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

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

Iowans who buy health insurance through Wellmark Blue Cross and Blue Shield won’t be getting premium rebates anytime soon. Wellmark has a near-monopoly on Iowa’s individual and employer health insurance market. After the company announced last summer that it would not participate in the state’s health insurance exchange during its first year of operation, Democratic State Senators Jack Hatch and Matt McCoy questioned why the company was holding about $1.3 billion in reserves. The senators argued that the Iowa Insurance Division had previously justified Wellmark’s large cash reserves on the grounds that the company would be selling policies through the health exchange created under the 2010 Affordable Care Act. Hatch and McCoy asked Iowa Insurance Commissioner Nick Gerhart to study the issue, and in November, Gerhart retained Risk and Regulatory Consulting to investigate Wellmark’s reserve levels.

The consultants’ report, made public yesterday, concluded that Wellmark’s cash reserves are “reasonable and prudent.” Click through to read the full six-page report at the end of the article by Tony Leys of the Des Moines Register.

I’ve enclosed below a few excerpts from Leys’ report, Hatch’s letter to Gerhart last July, which provides background on the issue, and the joint statement Hatch and McCoy released yesterday. They noted that Wellmark “will be using its current reserves to protect them from risks that do not exist for them; namely, the Insurance Marketplace Exchange.” Hatch and McCoy added that the report “puts to rest the notion that the ACA could ever be the basis for a future premium increase by the company, at least in the next three years.”

After many years of double-digit percent increases in health insurance premiums, Wellmark did not raise premiums for many of its individual customers this year, presumably to deter them from shopping for a better deal on Iowa’s exchange. I predict Wellmark will cite the 2010 health care reform law as an excuse for raising premiums again before too long. Iowa individuals and families can purchase policies on the exchange from either Coventry or Co-Oportunity Health. Only Co-Oportunity is selling employer health insurance plans through Iowa’s exchange.

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.  

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.

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.  

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.

UPDATE: The vote on the rules for the reconciliation bill debate passed 224-206 (roll call). The final vote on the Senate bill will be late tonight.

FINAL UPDATE: The House approved the Senate bill 219-212, with no Republicans voting in favor and 34 Democrats voting against (roll call). It’s clear House leaders did not have the votes without the Stupak bloc.

VERY FINAL UPDATE: Two more roll calls: a Republican-backed poison pill that would have inserted the president’s executive order language on the Hyde amendment into the reconciliation fixes failed 232-199. Then the House passed the reconciliation fixes to the Senate bill by a vote of 220-211.

The House of Representatives began debating the health insurance reform legislation on Sunday afternoon. Speaker Nancy Pelosi is using the gavel Representative John Dingell’s father used the day the House approved Medicare in 1965. I will update this post as votes are taken on the reconciliation package and later on the Senate’s bill.

Some kind of new deal appears to have been struck with Bart Stupak and his group of anti-abortion Democrats. Link to follow later when more details become available. I assume this means House leaders didn’t have 216 votes without the Stupak bloc, which is how the whip counts have been looking. (UPDATE: The president agreed to issue this executive order affirming that the health insurance reform bill “maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges.” The executive order allows Stupak and his bloc to vote for the bill without the appearance of caving.)

Republicans are making fools out of themselves warning about the death of liberty and the “government takeover.” Gubernatorial candidate Rod Roberts has filed amendments to two Iowa House bills seeking to “challenge the constitutionality of President Obama’s plan to nationalize the health care industry.” He also says that as governor he would sue the federal government, claiming that health insurance reform violates the 10th Amendment to the U.S. Constitution. Roberts is copying a Bob Vander Plaats campaign promise here, which supports my view that Roberts’ main function in the governor’s race is to undermine Vander Plaats in the GOP primary.

