Senate Democrats negotiating health care reforms with Sen. Charles Grassley are finding out the hard way that the Iowa Republican, while boasting a reputation for reaching across the aisle, appears hard set on supporting GOP leadership above bipartisan compromise.
Not only is Grassley threatening to vote against the bill — even a bill he supports — if it doesn’t gain enough GOP backing, but his home-state recess tour has found him echoing false GOP accusations that the Democrats’ plans would empower the government to ration services and euthanize seniors. Many health policy experts say the behavior is indication that Grassley — the senior Republican on the Senate Finance Committee who’s up for reelection next year — has bowed to pressure from conservative colleagues to oppose the health care overhaul in favor of more incremental reforms. Or none at all.
“The hard-core Republicans are pretty hard core and so he is hearing a lot from them and less from others,” Michael Bailey, political science professor at Georgetown University, said in an email.
David Mayhew, professor of political science at Yale University, pointed out that Grassley’s GOP colleagues aren’t the only ones applying the pressure. Constituents at animated town hall gatherings this month have also made clear their reservations with the Democrats’ reform plans, and Grassley has already held four such events, with 16 more planned for next week. “Grassley seems to be drifting to an anti position on this health-care drive,” Mayhew said in an email. “That is not surprising … Right now, the median voter in Iowa must be quite nervous about this drive. The median voter in any upcoming Republican primary in Iowa is more than nervous.”
The comments arrive as the nation’s health care spending continues on its unsustainable skyward path, and the Democrats, behind a fervid push from the Obama administration, are proposing sweeping reforms to rein it in. Four congressional committees — three in the House and one in the Senate — have already passed reform proposals. Only the Senate Finance panel has yet to contribute a bill. As a result, all eyes this month are on the Gang of Six, the bipartisan group of Finance members charged with crafting a compromise.
Grassley, a member of that bunch, issued a statement Wednesday reiterating the importance of coming up with a bipartisan bill. “Something as big and important as health care legislation should have broad-based support,” Grassley said. “So far, no one has developed that kind of support, either in Congress or at the White House. That doesn’t mean we should quit. It means we should keep working until we can put something together that gets that widespread support.”
But that call for widespread support is making some observers anxious, particularly in the wake of comments by Sen. Jon Kyl (Ariz.), the Senate’s second-ranking Republican, vowing to oppose the Democrats’ proposal unless they scrap the current plan and start anew. “There is no way Republicans are going to support a trillion dollar bill,” Kyl told reporters.
In an interview with National Review Wednesday, Grassley fingered four policy priorities he wants from the final bill: the absence of a public insurance plan, protections against rationing, assurances that Washington won’t disrupt the doctor-patient relationship, and tort reform.
Yet, to the surprise of many health care experts, Grassley is also threatening to vote against a health reform bill — even one he backs — if it doesn’t win enough votes within the Republican caucus. “If I can’t negotiate something that gets more than four Republicans,” he told MSNBC Monday, “I’m not a very good representative of my party.”
Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, said that stipulation, by hinging Grassley’s support of whether guys like Kyl get on board, leaves Democrats with little power of negotiation.
“That’s a really big deal,” Hobson said. “That comment alone may have done [substantial] harm to the process.”
Jonathan Oberlander, health policy professor at the University of North Carolina-Chapel Hill, echoed that message, warning that any bill capable of winning 15 or 20 Republicans would lose too many Democrats to pass. Such GOP support won’t be possible, he said, “unless the legislation falls far, far short of what most of the Democratic caucus supports.”
Grassley’s office didn’t respond to requests for comment, but issued a statement Wednesday reiterating the Iowa senator’s commitment to fighting for a bill that a substantial number of Republicans would support.
Not that Grassley isn’t capable of political independence. In 2007, for example, he bucked both the Bush administration and Republican leadership by leading the unsuccessful bipartisan effort to reauthorize the State Children’s Health Insurance Program. Revealing the limitations of that independent streak, however, he ultimately voted with GOP leaders against SCHIP’s renewal when it came up again in January, arguing that the expansion was too broad and would encroach on private insurance markets. Further displaying his party-line feathers, in 2003 it was Grassley, then-Finance Committee chairman, who pushed through controversial Republican legislation creating Medicare’s prescription drug benefit and the Medicare Advantage program, both of which took steps toward privatizing the popular Medicare program. The American Conservative Union rates Grassley with a lifetime score of 83.
“More often than not he is a reliable conservative Republican, especially on economic issues, which may be at the core of his discomfort with the health care bill,” David P. Redlawsk, political scientist at Rutgers University, said in an email.
The historic relationship between Grassley and Senate Finance Chairman Max Baucus (D-Mont.) is an unusually close one, riding straight into this year. Baucus has gone out of his way to appease his counterpart throughout the health reform debate, delaying release of the bill until September so the sides could iron out differences. Yet Grassley has reportedly balked this month over a face-to face meeting between members of the Gang of Six. Moves like that have left many health policy experts wondering if, on this health reform drive, the committee’s working relationship isn’t deteriorating.
Oberlander said that Grassley’s eyebrow-raising behavior has created “the appearance of a strain” in the bipartisan working relationship among the Finance leaders.
“You have the Republican who’s supposed to be the most cooperative, and he’s out there talking about death panels,” he said.
An impasse in the Finance Committee could have serious consequences. Without Grassley’s endorsement of the bill, there are real questions whether a sweeping health reform proposal stands a chance in the upper chamber, where 60 votes will be required to defeat a likely GOP filibuster. Although the Democrats have a 60-member majority, it’s uncertain whether ailing Sens. Edward Kennedy (D-Mass.) and Robert Byrd (D-W.Va.) would be available to vote.
Taking a lesson from the Clinton administration’s failed health reform push in 1993 and 1994, Obama has been careful not to make specific policy demands, instead laying out broad goals he wants the reforms to accomplish. But, as the thorny Finance panel debate has revealed, that strategy has its perils as well. Some observers are beginning to wonder if the White House is being aggressive enough in its push for a health system overhaul.
“If Mr. Obama wants to jettison the now-weakened public plan to dampen overheated opposition,” editorialists at The New York Times wrote Wednesday, “he should say what he will insist on instead.”
Mike Lillis is Congress reporter for the Washington Independent.
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