Best news I’ve heard in a while: Coventry has told the Des Moines Register’s Tony Leys that it will continue to sell health insurance through Iowa’s exchange during 2016. Since the collapse of Co-Oportunity Health, Coventry has been the only provider selling individual and family policies on Iowa’s exchange. If the company had opted out for 2016, roughly 40,000 Iowans who qualify for federal subsidies would have had no way to obtain that assistance, likely pricing them out of health insurance for next year.

The 800-pound gorilla of Iowa’s insurance market, Wellmark Blue Cross/Blue Shield, will yet again opt out of our state’s exchange in 2016, Leys reported. Iowa’s Insurance Commissioner Nick Gerhart lacks the power to force Wellmark to sell through the exchange, because Governor Terry Branstad insisted on forming a “partnership” exchange with the federal government, rather than a fully state-based exchange.

More competition in Iowa’s health insurance market would be preferable; currently West Virginia is the only other state with just one company selling policies on the exchange. Still, Coventry’s decision to stay for next year removes a huge threat to the well-being of thousands of Iowa families. I was worried that Coventry would cut their losses here after taking on most of the relatively expensive former Co-Oportunity customers.

The U.S. Supreme Court’s pending ruling in King v Burwell remains another potential threat to the 40,000 Iowans who rely on federal subsidies to make health insurance affordable. It’s not clear whether the Republican-controlled Congress could pass a fix if the high court rules that those subsidies are not allowed for Americans who purchase health insurance through the federal website. Some Republicans would be willing to address the problem to preserve access to health care for millions, but others would insist on a full repeal of “Obamacare,” the 2010 Affordable Care Act.

UPDATE: At least one other company will also offer health insurance for 2016 through Iowa’s exchange. Excerpts from Leys’ updated report for the Des Moines Register are after the jump.

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.

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.”

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.

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.

Terry Branstad seems to have been around Iowa politics forever, but that doesn’t mean there’s nothing new to learn about him. This week I learned that in 2007, Branstad joined former Democratic Governor Tom Vilsack to advocate for new health insurance mandates in Iowa. More on that and other Branstad news can be found after the jump.

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?

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.

The big event of the week is President Barack Obama’s visit to Iowa City today. Approximately 16,500 people requested tickets for the event, where the president will tout the benefits of the health insurance reform law he signed on Tuesday. Some 150 to 200 people showed up for last night’s Republican event opposing the new law.

I hope some Bleeding Heartland readers will post comments or a diary about today’s presidential visit.

UPDATE: Scroll down for the full text of Obama’s remarks in Iowa City, as prepared. What he said about children with pre-existing conditions being able to get insurance coverage this year isn’t accurate, unfortunately.

I’m excited about a couple of other great events for progressives this weekend. Planned Parenthood of the Heartland (formerly known as Planned Parenthood of Greater Iowa) holds its spring book sale from March 25-29 in the 4-H building at the State Fairgrounds. It costs $10 to get in on opening night, but admission is free for the rest of the weekend. You will find a huge selection of books in almost every category you can imagine, as well as some CDs, DVDs, comic books and posters. Mr. desmoinesdem and I always find some wonderful out-of-print children’s books. Click here for opening hours and more details. Proceeds from the book sale support Planned Parenthood’s education programs in Iowa and Nebraska.

Another free event worth checking out this weekend is the Natural Living Expo at the Polk County Convention Center in downtown Des Moines Saturday from 10-6 and Sunday from 11-4. About 150 local businesses and non-profit organizations will be represented at the expo, including Iowa farmers, green home remodelers, and cloth diaper sellers. Francis Thicke’s campaign for secretary of agriculture and Iowa’s Water and Land Legacy will have booths too. Click here for a list of vendors, free lectures and panel discussions. If you have children, bring them along, because they may enjoy the storytelling, art and activities like hula-hooping and yo-yos in the kids’ area. I’ll be helping out a couple of non-profits at the expo, so I may see you if you stop by, but I won’t be wearing my “desmoinesdem” hat.

More events coming up this weekend are listed after the jump.

The Republican polling firm Rasmussen conducted a one-day survey of 500 “likely voters” in Iowa on March 17. Click here for topline results.

Senator Chuck Grassley still leads all his Democratic challengers, with no statistically significant change in his lead since Rasmussen’s last Iowa poll in February. He leads Roxanne Conlin 55 percent to 36 percent (the February numbers were 53-36). Grassley leads Bob Krause 57-31 (55-33 in February), and he leads Tom Fiegen 57-28 (56-28 in February).