Meanwhile, Democrats are making fools of themselves claiming that passing a Republican plan from 1993 is something to cheer about. We should be ashamed that corporate interest groups got everything they wanted in this bill, to the extent that the lobbying arm of the pharmaceutical industry is running ads supporting the bill. We should be outraged by all of President Obama’s broken promises on health care reform and the fact that he lied about supporting a public health insurance option after secretly agreeing to leave that out of the bill.

I don’t know whether better health care reform was achievable. Certainly Big Tent Democrat is right that progressives botched the negotiating process (see also here), but once the president decided not to do anything that angered corporate groups, we were probably stuck with what we’re getting. Some people will benefit from subsidized insurance and new primary health care clinics, but other people will be forced to downgrade their coverage, and there will be no new competition for the insurance companies that have near-monopolies in most of the country. I doubt this reform will reduce insurance company abuses, and I doubt it will save tens of thousands of lives a year, and I doubt future Congresses with (at best) smaller Democratic majorities will improve it in any meaningful way, but let’s hope I am wrong.

Failing to pass the bill might have hurt Democrats more in the short term, but I think over-promising the benefits will hurt us badly later. When Americans continue to face medical bankruptcies, and some insured people continue to find medical care unaffordable, and “wellness incentives” become the new method of discriminating against people with pre-existing conditions, Democrats will be blamed.

Listing the alleged “progressive victories” in this bill is just an exercise in self-delusion. This bill was written for the benefit of corporate groups. Many provisions that would have been in the public interest have been left out. It’s a disgrace that large Democratic majorities produced this reform, and it’s one reason the Democratic National Committee, the Democratic Congressional Campaign Committee and the Democratic Senatorial Campaign Committee will get no money from me for the forseeable future.

You can claim the bill is a slight improvement on the status quo, but calling it “progressive” or a sign of interest groups in decline is an insult to everyone’s intelligence. Not as stupid as calling it a “government takeover,” but almost as deceptive.

Share your own thoughts in this thread, whether or not you feel like celebrating today’s “historic victory.”

UPDATE: Republican strategist David Frum argues that the GOP made a huge mistake by refusing to make a deal with Obama on health care reform:

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. […]

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead.

Wellmark Blue Cross-Blue Shield recently announced premium increases averaging 18 percent for about 80,000 policy-holders. Tens of thousands of customers were facing rate hikes of 22 percent, effective April 1.

Today Governor Chet Culver halted the planned increases by Iowa’s largest health insurance provider. Details are after the jump.

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.  

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.

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.

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.

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.

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.

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.

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.

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.

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.

BruceMcF breaks it down for you:

So: (1) Public Choice

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

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

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

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

(2) Robust

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

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

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

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

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

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

Around 5:30 on Friday afternoon I received a robocall paid for by the Democratic National Committee on behalf of Organizing for America. The voice informed me about a rally for health care reform, scheduled for Saturday at 6 pm just west of the state capitol building in Des Moines. Press 1 if you plan to attend.

I didn’t press 1 and stayed on the line to see what would happen. The voice came back, telling me “The president needs you to show support” for reform.

The folks at Organizing for America have some pronoun trouble. It’s not President Obama who needs us. We need him to show support for real reform.  

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

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

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

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

David Mizner has more on why this is important.

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

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

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

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

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

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

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

Thanks, but no thanks for that bridge to nowhere.  

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

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

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

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

Event details are after the jump.

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

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

I understand that fear of the unknown is often stronger than fear of the known, but even so I’m struck by how many people argue against a potential public health insurance option while ignoring huge problems with our current system.  

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

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

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

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

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

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

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

I don’t publish enough linkfests at Bleeding Heartland. Here are a few pieces that any Democrat should read before deciding to accept a health care reform compromise without a strong public option. The first three are personal stories.

A cardiologist recommended a nuclear stress test for this middle-aged man with a family history of fatal heart attacks. The scheduled test was canceled after the patient’s insurance company refused to cover it. Who’s getting between patients and their doctors again?

AdmiralNaismith explains how his wife’s embolism left his family “drowning in medical bills, despite insurance.”

