine my surprise, then, to see this press release from Representative King’s office a few days ago:

Congressman Steve King has released the following statement in support of the Veterans Affairs Department’s decision to locate a new Veterans’ Community Based Outpatient Clinic at St. Anthony Hospital in Carroll, Iowa.

“The VA has wisely chosen to locate its new VA clinic at St. Anthony Hospital. The Carroll community and the providers, administrators, and staff at St. Anthony have made significant investments in the hospital in recent years, and the veterans who will be making regular visits to the new clinic will be the beneficiaries of many of the improvements that have been made,” said King.

“St. Anthony Hospital has served as an important anchor in the Carroll community for decades, and it makes sense for the VA to turn to it to facilitate the opening of a new clinic to better serve the many veterans who live in the area. In the past few years, I’ve worked with the VA to increase Fifth District veterans’ access to health services through the establishment of new VA clinics in both Spirit Lake and Shenandoah. Setting up this new clinic in Carroll will make it even easier for western Iowa’s veterans to get the care they were promised. It has been a privilege to be part of the process and the credit goes to St. Anthony’s administration and staff. I’m pleased the VA has finally put its stamp of approval on this proposal. Congratulations to our veterans, St. Anthony’s and the Carroll community. I look forward to the ribbon cutting.”

Nothing in the United States resembles socialized medicine as much as the VA. The government runs the veterans’ clinics, employs the doctors and other staff, and uses its bulk purchasing power to reduce some costs. (Medicare is sometimes described as socialized medicine but is actually a single-payer system, in which the government pays for care but doesn’t control the health care providers.) The health insurance reform law King detests didn’t even create a minimal government-run insurance plan, nor did it permit Medicare to negotiate for lower prescription drug prices.

I think King is smart enough to understand the inconsistency between welcoming the VA’s expansion in his district and warning that Obamacare has given the government control over “our skin and everything inside it.” It reminds me of how he hailed new funding for Highway 20 in northwest Iowa, hoping no one would notice that he voted against the 2009 stimulus bill which provided those funds. When it’s politically expedient, he’ll get behind “big government” spending and services that will be popular with his constituents.  

Less than a week after his first general election television ads went on the air across Iowa, Senator Chuck Grassley launched two new commercials today.

The first ad is the most brazen image make-over I’ve seen in a while, casting Grassley as a brave warrior against drug companies. The other commercial touts the way Grassley uses new media to keep in touch with constituents.

Videos, transcripts, and more are after the jump.

UPDATE: I’ve also added the Conlin campaign’s response to one of these ads.

Mariannette Miller-Meeks considered withdrawing from her rematch against Representative Dave Loebsack in Iowa’s second Congressional district this summer, the Republican candidate told the Des Moines Register’s editorial board yesterday. Miller-Meeks stepped down from her ophthalmology practice in early 2009 to focus on running for Congress again, so when her husband lost his job this July, her family had no income.

Miller-Meeks said she told no one about her dilemma, not even Republican Party officials. […]

The family financial crisis influenced her political perspectives, she said. It sharpened her beliefs that the government should stay out of debt and that steps must be taken to make health insurance more affordable.

Since stepping down from her medical practice, Miller-Meeks had had health insurance coverage through her husband’s job. He has a new job now, but Miller-Meeks told the Register’s staff that she has chosen not to be on his insurance plan.

“I’m a very healthy person, and what I’ve done is look at my family history and determine what my level of risk is,” she said. “Am I saying it’s a smart thing to do? No. I think we need to make health insurance more affordable.”

The country needs to get to a point where a family of four can pay $2,000 a year for a plan that covers immunizations, preventative medicine and catastrophic needs, Miller-Meeks said. She also supports a nationwide risk pool and allowing health insurance purchasing across state lines, she said.

If elected, she would like to choose a federal plan that covers only catastrophic illness or injury, she said.