Instead of asking respondents whether they approved of Grassley’s work in the Senate, Rasmussen asked whether they had a favorable or unfavorable impression of the senator. He was at 66 percent very or somewhat favorable, 31 percent very or somewhat unfavorable. (The latest Selzer poll for the Des Moines Register measured Grassley’s approval at 54 percent, but favorability numbers can often run ahead of approval numbers.)

Clearly the Senate race is still Grassley’s to lose, but he’s not likely to be re-elected with the huge margins he’s had in the past. There is also plenty of time for the race to tighten up if Grassley makes big mistakes. As Senate Guru reminded us in this diary, the current fundraising quarter ends March 31. I encourage Democrats to get involved and support one of Grassley’s challengers. Here are links to donate to the Conlin campaign, the Fiegen campaign and the Krause campaign.

Other notable findings from the latest Rasmussen poll: President Barack Obama’s approve/disapprove numbers were 50/49, but Governor Chet Culver is still in negative territory at 41 percent approve/57 disapprove. About 45 percent of respondents said they favored “the health care reform plan proposed by President Obama and the congressional Democrats,” while 53 percent said they opposed it. Remember, this poll was in the field before Congress gave final approval to the bill Obama signed yesterday. I am curious to see future polling on the issue. A quickie USA Today/Gallup nationwide poll released yesterday was the first in a long time to show net positive approval for health care reform: 49 percent of respondents said it was a “good thing” that Congress passed the bill over the weekend, while 40 percent said it was a “bad thing.”

Next week will mark the first anniversary of the Iowa Supreme Court’s ruling in Varnum v Brien. Seven justices unanimously concluded that the section of the Iowa Code enacted through our state’s Defense of Marriage Act violates the equal protection provision of the Iowa Constitution. Since the day that decision was announced, many Iowa Republicans have called for overturning the court’s ruling. Some have denied that county recorders were obliged to implement the ruling, or insisted that government officials may ignore a court’s opinion about the constitutionality of a law. Others have called on Iowans to vote against retaining justices who supposedly overreached their authority. For example, gubernatorial candidate Rod Roberts said last November,

“We need to send a message to the Iowa Supreme Court that they are accountable to the people of Iowa,” said Roberts, who has made restoring the role of the people in state government a centerpiece of his campaign. “The problem with judicial activism is that it thwarts the will of the legislature and of the people of Iowa.”

Now that Congress has approved a health insurance reform bill Republicans don’t like, some GOP politicians have decided judicial activism isn’t so bad after all. Gubernatorial candidate Bob Vander Plaats pledged to “invoke the Constitution’s 10th Amendment to protect Iowans from new federal mandates” on health care. Rod Roberts followed Vander Plaats’ lead:

Roberts said that if the federal government passes a nationalized health care plan that conflicts with the Roberts Amendment, as governor he will file a lawsuit in federal court against President Obama to have the plan struck down as a violation of Iowans’ Tenth Amendment rights. The Tenth Amendment to the U.S. Constitution provides that powers not delegated to the federal government (such as the regulation of health insurance) are reserved for the states.

Gubernatorial candidate Terry Branstad also supported the idea of using the courts to nullify the will of Congress: “Given the massive scope and effect of this [health insurance reform] bill, it is likely that various provisions will be challenged in the courts. Those challenges are both timely and appropriate.”

Any constitutional lawyer can tell you that the U.S. Supreme Court has long affirmed the power of Congress to regulate interstate commerce. Law professor Mark Hall explains in detail here why constitutional arguments against an individual mandate to purchase health insurance are wrong. As for the broader 10th amendment claim that the constitution doesn’t empower the federal government to regulate health insurance, Hall notes, “Congress has ample power and precedent through the Constitution’s ‘Commerce Clause’ to regulate just about any aspect of the national economy.”

Conservative legal scholar Eugene Volokh likewise does not find the constitutional arguments against health insurance reform convincing:

While I agree that the recent commerce clause cases hold that Congress may not regulate noneconomic activity, as such, they also state that Congress may reach otherwise unregulable conduct as part of an overarching regulatory scheme, where the regulation of such conduct is necessary and proper to the success of such scheme. In this case, the overall scheme would involve the regulation of “commerce” as the Supreme Court has defined it for several decades, as it would involve the regulation of health care markets. And the success of such a regulatory scheme would depend upon requiring all to participate. (Among other things, if health care reform requires insurers to issue insurance to all comers, and prohibits refusals for pre-existing conditions, then a mandate is necessary to prevent opportunistic behavior by individuals who simply wait to purchase insurance until they get sick.)

