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U.S. Rep. Bruce Braley (D-Waterloo) on the Health Care Initiative

posted on November 13, 2009

Borg:Counting votes. Legislation overhauling the nation's health care system narrowly passed the House of Representatives last weekend. Now the senate is counting votes, and eventually the house again will be rounding up votes on a compromise. Perspective from Iowa Congressman Bruce Braley on this edition of Iowa Press.

Funding for Iowa Press was provided by Friends, the Iowa Public Televisi6on Foundation. The Iowa Bankers Association … for personal, business, and commercial needs, Iowa banks help Iowans reach their financial goals. Iowa Community Foundations, an initiative of the Iowa Council Foundations, connecting donors to the causes and communities they care about for good, for Iowa, forever. Details at iowacommunityfoundations.org.

On statewide Iowa Public Television, this is the Friday, November 13th edition of Iowa Press. Here is Dean Borg.

Borg:Even though the House of Representatives passed legislation making major changes in the nation's health care system, it may be only symbolic. Some are calling the legislation dead on arrival in the senate. Whatever happens, it's a near certainty that if the senate can muster the votes to pass something similar, the house again will be voting on a bill compromising the house and senate versions. Given that the house passed the initial bill by a slim five votes, there's a lot of political maneuvering and persuasion ahead. We're seeking perspective today from Iowa's first district Congressman Bruce Braley of Waterloo, a member of the energy and commerce committees and subcommittee on health. Congressman Braley, welcome back to Iowa Press.

Braley:Great to be back on the show, Dean.

Borg:You know the two journalists across the table, Associated Press Senior Political Writer Mike Glover and Radio Iowa News Director Kay Henderson.

Glover:Congressman, as Dean mentioned, you voted in favor of the health care overhaul bill which passed by five votes. Tell us why you voted for that bill.

Braley:Well, it's one of the proudest bills I've ever taken on the house floor. We know that it's long past time that we address the problem of meaningful health care reform in this country. We've been struggling with this as a country for over a hundred years, Mike. And one of the reasons that President Barack Obama was elected and that many of us were reelected was to tackle one of the most important domestic issues we face. This bill that I voted on is going to improve access to health care for thousands of Iowans. It's going to provide providers in Iowa with improved reimbursements under the Medicare reimbursement amendment that I introduced. And it's going to provide a lot of seniors with security in knowing that their prescription drug benefits are going to be improved.

Glover:And both sides are threatening, people who voted for and against this, we're going to use this against you politically next year. What's the politics of this health care bill?

Braley:Well, you know, I did about 17 town hall meetings in my district in July and August, and people would say things like that to me at my town hall meeting. And I said, your absolutely right, one of the beauties of our constitution is you get to vote for me every two years. And if you don't like the votes I take, you can send me home. If I take a tough vote like the one I did on health care and it results in me not getting reelected, I can live with that vote. This is the most important vote that members of congress are going to take in 2009, and I was proud to cast the vote that I did.

Glover:After reflecting on that, the Cook political report has downgraded your status. They had listed you as a safe democratic seat. Now they're suggesting you're vulnerable. Has this vote made you vulnerable?

Braley:I don't think it's made me any more vulnerable than going out to all the counties in my district this summer and talking to my constituents about the importance of comprehensive health care reform. They had a lot of tough questions, and I did everything I could to answer their questions by looking them in the eye and telling them where I stood and why I supported meaningful health care reform. And the voters next November are going to judge me based upon the accomplishments that I had, whether I listened to them, and whether I worked hard to fight for their interests. And I believe that I have.

Henderson:You supported a so-called public option, which ended up being in the final house plan. Now the senate is debating this. Must the senate include a public option, or do you think this bill is dead?

Braley:No, I think the bill has to have a meaningful public option, because Iowa is representative of many states where there is very little competition in the health insurance market. Eighty percent of the coverage offered in Iowa is offered by two companies. In many other states, it's that percentage or higher. The reason we need a public health insurance option is because the private marketplace has had the opportunity to address these problems and hasn't done a very good job of it. So what we're trying to do is create more transparency, require essential benefits in any type of policy, whether it's private or public, so consumers have more choice in the marketplace and can make the best decision for them and their families.

Henderson:And related to that public option, an abortion debate. The house had an amendment regarding how spending could happen in that public option on abortion. First of all, how did you vote and why?