Downtowner explains “How I lost my health insurance at the hairstylist’s” and how medical checks she needs are unaffordable now that she is uninsured.

These are not unique stories; thousands of insured Americans face these kinds of problems. It’s not at all rare for insurance companies to cancel the policies of customers who become seriously ill. Never let any Republican tell you that we have the best health care system in the world.

My last two links for today are “strategy” posts.

Ian Welsh discusses the economic and political consequences of passing an individual mandate to buy health insurance with no public option. Spoiler alert: they’re not good unless you think “a regressive tax which will rise faster than wages or inflation” is a political winner.

Bruh3 explains the crucial flaw in President Obama’s negotiating strategy on health care. No one believes he will walk away from the table, no matter how bad a bill Congress sends him.

The floor is yours.

UPDATE: Some White House officials told Marc Ambinder that Sebelius misspoke, or the media misinterpreted her remarks. I would prefer a clear statement from the president.

Health and Human Services Secretary Kathleen Sebelius waved the white flag on Sunday:

Sebelius said the White House would be open to co-ops instead of a government-run public option, a sign Democrats want a compromise so they can declare a victory on the must-win showdown.

“I think there will be a competitor to private insurers,” she said. “That’s really the essential part, is you don’t turn over the whole new marketplace to private insurance companies and trust them to do the right thing. We need some choices, we need some competition.”

Sen. Richard Shelby, R-Ala., said co-ops might be a politically acceptable alternative as “a step away from the government takeover of the health care system” that the GOP has assailed.

(continues after the jump)

I was encouraged earlier this year when Congressman Leonard Boswell (IA-03) signed on to Health Care for America Now’s core principles, and his spokesman assured me that Boswell was strongly committed to a public health insurance option. More recently, however, Boswell left himself wiggle room when asked about the public option, so I was eager to hear about his town-hall event in Sigourney on Thursday.

Unfortunately, I have more questions than answers after reading this Radio Iowa report. (continues after the jump)

At yesterday’s town-hall meeting in New Hampshire, President Barack Obama had nice things to say about Senator Chuck Grassley:

“Now, I think that there are some of my Republican friends on Capitol Hill who are sincerely trying to figure out if they can find a health care bill that works – Chuck Grassley of Iowa, Mike Enzi of Wyoming, Olympia Snowe from Maine have been – yes, I got to admit I like Olympia, too. They are diligently working to see if they can come up with a plan that could get both Republican and Democratic support.”

In addition, Thomas Beaumont of the Des Moines Register noticed that Organizing for America is not mobilizing Obama’s supporters to show up at Grassley’s town-hall meetings in Iowa. Instead, Organizing for America is trying to drive turnout to events hosted by Iowa’s Democrats in Congress.

Grassley’s holding four public events today, and @iahealthreform is helpfully liveblogging them on Twitter. Look at how Grassley talks about health care reform and tell me whether Obama should praise Grassley’s efforts.

Former Alaska Governor Sarah Palin suggested on Friday that health care reform could kill her baby:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Of course, none of the Democratic health care proposals would provide for anything like Palin’s fantasy “death panel.”

In contrast, health care is rationed according to people’s medical history and ability to pay every day under our current system.

It is “downright evil” that uninsured trauma patients are 50 percent more likely to die than trauma patients covered by insurance.

And that uninsured people are often denied organ transplants on the grounds that they will lack the capacity to pay for anti-rejection medications.

And that insured as well as uninsured Americans to delay medical treatment for chronic illnesses because they can’t pay.

And that uninsured people are much more likely than insured people to be diagnosed with “advanced cancers […] that could have been detected early through proper screening.”

And that paperwork from insurance companies, rather than a doctor’s recommendation, determines a patient’s timetable for cancer surgery.

And that cancer patients forgo radiation or chemotherapy if they lose their insurance.

And that insurance company bureaucrats can override a doctor’s recommendation on whether a suicidal mental patient needs to be hospitalized.