The U.S. Supreme Court could overrule the will of Congress on health insurance reform only by reversing several decades of precedent about the definition of commerce. That’s textbook “judicial activism,” but it’s ok with some Iowa Republicans if it achieves the political end they are seeking.

By the way, Vander Plaats claims that as governor, he could issue an executive order halting same-sex marriages in Iowa. I wonder if he also thinks President Barack Obama could issue an executive order overturning a possible Supreme Court ruling against health insurance reform.

UPDATE: Kevin Drum considers prospects for a lawsuit challenging the individual mandate to buy health insurance. He makes the same point about Congressional authority to regulate interstate commerce and adds,

What’s more, the penalties for not buying insurance are tax penalties, and if anything, Congress has even wider scope in the tax area than in the commerce area. The Supreme Court has frequently ruled that Congress can pass tax laws that essentially force people to do things that Congress doesn’t have the direct power to require.

[…]here’s the thing: if the Supreme Court decided to overturn decades of precedent and strike down the mandate even though Kevin Drum says they shouldn’t (hard to imagine, I know), the insurance industry will go ballistic. If they’re required to cover all comers, even those with expensive pre-existing conditions, then they have to have a mandate in order to get all the healthy people into the insurance pool too. So they would argue very persuasively that unless Congress figures out a fix, they’ll drive private insurers out of business in short order. And that, in turn, will almost certainly be enough incentive for both Democrats and Republicans to find a way to enforce a mandate by other means. If necessary, there are ways to rewrite the rules so that people aren’t literally required to get insurance, but are incentivized so strongly that nearly everyone will do it. As an example, Congress might pass a law making state Medicaid funding dependent on states passing laws requiring residents to buy insurance. Dependent funding is something Congress does routinely, and states don’t have any constitutional issues when it comes to requiring residents to buy insurance. They all do it with auto insurance and Massachusetts does it with health insurance.

Like Drum, I view these proposed legal challenges as Republican posturing rather than a serious threat to nullify the law Obama signed this morning.

President Barack Obama is expected to sign the health insurance reform bill on Tuesday. Meanwhile, Iowa politicians from both parties have been responding to last night’s votes in the House of Representatives. After the jump I’ve posted lots of reaction quotes, plus some bonus embarrassing comments from Steve King.

The president is coming to Iowa City this Thursday to promote the health insurance reform bill:

Iowa City was where candidate Obama announced his health-care plan before the 2008 caucuses, when he was in a scrap with Hillary Clinton and John Edwards for the party’s presidential nomination.

A White House official said today the president will be in the state to “discuss how health insurance reform will lower costs for small businesses and American families and give them more control over their health care.”

I’ll be curious to see the public polling on this issue in Iowa. A new nationwide CNN poll released today showed that 39 percent of respondents support the Senate bill just approved by the House. Some 43 percent oppose the bill because it is “too liberal,” while 13 percent oppose the bill because it is “not liberal enough.” In other words, more than half the respondents either support the bill or (like me) feel it doesn’t go far enough.  

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.

On Sunday, the House of Representatives will vote on the Senate’s health insurance reform bill and some “fixes” to that bill. The procedural details have not been fully worked out (David Waldman takes you through the weeds here and here), but it’s clear that the vote will be very close. House Speaker Nancy Pelosi needs to find 216 votes to pass the bill.

Various whip counts are floating around the internet. Take your pick from David Dayen’s version at FireDogLake, the Chris Bowers tally at Open Left, or the latest from The Hill staff. Several Democrats who voted against the House health care reform bill in November have announced plans to vote for this version. However, others who voted for the House bill remain undecided or have said they will vote no.

Today Peter DeFazio (OR-04) threatened to vote no on the bill because of changes in language on correcting geographical disparities in Medicare spending. DeFazio explained, “We spent months working this out. If we don’t get it in this bill, we will never get it.” The Huffington Post reported that other House Democrats share DeFazio’s concerns.

Because all three Iowa Democrats in the House strongly supported the changes to Medicare reimbursement rates that were included in the House bill, I contacted their offices today to find out whether they, like DeFazio, consider this issue a deal-breaker. I have not yet heard back from staffers for Representative Leonard Boswell (IA-03) or Dave Loebsack (IA-02), but a spokeswoman for Bruce Braley (IA-01) sent me this response:

Congressman Braley has spent hours in meetings with Speaker Pelosi and House Leadership this week, discussing the need to correct geographic disparities in Medicare reimbursement and how those corrections can be accomplished in this final bill.  Congressman Braley is still very much undecided on how he will vote on the reconciliation package and this is one of many factors that will play a role in his final decision.

