An important vote on health care reform comes off tomorrow, when the U.S. Senate will undertake a procedural vote on the recently introduced Patient Protection and Affordability Act. It is not a vote to pass the bill out of the Senate, but to move full consideration of the bill in the chamber. There are 58 Democrats, 40 Republicans and two independents who typically vote with the Dems, but perception is that a few Democrats could balk and aid plans by the GOP senators to filibuster the bill if 60 votes aren’t garnered.

That would be too bad, says U.S. Sen. Tim Johnson, a Democrat who hails from nearby Vermillion, S.D. Johnson today is saying the bill deserves the opportunity to be considered on the Senate floor, and so thinks the measure should be passed along tomorrow without all the hue-and-cry. He likes that the bill is estimated to give health care coverage to 94 percent of Americans as part of the effort to stand “up to the big insurance companies on behalf of the American people.”

You can count on Republicans John Thune of South Dakota, Charles Grassley of Iowa and Mike Johanns to vote nay tomorrow, while Johnson and Tom Harkin of Iowa will vote affirmatively. That leaves Ben Nelson (above), a Nebraska Democrat as a wild card, and the National Republican Committee is pressuring Nelson to vote ‘no.’ Additionally, Nelson will come to his voting presumbly having digested the editorial by the Omaha World-Herald to scuttle the Patient Protection and Affordability Act now.

In a release two days ago,  Nelson doesn’t say how he’ll vote, but I’ll read that he’ll be a ‘yes.’ You decide what this means:

“Some who define it as a vote in front of the (Harry) Reid bill are misinformed, or are intentionally trying to mislead people. I remember that some in my party said the same thing — equating this procedural vote with a vote for a bill — when the Republicans were in charge. If your goal is to obstruct, that’s a convenient argument.

“… In reality, the meaning of the motion to proceed is very simple: It’s a motion to commence debate and an opportunity to make changes. Let me say it again: it is a motion to start debate on a bill and to try to improve it. If you don’t like the bill, then why would you block your own opportunity to amend it? Why would you stop senators from doing the job they’re elected to do — debate, consider amendments and take action on an issue affecting every American?”

It’s worth noting the Senate PPAA bill is not the same as what passed out of the House two Saturdays ago. Apparently the important 2009 federal health care reform bill votes must occur on Saturdays.

A report Tuesday showed the obesity rate for Americans hanging (like a gut) again in the low-30s percent, while pointing to the rate climbing to 43 percent by 2018. Obesity is measured at 30 pounds above a healthy weight, and if it rises to the 2018 projection, one-fifth of all health care costs will be related to medical conditions arising from being considerably overweight.

I asked U.S. Sen. Charles Grassley, R-Iowa, what federal officials can do to reduce obesity at a time when  health care reform is being debated in Congress. He said the federal government can push a few things, but said Americans need to take control of their own health.

Said Grassley, a three-mile-per-day jogger: “The answer is yes (for federal action), but not very directly, because you aren’t going to control what people can put into their mouth and whether or not they walk enough and exercise enough or what they eat that is unhealthy.”

Grassley laid out four areas for action: (1) more education to aid healthy living decisionmaking (he cited education being instrumental in reducing smoking rates), (2) having more doctors encouraging preventive medicine when speaking with patients and (3) creating healthier school meals, which is something Iowa’s other senator, Tom Harkin, frequently has worked towards. The fourth Grassley suggestion is Congress creating an opening for health insurance companies to have differing insurance premium costs depending on whether a person is obese.

“I would propose that we have different premium levels for people that don’t have a healthy lifestyle,” Grassley said. “By the way, a Safeway executive has made several appearances on Capitol Hill talking about how his company does that through their health insurance program, where they give people money for first-dollar costs of health care, and they get more money if they have a healthy lifestyle.”

Grassley again relayed his continuing opposition to a soda pop tax, which had at one point this summer been pitched as a means to pay for health reform.