Braley:Well, I voted against the Stew Pack amendment because the bill that we had already introduced, including the bill I voted on in the energy and congress committee, had strong language preserving the Hyde amendment that said that no federal funds could be used to pay for abortion. It also preserved the Weldon amendment choice of conscience for health care providers, insisting they couldn't be forced to perform abortions if it was a violation of their conscience. That was already in the bill. What was happening with this amendment that we voted on in the house floor is that certain people felt that that language wasn't strong enough, and many of us felt that the language that was already in the bill preserved the status quo for federal funding of abortions, and that's why the vote came out the way I did.

Henderson:Several democrats in the house have suggested that if the bill that's developed in a conference committee includes that abortion language which passed the house, they'll vote against the bill. How will you vote?

Braley:Well, a lot of us are looking at the bill in its entirely, because many people think that the public option is the only important aspect of health care reform. But if you look at what medical economists are talking about, the prevision that we put in to move Medicare from a fee-for-services model to one that pays based upon quality patient outcomes is what most economists suggest is going to be most significant in improving quality and efficiency in how we pay for health care. So I don't sit there and look at one specific issue and say this is determinate for me. I'm going to look at the balance of the bill when it comes out of conference committee, weigh whether it's best for the people that I represent, and then cast my vote.

Borg:I want to get a little more specific on what you've just said. You've called this the most important vote that you've cast in 2009 and also said it must have a public option -- a final legislation going to the White House must have a public option. Are you saying that you would vote against a comprehensive compromise if it didn't have the public option?

Braley:Well, one of the challenges of answering that question, Dean, is there are so many different proposals out there that are some facet of a public option. The senate has provisions in their bill for co-ops, which they're calling a public option. We've tried co-ops in Iowa and they failed. And I think if you're going to have a robust public option to compete with the private marketplace and give consumers more choice, it's got to be a real public option. Then there are proposals to have that public option kick in at a certain point in time if the marketplace doesn't respond to the concerns we've been talking about. I believe the language in the house bill creates a reasonable alternative to give consumers more choices with a realistic public option that people can go into the national health insurance exchange and choose what's best for them.

Borg:Let me just put some words in your mouth and see if you say yes or no to it. Are you saying that any health care overhaul is better than nothing?

Braley:No, I am not one of those people who says pass a bill, any bill, it's good for America. What I will tell you is having spent the greater part of a year working on this legislation, having read thousands of pages of health care policy and health care economics analysis, gone to ten hearings and listened to over 90 witnesses testify, that the provisions in the bill that we passed on Saturday night have a host of different important measures to improve the delivery of health care for all Americans including things like innovative patient delivery models like the medical home, accountable care organizations, bundling of medical payments, promoting more primary care. So that's been a big focus of mine is how we improve the quality of care for Americans. That should be what drives the ultimate vote for everybody in the house and senate.

Glover:Congressman, let's go to another issue involving health, although only tangentially, and that's Afghanistan. President Obama faces a decision on sending more troops to Afghanistan. There's some signs he's getting relatively close to making that decision. What's your take, should the president send more troops to Afghanistan? Should he commit the nation to a long-term war there? What should he do?

Braley:Well, I just came back from Camp Dodge where I met with members of the Iowa National Guard who were facing another deployment to Afghanistan, Mike, so this is something that weighs very heavily on me. I have insisted all year long and have been part of a coalition of both democrats and republicans who have signed off on a letter and sponsored legislation to President Obama that says before you commit to increasing the level of troop involvement in Afghanistan, we want to know what your exits strategy is. It's no different than the pal doctrine we used before the first Gulf War. You need to lay out for us what your exit strategy is before you ask us to send these Iowa National Guard members into harm's way.

Glover:And have you seen that strategy, a way to accomplish what we're trying to accomplish and get out? Have you seen it?

Braley:No, we have not seen a direct response to that request. We've heard from General McChrystal about what his visions are for an increase in troop involvement, but in terms of the long-term strategy for accomplishing both our military and political objectives and bringing those troops home, we have not seen that?

Glover:And people don't like to talk about politics and wars, but in fact there is politics to these kinds of decisions. Every poll I have seen shows that a majority of Americans oppose stepping up the war in Afghanistan. What are the politics of this decision for President Obama? Is he so afraid of being viewed as weak that he'll send troops into an area without that point?

Braley:You know, Mike, I'm not going to speculate on what President Obama may or may not do.

Glover:So what's the politics of it?