And that insured as well as uninsured people can face bankruptcy or crushing debts after completing cancer treatment or care for a medical emergency.

Feel free to add to this list in the comments.

UPDATE: Charles Lemos posted the full text of Palin’s Friday comments on health care reform.

SECOND UPDATE: Speaking of rationing, read this diary by the father of a 13-year-old girl with type 1 diabetes. Excerpt:

Managing diabetes is about preventing future complications and a greater expense. My daughter’s Doctor had prescribed six needles per day. Each needle represents a meal, a snack or a correction. In effect the insurance company was saying to her you may eat four times a day. Or, eat three and correct once. Well her Doctor believes in more and smaller meals. Tell me Mr. President who stands between her and her Doctor? Who has a concern for preventive care and maintenance? Why do I have to have this conversation month after month? Why does my policy increase nearly ten percent a year and some times more?

MONDAY UPDATE: Natasha Chart and I are on the same wavelength.

Such as the revolving door between Congress and corporate lobbyists:

The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records. […]

Nearly half of the insiders previously worked for the key committees and lawmakers, including  Sens. Max Baucus (D-Mont.) and  Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

So corporate groups are spending $1.4 million a day on lobbying to block a real public health insurance option, which most Americans want.

That’s on top of the millions of dollars the same corporate groups have donated directly to Congressional campaigns. Iowa’s Senator Chuck Grassley has taken hundreds of thousands of dollars from the industries with the most at stake in health care reform.

Members of Congress claim lobbyists and campaign money don’t shape their opinions, but Grassley should know better. He understands that big money from pharmaceutical companies can influence the conclusions of medical researchers–why not elected officials?

Nate Silver has found strong evidence that special-interest money affects Democratic senators’ support for the public option in health care reform.

By the way, I wasn’t too cheered by Senator Chuck Schumer’s promise over the weekend that the health care bill will contain a public option. The current draft in the Senate Committee on Health, Education, Labor and Pensions excludes lots of people from choosing the public option over their current health insurance. That will limit competition for the private insurers that have near-monopolies in many markets.

Back in 2003 all the Democratic presidential candidates talked a good game on health care. Now Dick “this is a moral issue” Gephardt is lobbying for a pharmaceutical company. I’ll stand with Howard Dean and hope that John Edwards was wrong about the system being rigged because corporations have too much power in Washington.

Final note: Moveon.org is organizing health care rallies this Thursday, July 9, at senators’ offices in their home states. Sign up here to attend a rally near you.

Senator Chuck Grassley has been holding town-hall meetings around the state this week, and the Iowa Democratic Party highlighted a fun clip from his June 30 meeting in Waukon. A constituent wanted to know why his health insurance policy was so much more expensive than Grassley’s, despite having less generous coverage.

The senator advised the questioner to “go work for John Deere” if he wanted a better insurance policy. (Not too practical, since Deere has laid off workers in Dubuque, Ottumwa and the Quad Cities this year.) As Grassley tried to move on to the next question, the man continued to press for details about Grassley’s own coverage, and the senator advised him to go talk to the people at the Farm Services Administration about health insurance.

But the questioner followed up again: “How come I can’t have the same thing you have?”

To which Grassley replied, “You can. Go work for the federal government.”

Since there aren’t too many federal government jobs in the Waukon area, I have a better idea: why doesn’t Grassley support a real public health insurance option for all Americans?

UPDATE: Here was Grassley in Iowa City today:

Hoping that health care reform plans implode under weight of Democratic in-fighting is a bet he’s not willing to make.

“I’m not a gambler.” Grassley said. “If you go a partisan way, the Democrats have the capability of screwing up our health care system forever. If it is screwed up forever, we could get big majorities two or four years down the road, but we ain’t going to turn it around. So I’m a little more cautious than a lot of my Republican colleagues.”