“I’m not convinced that would work, and I am very convinced it is a nuisance tax,” he said.

Steve King looks at the health-care proposal.

You may have seen the big feature in The Journal today concerning health care reform and Steve King. It was something of a shocker that has people talking — Republican King is so opposed to health reform pushed by Democrats that he chose to stay in D.C. Saturday to cast a ‘nay’ vote instead of coming back home to see a son get married.

King also on Saturday had a second big public event in three days to air his concerns with the bill. In an interview with me yesterday, King said the genesis of the public rally idea came from Sioux City native Col. Bud Day, a big buddy of 2008 presidential candidate John McCain after the two were prisoners of war in the Vietnam War.

King said he’d been hunting with Day in Northwest Iowa when the most decorated American veteran came up with the rally idea. Separate from that, in an interview with fellow Journal reporter Michele Linck, Day on Friday praised King for his leadership in setting up the rallies. Day will be in a Journal feature this week after being included in a new Topps cards (you know, the company that makes baseball cards) series entitled American Heritage Heroes. He is one of the 10 military heroes, while there are 10 political heroes (including Ronald Reagan and Barack Obama), 10 civil rights heroes, and so on.

Talking with Michele, I connected the dots on the mutual admiration the two men have for each other. Day told Linck about hunting in the Loess Hills, when he suggested less talk and more action in a demonstrative way, including perhaps surrounding the White House. King then worked with Congresswoman Michele Bachmann, R-Minn., on the plans. One image from the Thursday rally showed King (left) holding the 1,990 pages of the health reform bill (that ultimately passed on 220-215 count). You can see more images from Saturday’s event here.

“I got this real excited call from Steve. ‘I took your advice, we charged The Hill, surrounded Congress,’ ” Day related.

The three-day gap in posts here is due to a long weekend in Cedar Falls. Had a good time — and had a political connection when watching University of Northern Iowa Panther volleyball. In walked U. S. Sen. Charles Grassley, who goes to a lot of volleyball, in part to hear his son Jay handle the announcing. We had a brief chat, then others in the crowd hit him up as well, so I suppose Grassley didn’t get to see too much of the Panther plays.

Anyway, being away from computer and television for the weekend, my news dosage was simply reading the Sunday newspaper. Settling back into town here I see the U.S. House passage of federal health care reform ran on P5 of the Journal, while in the Waterloo Courier it warranted P1. The Courier also devoted much of the jump page to a comprehensive breakdown of what was in the reform bill,  as well as what was in the competing Republican reform bill that wasn’t enacted. I knew from reading the piece that only one Republican voted for the bill, so was certain that tri-state Republicans Steve King of Iowa and Jeff Fortenberry of Fortenberry did not vote for it.

However, several Democrats voted against the measure, but there was no breakdown of names in the article. So the nagging thought the rest of the weekend was whether South Dakota Congresswoman Stephanie Herseth Sandlin, a Democrat who lines up with the fiscal moderate Blue Dogs, had bucked the party line and voted against the bill. She’d expressed concern over health reform in a conference call just over a week ago, and I had an inkling she might not vote for reform in a state where Republicans dominate politically.

Sure enough, Herseth Sandlin voted ‘nay.’ As this Mount Blogmore post relates, that riled some South Dakota Democrats who saw merits in comprehensive reform. In a statement, Herseth Sandlin bemoaned the potential impact on Medicaid provisions on S.D.’s state budget and reductions in payments for long-term care under Medicare. She also pointed to insufficient cost containment and deficit reduction provisions. Herseth Sandlin said South Dakota families just didn’t support that particular reform package, as much as she still thinks reform is necessary.

So all three Siouxland members of Congress voted no on HR 3962. Now the gaze turns to the Senate, where this piece relates how that bill is unacceptable to some senators.