Braley:Well, I'll tell you what the politics is. It's not just Americans who are opposed to expanding our role in Afghanistan. Only 13 percent of Afghanis support an increase in troop involvement by America. If you look at the history of that company, it's not hard to understand why that opposition is so fierce. But I've also talked to people who have returned from Afghanistan and who are looking at what's happening on the ground to try to create educational opportunities for women and girls and create a more vibrant economy, and I think the big setback was the political fiasco from the national elections that many of us hoped would lead us to a better future for Afghanistan. So the politics is really how do we as a country define our continuing role in such a troubled area of the world? And that's why it was not just democrats who signed onto this letter. There were seven republican colleagues of mine.

Glover:It sounds to me like you're setting the bar pretty high. He's going to have to come up with a pretty persuasive argument to do this.

Braley:That's right.

Borg:When you were telling about being out at Camp Dodge, you emphasize yet another deployment. That leads me to ask -- because that's fatigue, what you're really -- battle fatigue and stress. Is the only solution to that to increase the size of the military?

Braley:Well, you know, Dean, we did increase the size of the military last year. We authorized the expansion of the Army and the Marine Corps to address this problem that we saw in Iraq where we had 180,000 civilian contractors and 130,000 members of our military serving in a combat zone. And in response to a request from the Pentagon and the enormous stress it's placing on our troops, we did agree to that expansion. And that was with a view going forward that we were looking at a two-front ongoing war that was going to continue to deplete and tax our military.

Borg:But it hasn't solved the problem.

Braley:It hasn't because one of the things I can tell you about the Pentagon is they're very slow to move, to ramp up, and to implement those plans. And we know that because I was just out at the Iowa National Guard talking about a two-year struggle to get them respite leave benefits that they earned during their last deployment in Iraq and still haven't been paid by the Pentagon. And President Obama signed a bill on October 28 to finally give them the $200 a day of additional combat pay that they've been entitled to since they returned.

Henderson:Let's shift gears and talk about the financial services industry. After the debacle of 2008, there seemed to be an imperative, congress was going to enact more regulation of the industry. Why has that failed to happen?

Braley:Well, I think it's failed because we have been taking a deliberate approach through the financial services committee in the house and the finance committee and other committees in the senate to look very closely at the underlying causes of that collapse, to try to put in place a regulatory framework that's going to respond to those issues going forward. And, you know, to be honest, it's very difficult because there's so many people affected by that legislation. They come down with their own agenda for what they would like to see happen. So it's been a very tough slog to get this bill to the floor for a vote.

Henderson:So do you see stalemate?

Braley:No, I don't see stalemate. One of the things we know is that health care has been the 800-pound gorilla in this legislative session. As soon as we've got health care cleared up in the house, it will free up more time to devote to financial --

Glover:Let's go back to another issue. It was about one year ago that America elected Barack Obama as president, and he took office last January. Give me your report card on Barack Obama's first year in office.

Braley:Well, I think that he has been very effective in sending a new message to our global allies about the new role that America is going to play in the world as someone who will provide strong leadership in addressing the worldwide financial crisis, worldwide security concerns, and wants to be a partner in important decisions like the upcoming climate summit in Copenhagen. So I think that's been a positive message. People still don't realize the enormity of the challenges that he faced when he took over office. If you look at what we have passed in his first year in office, every one of these pieces of landmark legislation in any other year would have been the signature piece of legislation, and they just keep building and building and building because of the struggle that we're in.

Glover:There are some who suggest that his opposition to his effort to overcome health care reform is actually an effort to derail the Obama presidency. A lot of republicans say if we can beat this president on health care, we can effectively stall his presidency. How much of that is going on here in this debate?

Braley:Well, I think a lot is going on in this debate. If you saw what happened in August, a lot of the anger that showed up at town hall meetings was being driven by forces like Fox News and other organized efforts to give people the motivation to go out and derail the president's signature piece of legislation. Senator Jim DeMint of South Carolina said we need to make health care Obama's Waterloo. And as someone who lives in Waterloo, I was outraged by that statement. We need to do everything we can to succeed. When you make a comment like that, it takes the focus off what we should be doing, is working together.

Glover:You're up next year. I assume you're going to run again.

Braley:I certainly am planning on it.

Glover:And would Obama be helpful? Would you like to see the president come to your district and campaign for you in northeast Iowa? Would he be helpful?

Braley:I would love to have President Obama come to my district and campaign for me.

