Weekend update: “incarcerate, educate & medicate”

‘Tis the season to post on the blog sporadically.  Below are some of the top Iowa political stories of the past few days (you have to scroll all the way to the bottom for an explanation of that headline!).

In case you were making a list and checking it twice, there is another potential candidate for governor.  Jonathan Narcisse, a former Des Moines School Board member who went on a speaking tour with Republican gubernatorial candidate Chris Rants earlier this month, is “exploring” a run for governor.  Narcisse is a registered Democrat, but Narcisse says he’ll consider the idea of running as an Independent as well as the idea of running against  Democrat Chet Culver, the current governor, in a primary.  Narcisse sent reporters an advisory at 4 p.m. on 12/23/09 and held a news conference at 8:30 a.m. on Christmas Eve.   (I didn’t “work” on Christmas Eve; I hosted dinner for 16 at my house instead.)

As expected, U.S. Senator Tom Harkin (D-Iowa) voted “yes” and U.S. Senator Chuck Grassley (R-Iowa) voted “no” on the health care reform bill on Christmas Eve.  The White House released a list of people President Obama called after the vote; it included Senator Harkin. Read statements from Iowa’s two senators below.

WASHINGTON, D.C. – Senator Tom Harkin (D-IA) today joined the Democratic Senate majority in supporting The Patient Protection and Affordable Care Act.  The legislation passed the Senate by a vote of 60 to 39 and will now go on to conference with the House.  Harkin is Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, one of the two Senate committees charged with crafting health reform.

“Today I cast one of the defining votes of my Senate career – a vote that will bring the promise of comprehensive health reform closer to every American,” said Harkin.  “Our legislation has a simple goal: decrease the number of uninsured, increase access to affordable care and make health insurance companies more accountable.  In passing it today, we send an important message to Americans that help is on the way – that your insurance company can no longer discriminate against you for a pre-existing condition or based on your gender; if you’re a small business owner, you will have more choice and competition in the marketplace, and if you’re a senior, you will the prescription drug coverage you need.

“But we also know that in order to truly bend the cost curve, we must break the cycle of rising chronic disease that is keeping health care costs high,” continued Harkin.  “I can say without hesitation that this legislation provides an historic investment in prevention and wellness at every level –federal, clinical and in our communities to remove the barriers to healthy living.

“The Patient Protection and Affordable Care Act is landmark legislation and it will provide the reforms our country so desperately needs at a time when we need them the most.”

Some of the immediate benefits of the bill include:

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions: the bill provides $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective in 2010, and coverage under this program will continue until new Exchanges are operational in 2014.

Access to Quality Care for Vulnerable Populations: the bill makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $10 billion investment begins in 2010 and extends for five years.

No Pre-existing Coverage Exclusions for Children: the bill eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the Managers’ Amendment prohibits health insurers from excluding coverage of pre-existing conditions for children, effective in 2010 and applying to all new plans.

Closing the Coverage Gap in the Medicare (Part D) Drug Benefit: the bill reduces the size of the “donut hole,” raising the ceiling on the initial coverage period by $500 in 2010.

Small Business Tax Credits: the bill will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.   Tax credits of up to 35 percent of premiums will be immediately available to businesses that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while businesses with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.

Free Prevention Benefits: The Patient Protection and Affordable Care Act will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect in 2010 and applies to all new plans.

No Lifetime Limits on Coverage: The Patient Protection and Affordable Care Act will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect in 2010 and applies to all new plans.

Restricted Annual Limits on Coverage: The Patient Protection and Affordable Care Act will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned.

Rural and underserved communities:  Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.

Preventive medicine and public health training grant program: Amends and reauthorizes section 768 of the Public Health Service Act, the preventive medicine and public health residency program.

Loan repayment for faculty at schools that train physician assistants: Includes faculty at schools for physician assistants as eligible or faculty loan repayment within the workforce diversity program.

National diabetes prevention program: Establishes a national diabetes prevention program at the Centers for Disease Control and Prevention. State, local, and tribal public health departments and non-profit entities can use funds for community-based prevention activities, training and outreach, and evaluation.

Adjustment to Low-Volume Hospital Provision (“Tweener” Hospital Fix):  The amendment increases threshold for eligible hospitals from 1,500 Medicare Part A discharges per year to 1,600 per year.

Rural physician training grants: Authorizes grants for medical schools to establish programs that recruit students from underserved rural areas who have a desire to practice in their hometowns. Programs would provide students with specialized training in rural health issues, and assist them in finding residencies that specialize in training doctors for practice in underserved rural communities.

