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Grassley: Look How Great This Health Care Bill Is

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Newscom / Steve Pope

Grassley has been among the most vocal opponents of Democratic reform over the past year, but he's also known as one of the biggest flip-floppers on the issue.

At the start of the process, Grassley was expected to be among those Senators working to craft a bipartisan bill. But it wasn't long before he abandoned that effort, and helped to start the "death panel" meme heard at town halls across the country throughout last summer.

[TPM PHOTO FEATURE: The Evolution Of The Death Panel Meme]

Later on, Grassley joined with the Republicans in condemning the bill's medicare provisions. He jumped through several rhetorical hoops when he tried to explain his position in support Medicare while also attacking the idea of a public option last September.

"Medicare is part of the social fabric of America," he said. "And I think there's a lot wrong with it."

Now, Grassley seems to be jumping through the same hoops after the bill has been signed, talking up the changes reforms he once said will allow the government to "decide when to pull the plug on Grandma" are making to the health care system.

In the memo send out to reporters by his staff on on the Senate Finance Commitee, Grassley claims that the bill will ensure that "Congress, the IRS, and the public will now
have additional tools and information to ensure that charitable hospitals act charitably."

There's a reason the bill is so good when it comes to hospitals, Grassley's staff writes -- bipartisanship.

"The health care legislation signed into law yesterday includes provisions Grassley co-authored to impose standards for the tax exemption of charitable hospitals for the first time," his Finance Committee press staff writes.

Grassley has been and on-again, off-again fan of the concept during the health care debate. At first, he was a member of the so-called Gang Of Six, a group of Finance Committee Senators who tried to draft a bill, they said, that would be appealing to both sides of the aisle. At the time, Grassley said any successful health care bill should have 80 votes for final passage.

Then, in statements generally recognized as not being conducive to bipartisanship, Grassley said the government was a "predator" (though he admitted he had prospered in part by living off "the public tit") and said that his Democratic colleagues were supporting a bill that would create death panels and kill grandma.

Shortly after that, Grassley said he wanted to find a bipartisanship solution again, and went looking for a new group to help him do it. That didn't work out.

So, though he admits that the final bill has his language about charitable hospitals in it, does Grassley support this bipartisan bill? Well, not exactly, his staff told me.

"Overall, no," Grassley's press secretary Jill Gerber told me when I asked her if the hospital stuff meant that Grassely thought the reform bill was worth passing.

"There are some things that he supports," she said. "That's true of a lot of large bills like this."

See the full text of the memo, send to reporters this morning, below:

M E M O R A N D U M

To: Reporters and Editors

Re: tax-exempt hospitals provisions in new health care law

Da: Wednesday, March 24, 2010

Sen. Chuck Grassley, ranking member of the Committee on Finance, with
jurisdiction over taxes, has worked to hold tax-exempt hospitals accountable for the federal tax benefits they receive. The health care legislation signed into law yesterday includes provisions Grassley co-authored to impose standards for the tax exemption of
charitable hospitals for the first time. The bill requires that a hospital complete a community needs assessment once every three years and adopt and publicize a financial assistance policy; prohibits billing those who qualify for financial assistance the top rates; and prohibits a hospital from taking extraordinary collection actions if the hospital has not made reasonable efforts to notify patients of its financial assistance policy.

The bill also requires the IRS to review the tax-exempt status of each hospital every three years; requires Treasury and Health and Human Services to submit an annual report to Congress on the level of charity care, bad debt expenses and the unreimbursed costs of means-tested and non-means-tested government programs; and requires Treasury and HHS to provide a report in five years on the trends on the items reported on an annual basis.

Grassley made the following comment on the advancement of these provisions.

"Tax-exempt hospitals don't have many measures of accountability for their special status. The law hasn't given them much direction, and so they've defined standards for themselves. Sometimes that's resulted in providing very little charitable patient care or other community benefits, failing to publicize charitable care to patients, charging
indigent, uninsured patients more than insured patients, and using very aggressive collection practices. The Government Accountability Office and others, including the former IRS commissioner, have said for a long time that there is often no discernible difference between the operations of taxable and tax-exempt hospitals. These new provisions are modeled after principles and polices that the Catholic Health Association has had in place for years. I appreciate the association's willingness to have honest, forthright conversations about charitable hospitals' activities. The provisions take steps to differentiate tax-exempt hospitals from for-profit hospitals and provide further transparency about tax-exempt hospitals' fulfilling their charitable mission. Congress, the IRS, and the public will now have additional tools and information to ensure that charitable hospitals act charitably."

The provisions enacted in the new health care law are the result of
Grassley's leadership on tax-exempt organizations' accountability and
transparency, including hospitals. In 2005, he sent letters of inquiry to some of the nation's largest tax-exempt hospitals. In 2006, he convened a hearing and released a summary of the hospitals' responses. In 2007, he released a staff discussion draft of potential legislative reforms and convened a roundtable of experts to discuss the potential reforms. In 2008, he followed up with letters of inquiry to more hospitals and received a report he'd requested from the Government Accountability Office. In 2009, he drafted legislative reforms and succeeded in persuading the Democratic majority to include several of the reforms in the new health care law.

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