Henderson:You mentioned the anger at the town hall meetings. Some of that anger was directed at the bailout, which took effect during the Bush administration and has been administered by President Obama's staff. You've been a critic of the bailout too. Should there be more regulation? What should happen with what's going on with that Wall Street bailout?

Braley:Well, let's talk about the components. On the good news front, we loaned about a billion dollars to bank and financial services with that TARP money. And I'm very pleased to report that $72 billion of that has been paid back to the federal treasury with a $12.5-billion profit on the money that was paid out. We need to use that as a model for going forward because we promised the American taxpayers that we would do what we could to protect them. But on the regulatory response, we have to put in a framework that is finally going to provide some level of supervision for the derivatives and swaps market, and there's legislation already pending in congress to do that. But we really need to get away from this focus that something that is too big to fail is really too big. And I think the American people who have dealt with this crisis in the last year would agree with that.

Henderson:Across the river from Wall Street in New Jersey and in Virginia, democrats who ran for governor suffered losses on November 3. What's your analysis of those elections and what those losses mean for the Democratic Party?

Braley:Well, as somebody who is much more interested in house races, I was focused on what went on in New York 23, which I think is a much more indication of what's going on in this country. Here you had a seat in upstate New York that hadn't been a democratic seat since reconstruction. And the republican nominee was attacked so hard from the right that she withdrew on the last weekend of the campaign, endorsed the democrat who was elected, and helped us expand our majority.

Borg:So what's the lesson there?

Braley:The lesson is that if the people who show up at these tea party rallies think that they're changing the Republican Party, what they're really doing is marginalizing it further and creating opportunities for democrats in 2010.

Glover:I can understand why you want to talk about that congressional race. That was better news for democrats than those two governor's races. But I'd like you to step back and answer a larger question. You're up for reelection next year. There are 37 governorships, I think, up for election. It's a big mid-term election. History would tell us that the first midterm election of a democratic president is a good election for republicans. But history would also teach us that when the economy is driving the debate, that's good news for democrats. And the economy is currently driving the debate. Which is going to win out next year? What's the climate for next year?

Braley:I think that the litmus test for candidates in 2010 is going to be what we do to create jobs for Americans, because I think that when you talk to a economists who talk about the state of the economy and talk about the recession being over or they talk about things like a jobless recovery, if you're one of those people, those millions of Americans without a job, that's not a recovery.

Borg:So you'd support another stimulus program?

Braley:I would support another stimulus program that focuses on infrastructure improvement, that will put jobs here in America, that will create jobs that will provide good paying opportunities and help reduce the high level of unemployment in Iowa and all over the country.

Glover:And what are your constituents telling you about this recession being over? I mean that's the buzz word we hear, the recession is over. But the unemployment report just came out, 10.2 percent. That doesn't sound like the recession is ending.

Braley:No, it doesn't. And one of the things that I think is so troubling is when I would go to my town hall meetings, Mike, and talk about the crisis that we faced a year ago and it being the greatest economic crisis since the great depression, people would boo me. They'd forgotten how bad things were. And one of the reasons is -- I was out at the food bank in Waterloo recently. Our food banks do such an enormous job of taking care of people in need, we don't see people standing in bread lines in our streets, but they're there. They're there in the same type of need as they were in the Depression. But we as a society, we just don't feel the pain that most people are facing in this country who don't have a job or have lost their home.

Glover:Sure. And you've made it clear you're running for reelection next year, correct?

Braley:Yes, I am.

Glover:What's your future? You're -- I often hear your name come up in conversation speculating about a run for still higher office, potentially United States Senate when one of those seats come open, potentially even governor. What's your future? What would you like to accomplish?

Braley:What I'd like to accomplish is get this health care bill passed, and then I would feel like I really made a difference in my term in congress. One of the things that I decided to do when I ran for congress was take an opportunity to give back by serving my constituents in the first district of Iowa, and they have given me the privilege to represent them twice. I learned a long time ago when I lost my father at a young age that you can't count on anything in the future, mike. If some other opportunity presents itself for me to serve this state in a different capacity, I would certainly be interested in looking at that. But right now my total focus is on representing the people in the first district and hopefully convincing them to reelect me in 2010.

Henderson:You currently serve on the energy committee in the house. A cap and trade bill, which deals about climate change issues, cleared that panel and is pending in the congress. How do you tell people, especially farmers in your district who are wary of that legislation, that this is something that they should support when clearly many of them don't?