Posted on Twitpic by Somethingfishie

Federal health care reform talks have achieved critical mass, as the end of this week will be a key time to see whether reform moves forward. The U.S. House could vote on a measure Saturday, and today some local chapters of the American Association of Retired People are holding press conferences to talk about support for the House bill. That will happen in a few minutes in Des Moines with Iowa AARP talking about advocacy efforts.

On the flip side, at noon Republicans like Iowa 5th District Congressman Steve King and Minnesota Congresswoman Michele Bachmann will follow through with a press event called a “house call” on the east steps of the Capitol in Washington to beat back reform. Two days ago King and other reform critics called on Americans to “fill the streets of Washington and opposed the (House Speaker Nancy) Pelosi health care bill. ”

“For liberals, this legislation is the crown jewel of their socialist agenda,” King said, since it “will place bureaucrats between patients and doctors,” and raise taxes on small businesses. Bachmann pitched the “house call” with, “Nothing scares members of Congress like freedom-loving Americans.”

With equal conviction he’s right on the issue, on Tuesday a Storm Lake newspaperman gave testimony to the Senate Health, Education, Health and Pensions Committee hearing on health insurance, as invited by U.S. Sen. Tom Harkin, D-Iowa. Art Cullen of the Storm Lake Times spoke about how the newspaper has struggled to continue to provide health insurance to 12 employees as costs rise. He cited rates doubling (and then annually increasing by double digits) after an employee had a kidney transplant in 2005, and bemoaned an inability to change insurers because of employees with pre-existing conditions.

“The Storm Lake Times now pays nearly $50,000 per year for health insurance coverage. That’s almost as much as we pay for newsprint. Were it not for such high insurance costs we could add more employees and help to grow our local economy,” Cullen testified.

Cullen noted Buena Vista County families have an average household income of $36,000 and it costs about one-third of that amount to buy an annual private health care plan. Click here to see the 176-minute hearing, including the very last minute in which an incensed, arms-waving Cullen goes off prepared testimony to vent about  insurance companies “screwing” Americans.

Two days, two U.S. Senators from Iowa, two different outlooks on the value of including a public option to access the federal employees health plan. Yesterday U.S. Sen. Charles Grassley, R-Iowa, said a public option isn’t defensible as part of federal health care reform since it will knock private health insurance companies out of the business. This morning, U.S. Sen. Tom Harkin, a Democrat, said a public option will ensure competition and make companies offer more pleasing packages.

Harkin is glad the bill being pushed by Senate Majority Leader Harry Reid includes a public option with an opt-out option individual states can have.  He said he’s not overly pleased with the opt-out option, but said that’s part of lawmaking — senators frequently vote for imperfect legislation that on balance is better than not acting. With the current health reform package, Harkin said, “There is too much other good stuff in the bill to sink it.”

Questioned, Harkin said he couldn’t think of a state that actually would opt-out. Additionally, he said Democrats will line up 60 votes to pass reform. That includes former Democrat, now Independent Joe Liebermann, who said Tuesday he’d try to sink the bill. For one thing, Lieberman still caucuses with Dems, Harkin noted, and “I don’t believe he wants to go down in history like that (opposing reform).”

He said there is a lot of jockeying going on for  concessions on this  bill (and perhaps other bills) by the few Democratic senators who are publicly balking, including U.S. Sen. Ben Nelson, D-Neb. Harkin said it’s a case of senators looking for “leverage, leverage, leverage.”

Again, Harkin greatly differs from Grassley on a public option. “There is strong support for a public option in poll after poll,” he said, then added, “Iowans I talk to see this as plain common sense.”

On another high-profile issue, Harkin said it is time for the U.S. to move forward to stem global warming via the Boxer-Kerry climate change bill that some see having dim odds of passage in 2009. Harkin says he supports the bill and “hopes” it advances, since the U.S. uses the most energy and is the globe’s biggest polluter.

“We have to take the lead in the world,” and “show the rest of the world we mean business” to reduce carbon emissions, Harkin said.