Senator Chuck Grassley, Ranking Member of the Committee on Finance, issued the comment below regarding his vote today against final Senate passage of the Patient Protection and Affordable Care Act:

“Starting a year ago, I worked for nine months for a health care reform bill that I thought would be a bipartisan product that would bring about true health care reform.  I don’t have any regrets spending those nine months.  There are a lot of good things that came out of that process.  But, about September 15, the White House shoved Republican negotiators to the side and decided to go ahead in a partisan way.  So, I’m voting no on the health care bill before the Senate today.  When Social Security was first passed, when Medicare and Medicaid first passed, and civil rights laws passed, they were very bipartisan because there’s a feeling in this country that when you make big social change, it ought to be done on a more consensus basis, or a bipartisan basis.  Not true this time, and I regret that very much, particularly having worked for a bipartisan bill for about nine months.  There are some good provisions in the Senate bill today, but there are core things that are part of this bill that quite frankly Democrats, in order to do what they wanted to do, would not compromise on, and I think these four things are bad for the country.  Number one, taxes are going to go up.  Number two, premiums are going to go up.  Number three, there’s almost a half a trillion dollars coming out of Medicare, which is financially broke, to set up a new entitlement program.  And four, inflation in health care is not going to go down.  If there was a discussion group in Iowa, and I was asked what this bill did, and I said taxes were going to go up, premiums were going to go up, there’s a half a trillion dollars taken out of Medicare to fund another program, and we weren’t addressing increasing costs of health care, you’d say, well that doesn’t sound like health care reform.  And I don’t think this bill is health care reform.  Instead, it’s a two-and-a-half trillion dollar cost to the taxpayer that’s not going to accomplish what we set out to accomplish a year ago.  I regret it very much, but that’s where we are today.”

Lots of other statements came in over the transom on Christmas Eve. Here are a few:

Washington, DC – Today, Congressman Leonard Boswell released a statement following the Senate’s passage of historic health care legislation.

“Today’s vote in the Senate marks a major step forward to improving the quality, access, and affordability of health care for every American,” Boswell said. “I applaud my colleagues in the Senate for sacrificing time away from their families during this holiday season to vote on this transformative legislation. I look forward to working with my colleagues in the House and Senate to produce final legislation that will repair the health care system for all Iowans – families, children, young adults and seniors alike.”


DES MOINES, IA –  Today, the Senate voted to pass the Patient Protection and Affordable Care Act.  The bill passed with unanimous support from Democrats despite weeks of Republican stall tactics and attempts to keep the bill from coming to a vote.  In response, Iowa Democratic Party Chairman Michael released the following statement:

“Today, on Christmas Eve, we thank President Obama, Senator Harkin, and other Senate Democrats for their strong leadership on this issue and as they continue to move closer than ever to making comprehensive insurance reform a reality for all Iowans.

“This morning’s vote marks a historic moment in the decades-long struggle to pass comprehensive health reform.  I am so proud of Iowa Senator Tom Harkin who was at the helm directing such a significant effort.

“Make no mistake – this bill is a clear victory for Iowans.

“The Patient Protection and Affordable Care Act will provide quality, affordable choices for the uninsured as well as stability and security for those who already have coverage. And, it will expand coverage to more than 30 million Americans while reducing the deficit by more than $130 billion over the next 10 years.

“While Senate Democrats were united in their effort, health reform passed with Senator Grassley and every other Republican voting ‘no.’ As we approach the 2010 elections, Senator Grassley will need to explain to Iowans why he chose to side with health insurance executives over everyday Iowans.”

Des Moines – Matt Strawn, Chairman of the Republican Party of Iowa, issued the following statement this morning after the U. S. Senate approved a health care bill along partisan lines:

“Today’s vote should be a major disappointment for all of us who want to see affordable health care reform. After months of bipartisan work, Democrats pushed Republicans like Senator Chuck Grassley aside and rammed through a partisan bill that does not accomplish what Americans want. Instead of lowering health care costs, this bill will result in increased taxes, higher premiums and cuts to Medicare.”


OTTUMWA – While Senate Democrats praised themselves today on the passage of a bill that drastically reshapes America’s health care system, Republican congressional candidate Mariannette Miller-Meeks warned its crushing costs will fall on middle-income families in Iowa and across the nation.

“The bill approved today will benefit insurance companies at the cost of the taxpayer and ordinary working, middle-income Iowans and Americans.  It does not bend the cost curve down or control escalating health care costs,” the Ottumwa ophthalmologist said this morning. “It will increase health insurance premiums.  Despite its tremendous cost, it does not provide universal coverage and, even more importantly, it fails to provide portable insurance for individuals so they’re able to keep their insurance coverage as they go from one job to another or one state to another.”

Miller-Meeks noted that Rep. David Loebsack voted for the House version that will be the basis for negotiations with the Senate as the two chambers work to cobble together a compromise bill early in 2010.

“The Senate bill is terrible. Unfortunately, the House bill is even worse. The entire process led by Harry Reid and Nancy Pelosi is a disaster for America because it’s going to cost trillions of dollars going forward and it’s going to make the health-care system worse instead of better. It’s already been widely reported that Nebraskans will never have to pay the increased costs for Medicaid.  That was a deal that was cut to get Senator Ben Nelson to vote for it. We can only imagine how many more deals like that are going to have to be made at the expense of the American people so the Democrats can get the votes they need to take over our health care system.”

