Obama's health insurance push gains support

by Lesley Politi on April 9, 2009

Obama’s health insurance push gains support


President Barack Obama’s health care initiative will benefit from a key change in the political landscape since the Clinton administration’s effort failed in 1994, Iowa’s two senators say.

Government and business now agree there is a problem that needs fixing, said Sens. Tom Harkin and Charles Grassley.

The senators also say Obama’s request that Congress write the bill is a better course than President Bill Clinton’s closed-door strategy 15 years ago.

The new push for health care reform continues Monday when the Obama administration seeks public comments during a forum at the Polk County Convention Complex.

The session is one of five around the nation this spring as part of an effort by the president to forge a public consensus on what needs to be done to address the nation’s health care problems.

As the debate gears up in Washington, Harkin and Grassley are expected to play key roles in Congress’ deliberations. That means Iowans’ concerns, such as rural health care and the effect on the state’s insurance businesses, will be represented.

Since President Clinton took a crack at overhauling the health care system, the number of uninsured Americans has risen from 39.8 million people in 1994 to 46.5 million in 2007, the Kaiser Family Foundation reported.

During that time, Harkin’s push for disease-prevention policy has grown from a tangential idea to one of the pillars of the approach to lowering health costs by Democrats in Congress.

Since Clinton’s attempt, Grassley has moved from the end of the bench on the key health care spending committee to its most powerful Republican. That makes him a linchpin to broad GOP support for a health care bill this time.

Both senators also bring knowledge and influence they have acquired since the Clinton plan failed, longtime observers say.

“In the past 15 years, they have become personally more expert in the field of health care policy,” said Peter Reinecke, a former Harkin legislative aide.

“Both of them have developed a skill set that enhances how influential they will be in determining the outcome of this process.”

Harkin and Grassley were at the table in 1993 and 1994, but the public’s attitude was much different about the need for changes, they said.

Harkin, then midway through his second term, was a member of the White House committee studying changes. Grassley, then beginning his third term, was the most junior minority member of the Senate Finance Committee.

Harkin says the big change between 15 years ago and now is that groups that fought expanding health insurance coverage in 1994 now see it as worth the money, considering the increase in costs and number of uninsured Americans.

“There just wasn’t that sense of urgency and everybody coming together,” Harkin said. “We did not have the business community on our side. We didn’t even have the labor unions on our side at that time. So I think everyone agrees this is the time.”

Grassley said there was not a consensus in Congress for change in 1994.

Daniel Patrick Moynihan, the Democrat who chaired the Senate Finance Committee, was not among the leading advocates for overhauling health care.

Today, finance committee Chairman Max Baucus, D-Mont., is working closely with Grassley with the shared hope of passing a bill with Republican support this summer.

Grassley says the bigger change is that the Obama administration is wisely seizing on the call from business, labor and the health care industry and putting the legislation in Congress’ hands.

It was a much different approach when the Clinton administration sought to reform health care in the 1990s.

Clinton appointed his wife, Hillary Clinton, to lead the effort, along with the president’s chief health care policy adviser, Ira Magaziner.

The Clinton team conducted most of its deliberations in private. The president then presented a plan to Congress that would have created a government-run health insurance program.

A compromise bill was offered by Senate Democratic Leader George Mitchell, but the bill failed to muster sufficient support from majority Democrats in Congress and the proposal died.

Grassley praised Obama for inviting an array of lawmakers and interest groups to the White House summit this month. Harkin and Grassley were there.

“The president wants to work with the Congress,” Grassley said. “These are all references to 1993 and 1994, where the president spent months and months and months behind closed doors and came out with something that couldn’t get bipartisan support.”

Today, Harkin is viewed as the Senate’s authority on prevention policy. Grassley is the Republicans’ senior expert on taxes and health care financing.

Harkin is a senior Democrat on the Senate Health, Education and Labor Committee. He was one of three senators picked by the committee’s chairman, Sen. Edward Kennedy, to draft the health care policy language in a Senate bill.

Harkin has argued for more than 20 years that including incentives for preventative measures in health care policies can bring down medical costs.

Obama’s domestic policy council director, Melody Barnes, specifically asked lawmakers, business leaders and health care advocates during the White House summit to insist that a health care bill include prevention language.

Dan Smith, Harkin’s chief of staff in 1994 and now president of the American Cancer Society’s advocacy group, said, “He was talking about prevention long before it was cool to talk about prevention.”

Ted Totman, Grassley’s former health care adviser, said the Grassley has become an expert on Medicare and the medical concerns of older Americans. Grassley was chairman of Senate Committee on Aging from 1997 to 2000, and he worked with the Clinton administration on tightening government oversight of nursing homes.

In 2003, Grassley, then Senate Finance Committee chairman, worked with Baucus to write the bill that created a prescription drug benefit for Medicare recipients.

Grassley has also established trust with key members of Congress in both parties and with officials in the Obama administration, Totman said.

Nancy-Ann DeParle, Obama’s director of the Office of Health Reform, worked closely with Grassley when she was director of the Health Care Financing Administration under Clinton .

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