U.S. Sen. Charles Grassley, R-Iowa,  isn’t looking with humor at the back-and-forth on whether Democratic Senate Majority Leader Harry Reid has lined up 60 votes for a public option in federal health care reform. Reid announced two days ago that his counting showed 60 votes for the public option, but reports since indicate that might not be solidly so. In a conference call with reporters this morning, Grassley said passing valid health care reform is important business, so he’s not chuckling over Reid’s beancounting.

Grassley said Iowans want elements of reform like portability of insurance coverage over state lines and with setting medical malpractice award maximums. “There is no Republican satisfied with the status quo on health care,” he said.

Some contend minority party Republicans marginalized themselves by standing up against reform measures that Democrats wanted and with talk of “death panels,” and so effectively  shut themselves out of negotiating health reform details. Grassley, who opposes a public option to access the federal employees health care system because it would undermine private plans, said the GOP negotiated in good faith and offered amendments in committees, which were voted down on party lines.

“This is true — opt-in, opt-out, trigger  or just pure (public) option — you get the government as a competitor… it is going to ultimately force private insurers out of business,” he said.

Asked if he foresees Democrats being subjected to major crunch time arm-twisting to vote for reform, Grassley said there “is tremendous pressure” to deliver a political victory for President Barack Obama, who was elected by a large margin in the Electoral College.

“This is his Number One goal,” Grassley said. “Now, the further you get away from that (2008) election and that mandate, then there can still be the same amount of pressure and arm-twisting — and I’m using your words, not mine — (but) less effective than it is right here  in the first year. That’s my experience, probably with more than one president.”

Grassley said Republicans are fighting an uphill battle against Democrats. “There are 60 of them. And if they 60 stick together, they’re going to get it done. Now, are they going to stick together?” he said.

Just after 2 this afternoon, U.S. Sen. Harry Reid, who heads the Senate Democratic caucus, sent out the following tweet of note:  Just announced that the merged health care bill will include a public option for ins coverage w/ a state opt-out clause #hcr

Opponents of health care reform will lament that federal Democrats seem over the last few days to have ironed out differences that had slowed measures moving through Congress. And those who have even more problems with the leadership by Reid and Nancy Pelosi in the U.S. House can do more than lament.

Just got an e-mail off the Christian Newswire on behalf of Randall Terry, founder of Operation Rescue. We’re advised there’s an option, “in the spirit of American political protest and Halloween,” to enter a contest and make the best video in which Pelosi and Reid “Burn in Hell.” Terry notes that first prize is an expenses-paid weekend in Washington, D.C., during the January anniversary of the U.S. Supreme Court Roe V. Wade abortion decision.

Says Terry, “Nancy Pelosi and Harry Reid are like hardened criminals; they are bent on ‘holding a gun’ to American taxpayers and stealing our money to force us to pay for the murder of babies under so-called ‘health care.’ ”

Later, he adds this “Legal Mumbo Jumbo: Obey local laws on open flames; be careful; if under 18, do not burn Nancy Pelosi in effigy unless your mom or dad is with you and gives you permission and strikes the match; do not burn yourself; do not burn another human being; do not burn small animals; do not burn large animals; do not burn anyone from PETA; and remember: this is not a threat to Nancy Pelosi’s or Harry Reid’s person, it is a prophetic witness of what awaits them when they die if they do not repent for this horrific sin.”

Whenever I write about Terry, I recall him standing outside Planned Parenthood of Siouxland in November 2003 and passionately asking Siouxlanders to help beat back the federal right to abortion that resulted from the Roe V. Wade decision. Do you put this video contest by Terry as beyond-the-pale pot stirring (Halloween, right?) or toughminded satire?

South Dakota Congresswoman Stephanie Herseth Sandlin won’t accept the National Republican Congressional Committee derogatorially labeling Democrats who are open to a public option as part of health care reform. In the weekly conference call with reporters, Democrat Herseth Sandlin laid out her logic on a public option to access the federal employees health care plan, which is a complicated matter, she said, as much as the NRCC “may want to suggest it is black and white.”