She added, “If there’s ever a time when David Loebsack should listen to his constituents and support representative democracy, this is it. He needs to meet with the people of this district during the next few weeks and represent them instead of representing Nancy Pelosi.  And, I urge the people of the Second District to call Congressman Loebsack and tell him to stop this destructive bill by voting no.”

DES MOINES—AARP Iowa State Director Bruce Koeppl released this statement after this morning’s passage of the Patient Protection and Affordable Care Act.  The vote allows members of the House of Representatives and Senate to begin merging their respective bills and enact health reform legislation early in the New Year.

“This morning the Senate brought us closer to meaningful health care reform than we have ever been before.  Passage of the Senate health care reform bill clears the way for Congress to enact legislation in the coming weeks that will protect and strengthen Medicare, ensure millions more Americans can get affordable health coverage and sharply curtail discriminatory insurance company practices that keep those most in need out of the system.

“The bill passed by the Senate makes needed progress to prevent coverage denials due to health status and limit insurance companies from charging older Americans much more for coverage because of their age.  It also begins to close the dangerous gap in Medicare drug coverage known as the doughnut hole, and Senate leaders have committed that a final bill will close the gap entirely by 2019, in keeping with the President’s pledge.  In addition, the Senate bill adds important new Medicare benefits, like free preventive care, and encourages states to provide more home and community-based long-term care services and supports instead of costlier institutional care.

“AARP thanks the Senate for advancing this critical legislation.  We look forward to working with members of both chambers during the conference committee to improve this legislation and enact a final package that is even stronger so that America’s health care system finally meets the needs of our members and all older Americans.”

Statement of Peggy Huppert, Iowa Director of Government Relations, American Cancer Society, Midwest Division
In response to today’s passage of historic Health Care Reform legislation in the United State Senate

“The American Cancer Society thanks Senator Tom Harkin and his colleagues in the Senate for passing historic legislation to reform the health care system that will benefit cancer patients in important ways. We encourage Congress to finally finish this legislation and deliver it to President Obama to sign so cancer patients will no longer need to fear loss of coverage because their cancer is a pre-existing condition. They will no longer be forced to choose between their life-savings and life-saving treatment because annual and lifetime caps on coverage will be eliminated. Most importantly, this legislation gives patients and their families hope that we’re one crucial step closer to achieving the American Cancer Society’s ultimate goal: eliminating cancer once and for all.”

As the Senate chose to pass health care reform legislation on Christmas Eve, I was reminded of one of Hillary Clinton’s TV commercials that aired right before the 2008 Iowa Caucuses.  You may recall seeing it. It’s the one where she had wrapped packages with tags, including one “gift” she intended to the give the country — “universal health care.”  The fellow who beat Clinton in the 2008 Iowa Caucuses and who went on to win the presidency sent out a Christmas Eve message to his “Organizing for America” supporters.

Although it’s Christmas Eve, I wanted to share some exciting news: The Senate just passed a historic health reform bill.

In all the back and forth, it’s easy to lose sight of what this incredible breakthrough really means. But consider this: This Christmas, there are millions of Americans without health insurance who risk losing everything if they get sick.

There are mothers and fathers who wonder how they’ll provide for their children because an illness has wiped out their savings. There are small business owners who worry that they’ll have to lay off a long-time employee because the cost of insurance is rapidly rising.

If we finish the job, all this can change. We will have beaten back the special interests who have for so long perpetuated the status quo. We will have enacted the most important piece of social policy since the Social Security Act in the 1930s, and the most important health reform since Medicare in the 1960s.

In Decembers to come, millions more will have access to affordable coverage. Parents will have the security and stability of knowing their insurance can’t be revoked at a moment’s notice. And the skyrocketing costs plaguing our small businesses will be brought under control.

When you make calls, write letters, organize, this is the change you’re making — a better life for your family and for men and women in every state.

There is still more to do before I can sign reform into law — a last round of negotiations and final votes in the Senate and the House — and I’m counting on your help every step of the way. But for now, I hope that as you celebrate this holiday season, you remember that the work you are doing is making our union more perfect, one step at a time. For that, I am grateful to you.

Merry Christmas and happy holidays,

President Barack Obama

Here’s the Radio Iowa compliation of the top Iowa political stories of 2009. At least four Republican candidates — Terry Branstad (GOP candidate for governor); Rod Roberts (GOP candidate for governor); Chris Reed (GOP candidate for second district congressional seat) and Jim Gibbons (GOP candidate for third district congressional seat) — issued Christmas messages this year (those were the four I received via email).  And Chester J. Culver recently said the state’s mainly in the business to “incarcerate, educate and mediate.”

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About O.Kay Henderson

O. Kay Henderson is the news director of Radio Iowa.