Braley:Well, and it didn't just pass the energy and commerce committee. It passed the house and we wished that we had seen more action by the senate. Look, Kay, former Iowa Governor Tom Vilsack is the Secretary of Agriculture and has been very outspoken on the enormous economic potential that climate change and energy legislation has for Iowa's farmers. And when you look at what has transformed this state's economy, whether it's ethanol, biodiesel, wind, you see enormous opportunities for creation of jobs out in rural Iowa through expanding our access to renewable energy and reducing our dependence on foreign oil. I think that's good for this state's economy.

Henderson:So which was a more controversial vote, the health care vote or the cap and trade vote?

Braley:I don't know for whom -- I mean every vote I take is a tough vote. I was proud of both of the votes that I took, and I stand behind them.

Glover:Let's look again at your district, if we could. You have some urban centers in your district, Waterloo, Dubuque, et cetera, but you also have a lot of rural areas.

Braley:Yes.

Glover:What's your take on the health of the farm economy, the rural economy?

Braley:Well, you know, for dairy producers in northeast Iowa, this has been a really tough year, Mike, and I met with a group of them recently. Our dairy policy is one of the most complex and convoluted policies you could ever try to figure out. But one of the things that I know is that the rapid change in markets that didn't used to exist when my dad was running a grain elevator in central Iowa has placed enormous burdens on farmers to adapt and be flexible in their marketing approaches. So I this that there is a bright future for agriculture in this state, but I think education and ongoing extension outreach is a critical component of success for farmers in this state.

Glover:I often hear the dairy industry brought up when the farm economy is mentioned. Is there a role for the government in bailing out the dairy industry? I mean it's going through some really tough times right now.

Braley:Well, you know, I'm not one of those people who looks at safety nets as bailouts. One of the things we know is that going back a long ways in this country, we've had an agricultural support system to make sure that there is a floor in bad times to make sure we have a food supply that this nation depends upon. I think that it's time to start looking at some critical solutions or we're going to lose a lot of dairy producers, and I don't think that's good for this state or this country.

Borg:Follow along then, you said solutions. What might they be? You're indicating that the federal government may have a role.

Braley:well, I'll tell you that when I talked to Secretary Vilsack about this the last time, he'd been in New Mexico talking to dairy producers down there, Dean. And his advice to them is get together with your peers around the country and come up with the two or three things that you can agree upon, and we'll move forward to try to address those problems. But because dairy interests in California and dairy interests in Wisconsin and dairy interests in New England and upstate New York have completely different requirements on how they market their products, it creates a nightmare for the federal government to come in with a one-size-fits-all solution.

Glover:Have you come up with those two or three things?

Braley:I would not presume to because what may be good for my northeast Iowa dairy farmers may be a problem for --

Glover:Well, what do your northeast Iowa dairy farmers want?

Braley:Well, what they want is to have guaranteed opportunities for their marketing so that the government is there for surplus, supplies, and gives them a ready access to a market if the market falls out like it has recently.

Borg:Kay, quick question.

Henderson:Also, flooding in your district. What do you say to people who are critical of the federal government's response?

Braley:Well, you know, one of the things you can tell by looking at the municipal elections in my district from those towns impacted by flooding is that when some something of that magnitude happens, there's always blame to go around. I think on the whole, given the magnitude of that problem, that we have made great progress as a state in trying to get resources to people who need it. We've got a lot more work left to do.

Borg:And I'm sorry, our work here is over because we're out of time. Thanks so much for spending time with us today.

Braley:Thank you, Dean.

Borg:On our next edition of Iowa Press, we're getting perspective from a former congressional leader with lots of experience and tough legislative battles like the health care decisions, Democrat Richard Gephardt. You'll see the past Missouri congressman and former presidential candidate at our usual Iowa Press times next week, 7:30 Friday night and 11:30 Sunday morning. Now, if you have comments about our program, use the Internet to contact the Iowa Press staff. The e-mail address is iowapress@iptv.org. We'd like to hear from you and consider your comments. I'm Dean Borg. Thanks for joining us today.

Archive editions of Iowa Press can be accessed on the World Wide Web. Audio and video streaming is available, as are transcripts, at www.iptv.org.

Funding for Iowa Press was provided by Friends, the Iowa Public Televisi6on Foundation. The Iowa Bankers Association … for personal, business, and commercial needs, Iowa banks help Iowans reach their financial goals. Iowa Community Foundations, an initiative of the Iowa Council Foundations, connecting donors to the causes and communities they care about for good, for Iowa, forever. Details at iowacommunityfoundations.org.


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