I’ve never seen Braley on any list of wavering Democrats on the health insurance reform bill. If he and DeFazio do end up voting no, it will be much harder for Pelosi to find 216 votes. On the other hand, a compromise could be reached before Sunday:

At her press briefing Friday morning, House Speaker Nancy Pelosi (D-Calif.) was asked about Rep. Peter Defazio’s objections to the removal of the Medicare disparity fix from the final bill. “We’re working on that language,” said Pelosi. “I feel comfortable about where we are heading.” She said she supports the language that was in the House bill and is working toward restoring it as much as possible.

“We have reached agreement before,” she said of the dicey political issue.

I will update this post if and when I hear back from Loebsack’s and Boswell’s offices.

UPDATE: Loebsack’s spokeswoman confirmed that he will vote for the bill. Boswell seems like a firm yes as well, judging from an e-mail blast he sent yesterday, which I have posted after the jump.

SATURDAY UPDATE: Braley confirmed that he will vote for the bill because of the deal on Medicare reimbursement payments I discussed in more detail here.

Which isn’t easy, considering how high he normally sets the bar.

The Huffington Post covered Representative Steve King’s speech to yesterday’s “smaller-than-expected” Tea Party rally against health care reform:

King implored the crowd to bring the nation’s capital to a sort of paralysis. Warning, erroneously, that the health care bill would fund abortion and fund care for 6.1 million illegal immigrants, he demanded that concerned citizens “continue to rise up.”

“I look back 20 years ago in the square in Prague… when tens of thousands showed up there and they shook their keys peacefully and they took over their country and they achieved their freedom back again,” he said. “If you can keep coming to this city, fill up the congressional offices across the country but jam this city. If you can get on your cell phones, and get on your Blackberries and your email, and ask people to keep coming to this town. Storm this city, fill up Washington D.C., jam this capital so they can’t move. And if tens of thousands, hundreds of thousands of you show up, we will win. We will defeat this bill and you will have your liberty back.”

King stood his ground when given a chance to clarify his remarks, saying the current U.S. government is “very, very close” to the Czechoslovak Communist regime, because of “the nationalization of our liberty and the federal government taking our liberty over.”

I mentioned these comments to Mr. desmoinesdem, who has forgotten more about Czechoslovakia than King will ever know. He observed that if anything, the Obama administration resembles the government that took power after the Velvet Revolution. The administration changed some personnel and policies, but they didn’t punish or prosecute people who committed crimes on behalf of the old regime. That said, I don’t see Obama as much like former dissident Vaclav Havel, the first post-Communist Czech President (other than that both men are intellectuals and smokers).

Getting back to King, only the most deluded Tea Partier could imagine that the Senate health insurance bill nationalizes our health care system. The Obama administration and the Democratic-controlled Congress have sold out to corporate interests in almost every major aspect of this bill (as well as on financial regulation, energy policy, you name it).  

King’s wrongheaded analogy got me wondering how the Czech health care system measures up against ours. Here’s a report on changes in Czech health care since the Velvet Revolution. The Czech Republic spends about half as much on health care as the U.S. as a percentage of the country’s annual gross domestic product. The U.S. has slightly longer life expectancy than the Czech Republic, but our infant mortality rate is more than double theirs.

Another featured speaker at yesterday’s Tea Party rally was Representative Michele Bachmann of Minnesota. She recently encouraged non-payment of taxes as a response to the “illegitimate” health reform bill. Bachmann will headline an event for King next month in Sergeant Bluff (near Sioux City). The two have been collaborating on a “Declaration of Health Care Independence” since January. In October 2008, both King and Bachmann made Esquire’s list of the 10 worst members of Congress.

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

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

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

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

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

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

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

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

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

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

As you may have learned last week from LA Times reporting, and from Congressional Hearings, that Insurance companies routinely try to drop your Insurance policy, if you happen to get one of their “Hot List” illnesses.

Getting any of these illnesses, can Trigger the Insurance Company’s “Cancellation Police”, into action.

Denial Specialists scour your medical history, and cross-check that against your application, looking for any reason to Cancel, or rescind, your Insurance policy, thus saving the Insurance Company untold thousands in future payments for your expected Care. Denial Specialists, of course, earn bonuses for each Policy they cancel. What a system!

Those 4 illnesses (out of the 1000+ such Triggers) previously disclosed are:

breast cancer, high blood pressure, lymphoma and pregnancy

Well thanks to the tough questioning of the Oversight and Investigations Sub Committee, at least 2 more Triggering Illnesses have been disclosed, as indicated in the video and transcript of the Hearing:

The 2 other newly disclosed “Drop List” illnesses include:

ovarian cancer, and brain cancer