It must have been a very stressful summer for the Miller-Meeks family. While I’m sorry to hear about her situation, I wouldn’t recommend going without health insurance based on a good medical history. A flukey infection can incur tens of thousands of dollars in health care costs, to say nothing of a cancer diagnosis or some chronic illness. I also wouldn’t advise a friend to choose a limited catastrophic plan like the one Miller-Meeks prefers for herself and many others. There’s a reason such policies are commonly known as “junk insurance.” Letting people buy insurance across state lines sounds good in theory, until you consider how the race to the bottom gutted regulations for credit card issuers.

Miller-Meeks is a hard worker and clearly committed to seeing this race through, but some Republicans may be upset to learn that she was on the verge of quitting for the second election in a row. A wingnut faction in the Iowa GOP already distrusts Miller-Meeks for allegedly being too moderate.

Miller-Meeks has been campaigning energetically around the second district with a generic Republican message. She calls Loebsack names like “Do-nothing Dave” and Pelosi’s puppet, rails against the health insurance reform law and the 2009 federal stimulus:

Stimulus funding has failed to create jobs, and it probably would have worked better to funnel money directly to the American people, she said.

The stimulus bill created and saved millions of jobs according to Congressional Budget Office estimates. Without it the economy would have continued to decline steeply. Evidence is mounting that the stimulus wasn’t big enough, the opposite of Miller-Meeks’ claim. Tax cuts made up about one-third of the stimulus bill’s costs, even though government spending provides more “bang for the buck” than tax cuts do. The stimulus provisions with the biggest “bang for the buck” did give money directly to Americans in the form of extended unemployment benefits and food stamps. Other stimulus spending that kept teachers and public safety workers on the job helped ordinary Americans as well.

Few analysts expect the IA-02 race to be competitive this year, because the district has a strong Democratic lean, and Loebsack defeated Miller-Meeks by 57 percent to 39 percent in 2008. (A Green Party candidate who isn’t running this year picked up 3 percent last cycle.) Loebsack also has a large cash on hand advantage over his challenger. Then again, the overall political environment favors Republicans, and pockets of the second district have high unemployment.

I do agree with Miller-Meeks on one point: Loebsack should debate her. Barbara Grassley advised Miller-Meeks to schedule a debate and show up to face an empty chair if necessary (funny advice in light of Senator Chuck Grassley’s refusal to debate Roxanne Conlin). But I hope it doesn’t come to such theatrics. Miller-Meeks deserves a chance to debate the incumbent, just as fifth district candidate Matt Campbell deserves a debate against incumbent Steve “10 Worst” King.

Any comments about the IA-02 campaign are welcome in this thread.

CORRECTION: I didn’t realize that the candidates had agreed to three debates already: an AARP forum in Coralville on September 13, a joint Iowa Public Television appearance on September 24 and a debate hosted by KCRG in Cedar Rapids on October 12.

UPDATE: Miller-Meeks thinks staggered enrollment in Medicare is the way to make the program solvent. But people approaching retirement age are among those most likely to have pre-existing conditions and have sky-high private insurance costs. How is that going to work?

SEPTEMBER 24 UPDATE: Miller-Meeks said on Iowa Public TV’s Iowa Press program that she has catastrophic health insurance coverage.

Republican Congressional candidate Brad Zaun has promised to give voters 14 reasons not to re-elect 14-year incumbent Leonard Boswell in Iowa’s third district. Last week Zaun unveiled reason number 1: Boswell “has been listed as a ‘follower’ according to the non-partisan website www.GovTrack.us. […] Boswell has sponsored only 66 bills since January 7, 1997, and 63 never made it out of committee. Only three of Boswell’s bills were successfully enacted…and of those three, two were for renaming federal buildings.”

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

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

Last week the federal departments of Health and Human Services, Labor, and Treasury “released interim final regulations implementing five of the insurance enrollee protections of the Patient Protection and Affordable Care Act” (the official name for the health insurance reform law adopted in March). Timothy Jost analyzed the regulations for the Health Affairs blog, and his whole post is worth reading. While a lot of uncertainty surrounds the new rules, the cost of compliance is expected to be low. Jost finds that “[r]elatively few people will directly benefit” from the health insurance reform, but there will be “[l]arge benefits for those who are affected.”