The best bet for getting a bill to President Obama this year is the bipartisan work being done by the Senate Finance Committee where he is the ranking Republican, Grassley said. Whatever reform plan that comes out of the House will be highly-partisan just by the nature of the House, he predicted. Sen. Ted Kennedy’s Health, Education, Labor and Pensions Committee has rejected Republican input.

I’m supposed to believe that Grassley is worried about the public option because it would “screw up” health care so badly that Republicans couldn’t fix it even with large majorities?

First of all, Republicans aren’t going to win back the Senate majority in two or four years. It will be a longer climb.

Second, Republicans are fighting the public option because they’re afraid it would work too well, causing private insurers to lose market share to the more affordable public plan. (See here.) They are desperate to avoid that outcome because it would likely realign American politics in the Democrats’ favor for a long time. That’s what Republican messaging guru Frank Luntz is warning them against.

I sincerely hope that the House Progressive Caucus votes down a Grassley-friendly bipartisan health care bill (individual mandate to buy for-profit private insurance that doesn’t compete with any public plan). If President Obama wants to claim victory on this issue, he’ll have to get behind a bill that would be better than the status quo. Democrats would be fools to listen to Grassley on either the substance or the politics of health care reform.

Health and Human Services Secretary Kathleen Sebelius issued reports on Friday detailing the problems with the “health care status quo” across the country. You can find the reports at HealthReform.gov. The report for Iowa is here, and I’ve also posted it after the jump. Among other things, it shows the percent increase in family health insurance premiums since 2000 and the percentage of uninsured Iowans.

A couple of points jumped out at me:

• Choice of health insurance is limited in Iowa. Wellmark BC and BS alone constitutes 71 percent of the health insurance market share in Iowa, with the top two insurance providers accounting for 80 percent.11

Iowa is not unusual in this regard. Most insurance markets in the United States are dominated by one or two companies. My family’s Wellmark premiums went up 10 percent this year alone. Speaking of which, the annual salary of Wellmark’s CEO has “nearly doubled” in the past five years to about $2.5 million.

• Choice is even more limited for people with pre-existing conditions. In Iowa, premiums can vary, within limits, based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.

I know a family in Des Moines who were unable to purchase health insurance at any price because the mother has a thyroid condition. They are now covered through the father’s employer, but if he loses his job they will have no health insurance options.

Two more reasons why we cannot settle for health care reform without a public option, or with a fake public option. I was glad to see several House Democratic caucuses affirm that they will fight any health care bill lacking “a real and robust public option that lives up to our criteria”.

Click “there’s more” to read the whole report, with supporting footnotes.

I’m shocked, shocked to read that

Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.

Mr. Obama invited health industry leaders to the White House on Monday to trumpet their cost-control commitments. But three days later, confusion swirled in Washington as the companies’ trade associations raced to tamp down angst among members around the country.

Jason Rosenbaum has more on the story at Health Care for America Now.

Looks like the White House was a bit too eager to herald a breakthrough with various interest groups that want to block serious health care reform.

I think David Sirota was on to something when he wrote on Monday,

Isn’t President Obama legitimizing voices that will use that added credibility later on to try to derail serious health care reform? Today’s press conference has the President of the United States effectively saying that the health insurance industry should have a major seat at the health-reform table – and that it should be trusted. But any serious health care reform will need to take on the health insurance industry in a way that will make that industry unhappy. When that eventually happens, won’t the previous efforts to legitimize the health insurance industry’s voice add credibility to its opposition to reform? […]

Obama’s political calculus throughout his life has been to avoid making enemies. He seems to believe that he can make lots of different interests happy – and on many issues, that’s certainly possible. But on some issues, like health care, it’s a binary fight: Either you appease the health industry and preserve the status quo they are making big bucks off of, or you take on the health industry and make real change. Touting the industry’s “voluntary” commitment to not rip off consumers seems more in the appeasing camp than in the “real change” camp.

Obama won’t be able to get the health care reform we need without making enemies among those who profit from the current system. When push comes to shove, he may need a dose of FDR’s “I Welcome Their Hatred” tonic.