Herseth Sandlin said “I am going to be pragmatic,” and added that when she explains her rationale on a public option, South Dakotans understand the conundrum. She began by noting she’s part of the fiscally moderate Blue Dog Coalition of 52 Democrats, who “think far too much attention has been paid to the public option,” since there are lots of other portions of health care reform to consider, particularly long-term cost containment.

“The Blue Dog Coalition has a position that if a public option is included, that it should be based in negotiated rates, that it operates on a level playing field with the private plans and that it should be subject to a trigger,” Herseth Sandlin said, and that’s still her position.

She said she would not support a public option that is based on Medicare reimbursement rates (sometimes called a “robust public option”), since South Dakota for decades has “suffered” under disparity with the state’s Medicare rate being less than the national rate.  That would cause degredation to the state’s health care system, Herseth Sandlin asserted.

“I have never felt the public option is essential. I have not taken it off the table, because there are a whole host of other issues important to South Dakotans and our health care delivery system that I have wanted to be able to effectively negotiate. I think the President stated it well in his September address, that the public option, you know, its impact shouldn’t be exaggerated by the right or the left, and it unfortunately has been used, you know, in an ideological battle here. I think it is important to determine whether or not there is going to be any flexibility, going forward, to change how that public option would look. But if it remains a public option based on Medicare rates in the House version of the bill, I won’t be able to support that, but hope that I would be able to support a conference report that I know won’t include a public option based on Medicare rates,” Herseth Sandlin said.

Herseth Sandlin said the chances to get Republicans to join as part of a bipartisan health reform effort in the House have gone out the window. She wants to see reform that doesn’t “pass by the skin of our teeth” with the minimum 218 votes, but with 230 or more votes as a goal. That necessitates give-and-take over what the final bill would include, and she likes some things discussed in the Senate. Herseth Sandlin said it will be interesting to see whether House leadership bows to liberal Democrats who want a robust public option.

Iowa 5th District Congressman Steve King this morning said Republicans like himself need to beat back health care reform efforts led by majority party Democrats. King said “it is not a stretch to say they are for socialized medicine,” and chortled over Dems who deride Republican for “obstructing” health care. He said Republicans are offering pieces to the reform, but they’re not being placed into bills.

“(Democrats) have a 79-vote advantage in the House of Representatives. You know, they can’t agree among themselves at this point. That’s a pretty good sign that their ideas are bad. They aren’t bipartisan ideas,” King said.

He said the chief reform idea he heard repeatedly in his August town hall meetings, which makes it a good idea, is tort reform, or capping medical malpractice awards at $250,000.

King said health reform, cap and trade and immigration reform are the three priorities for Democrats in the 111th Congress. “One plays off the other — if they get their head handed to them on cap and trade, it hurts the health care reform too,” he said.

I asked King to provide 0-to-100 percent odds on a few items occurring in 2009:

(1) Likelihood that energy legislation dubbed “cap and trade,” which has already passed out of the House, will be passed in 2009 in the Senate: 35 percent

(2) Likelihood of a health reform bill emerging for a House floor vote: 45 percent.

(3) Likelihood of a health reform bill advancing for a Senate floor vote: 60 percent.

(4) Likelihood of immigration reform being forwarded to President Obama for signing: Less than 10 percent.

If a health reform bill goes to the House floor, King said it would get one Republican vote at most. He predicted Democrats will be able to amass votes to pass health reform in 2009, since the chamber leadership teams and Obama don’t want the egg of a political loss on their faces.

However, King said if Republicans can forestall the process until March 2010, defeat of health reform could happen. He said that will put the measure too close to the November 2010 election, making lawmakers “afraid” of voters being “angry” about the issue. By March, King said, “I think the nation will be a lot safer from these kinds of ideas.”