Grassley and Ernst, who voted for ill-fated Obamacare repeal bills, aren't surrendering

Iowa’s U.S. senators vowed Friday to continue trying to rein in Obamacare after coming up on the losing end of an early morning vote on a controversial “skinny repeal” bill.

Sens. Chuck Grassley and Joni Ernst were among 49 Republicans who voted for the bill. Three of their GOP colleagues joined Democrats in forming a 51-vote majority to kill it.

Critics of the bill, including health insurance industry leaders, said it would make shaky health insurance markets even shakier, driving up premiums and possibly pushing carriers out of states like Iowa. But Grassley and Ernst said they voted for the bill as a way to move forward on a revamp of the Affordable Care Act, also known as Obamacare.

Grassley had hoped the bill would provide an avenue into negotiations with the U.S. House. He called Friday morning’s outcome “disappointing.”

“The health care situation is the same as before,” he wrote in a statement. “Obamacare has not delivered on its promises and is failing. Those who have access to insurance often can’t afford to use it because of sky-high deductibles, premiums and co-payments.”

Grassley and Ernst have focused on 72,000 Iowans who buy their own insurance and could lose it next year if the sole remaining carrier of such policies pulls out.

Grassley said Friday he would continue to support a “stopgap” proposal from Iowa’s insurance commissioner, under which the government would help shoulder risk and encourage carriers to offer individual insurance policies in Iowa next year.

“Longer term, I’ll continue to work for access to affordable health care by promoting the free market, supporting efforts to decrease the costs of prescription drugs, and making sure Medicare and Medicaid continue to be available to those who need them,” Grassley wrote. “The American people deserve better than Obamacare’s failures.”

Ernst said Friday she’s also not ready to give up on repealing the Affordable Care Act.

“We don’t have the option to sit back and do nothing; Iowans are demanding relief from Obamacare,” she wrote in a statement released by her staff. “I am disappointed that the Senate was unable to advance important changes to this flawed law. We must now continue to find ways to work on behalf of Iowans and the American people who have been negatively impacted by Obamacare to find affordable, patient-centered solutions that work for them.”

Grassley and Ernst also voted earlier in the week for two previous Senate health care bills that went down to defeat. Friday morning’s bill, nicknamed the “skinny repeal,” would have ended an Obamacare requirement that most Americans obtain insurance. Insurance carriers complained the measure would destabilize the market by allowing people to delay buying coverage until they became seriously ill.

Medica, the only carrier planning to sell individual health insurance policies in Iowa next year, said Thursday that if members of Congress passed the bill, they could worsen an already shaky market.

“If they repeal the individual mandate and do nothing else, they will be taking the one action universally understood to be bad. Premiums go up and the market becomes more unstable,” a Medica vice president wrote.

Iowa hospital leaders have been among the most vocal critics of Republican efforts to repeal Obamacare. Many hospitals have benefited from seeing previously uninsured patients gain coverage under the law. That coverage means the hospitals no longer have to treat such Iowans for free as “charity care” patients. Industry leaders have warned that repealing the programs could cripple rural hospitals. 

Scott McIntyre, spokesman for the Iowa Hospital Association, hailed the defeat of the latest Senate health care bill.

“For vulnerable Iowans and their health care providers, this was a near miss that could have been catastrophic, so we are we are relieved at the outcome,” he wrote in an email to the Register. “Going forward, we see an opportunity for Congress to reset and refocus the health care discussion in an open, deliberative and bipartisan manner. While we remain committed to keeping Iowans covered, particularly those who depend on Medicaid, we welcome participating in further discussion with the goal of improving coverage and access to quality health care. We believe this is what Iowans both expect and deserve.”

Iowa Insurance Commissioner Doug Ommen said Friday he continues to push for his “stopgap” plan for next year while hoping for longer-term changes in the Affordable Care Act.

Among the things Ommen wants to see changed are the ease with which consumers can temporarily buy insurance when they need medical care, then drop back off. “It's the equivalent of letting individuals buy homeowners insurance once their house starts on fire. We are asking the federal government to allow us to limit that gaming under our waiver request,” Ommen wrote.

Ommen, who was appointed by Republican former Gov. Terry Branstad, also wants to see a better way to spread the financial risk of people with extraordinary healthcare needs. Under the current situation, too many of those costs are borne by the relatively small pool of consumers buying individual health-insurance plans, he said. Although many of those people qualify for substantial Obamacare subsidies, people with somewhat higher incomes have no such shelter. They face skyrocketing premiums.

The commissioner said he hopes the stopgap plan will be approved soon, but he warned the federal approval process is “rigid.”

“We still hope that Congress will find a way to fix the problem, but our common-sense proposal has received positive feedback from patient advocacy groups, hospitals, farmers, entrepreneurs, early retirees and many more that are dealing with the effects of the uncertainty coming out of Washington and the skyrocketing premium costs caused by the ACA,” Ommen wrote.

The U.S. House narrowly passed its own version of an Obamacare repeal bill in May. The controversy could wind up back there if the Senate eventually passes a different version.

On Friday, two Iowa members of the House gave opposite reactions to the failure of the Senate bill.

Rep. Dave Loebsack, the sole Democrat in Iowa’s Congressional delegation, referred to nonpartisan experts’ warnings that the Republican bills would have cost tens of millions of Americans their insurance. Now that such bills have run aground in the Senate, Loebsack expressed eagerness to work with Republicans on less radical improvements to the Affordable Care Act.

“Moving forward, there are things we can do to provide Iowans with better and more affordable health care options,” he wrote. “First and foremost, we must ensure protections for people with pre-existing conditions. We must also offer more health care options, rather than fewer, for Iowa's families like allowing people to buy into Medicare and expanding bidding areas in the marketplace to create more competition for rural areas.”

But Rep. Steve King, a western Iowan who is one of the House’s most conservative Republicans, expressed anger at senators who defeated Friday’s bill. His targets included two of the three Republicans who voted no, Lisa Murkowski of Alaska and John McCain of Arizona.

“Murkowski is a senator who was initially appointed to her position by her father, and whose 2010 write-in campaign was essentially a revolt against GOP primary voters,” King wrote.

McCain returned to the Senate this week, shortly after being diagnosed with brain cancer. His return was applauded by many colleagues, but his dramatic vote against Friday’s bill drew criticism from King.

“John McCain recently told the Senate he would return and ‘Give all of you cause to regret the nice things you said about me.’ He kept his word,” the Iowa congressman wrote.