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

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

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

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

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

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

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

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

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

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

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

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

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

Iowa Republicans are deluding themselves if they think Representative Leonard Boswell is highly vulnerable this year. The more I see of the Republican primary campaigns, the less worried I am about holding Iowa’s third Congressional district in the Democratic column.

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

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

Governor Chet Culver announced Friday,

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

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

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

Here are more details about the program:

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

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

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

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

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

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

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

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

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

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

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

Republican gubernatorial candidate Terry Branstad has become the most prominent booster of Brenna Findley, the GOP candidate for Iowa attorney general. Branstad brings up Findley’s candidacy “in every speech” while campaigning around the state. He also talked up her candidacy on Iowa Public Television’s Iowa Press program and in the first gubernatorial candidates’ debate.

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

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

Approximately 80,000 Iowans will face substantial health insurance premium hikes beginning May 1. An independent review has confirmed the “need” for Wellmark Blue Cross and Blue Shield to raise rates by an average of 18 percent. The higher rates were intended to go into effect on April 1, but last month Governor Chet Culver ordered a delay pending an review of the matter. The Des Moines Register reports today,

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

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

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

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

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

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

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

“It’s indisputable that those add to rates. That’s just the way it works,” he said.

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

“Mandates aren’t necessarily requirements that insurance companies sell something. They’re requirements that purchasers buy something,” he said.

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

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

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

Share any relevant thoughts in the comments.

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

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

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

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

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

Senator Chuck Grassley is still misleading Iowans about what’s in the health insurance reform bill Congress passed last month. On April 1 he had this to say in Mason City:

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

“It’s questionable whether the federal government can require you to buy anything,” Grassley said.

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

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

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

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

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

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

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

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

{Originally posted at my blog Senate Guru.}

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

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

The money question of the poll was:

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

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

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

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

The Iowa Independent reminds us:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

State attorneys general have filed two federal lawsuits challenging the individual mandate to purchase health insurance, which President Barack Obama signed into law last week. Those lawsuits look like pure political posturing to me, given the well-established Congressional powers to regulate interstate commerce and taxation.

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

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

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

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

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

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

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

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

Many Republicans in Congress are calling for repeal of the new health insurance reform law. They know that won’t happen, but it’s good political posturing, because the GOP base is fired up and ready to go against “socialist” Obamacare.

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

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

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

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

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

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

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

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

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

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

What do you think, Bleeding Heartland readers?

Woo-hoo. The healthcare bill is done.  People will see many of the provisions go into place immediately and then they can decide how they feel about these reforms based on reality instead of frenzied, uninformed rhetoric.  Let’s just take a moment to recognize this historic occasion.  

The student loan reform that Congress just approved as part of the budget reconciliation bill has been overshadowed by the health insurance reform process, but it’s very good news for future college students. Senator Tom Harkin’s office summarized some benefits in a March 18 press release, which I’ve posted after the jump. The most important change is that the government will stop subsidizing banks that currently make big profits on student lending. Instead, the federal government will expand its direct student loans, saving $61 billion over 10 years. Most of the savings will go to increase Pell grants.

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

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

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

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

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

An alert Bleeding Heartland reader in Des Moines received a brief robocall around dinnertime on Thursday, March 25. Fortunately, he did not hang up on the automated voice, but stayed on the line to get as many details as possible about the call.

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

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

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

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

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

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

Senate Republicans failed to derail passage of the budget reconciliation bill containing changes to the health insurance reform bill and to the student loan program. The vote was 56-43, with all but three Democrats (Blanche Lincoln and Mark Pryor of Arkansas, Ben Nelson of Nebraska) voting yes and all Republicans present voting no. The Democratic strategy was to defeat all proposed amendments, so no Democrat offered an amendment to put a public health insurance option in the bill. However, some changes to the part of the bill dealing with Pell grants were made, which means the amended version of the reconciliation bill will have to go back to the House for another vote.

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

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

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

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