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Critical Condition

NRO’s health-care blog.

“politics-as-usual in Washington with no change in sight.”



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Sarah Palin vs. Baucus; a Saturday-night Facebook post: 

Americans want health care reform because we want affordable health care. We don’t need subsidies or a public option. We don’t need a nationalized health care industry. We need to reduce health care costs. But the Senate Finance plan will dramatically increase those costs, all the while ignoring common sense cost-saving measures like tort reform. Though a Congressional Budget Office report confirmed that reforming medical malpractice and liability laws could save as much as $54 billion over the next ten years, tort reform is nowhere to be found in the Senate Finance bill. [17]

Here’s a novel idea. Instead of working contrary to the free market, let’s embrace the free market. Instead of going to war with certain private sector companies, let’s embrace real private-sector competition and allow consumers to purchase plans across state lines. Instead of taxing the so-called “Cadillac” plans that people get through their employers, let’s give individuals who purchase their own health care the same tax benefits we currently give employer-provided health care recipients. Instead of crippling Medicare, let’s reform it by providing recipients with vouchers so that they can purchase their own coverage.

It’s Now or Never



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Washington Times: 

House Republicans are planning an interest-group strategy to try to stop a health care bill and will spend the next three weeks arguing that the Democrats’ measure will be a bad deal for small businesses, senior citizens, and women and children.

With Republican lawmakers vastly outnumbered in the chamber, party leaders say their best strategy is to sway the public against Democrats’ health care plans. The best way to do that, they say, is to synchronize their messaging to focus on specific groups that could suffer from effects of the bill.

“What we want to do in the coming weeks is have all 178 members redouble their efforts to take the case against a government takeover of health care to the four corners of this country,” House Republican Conference Chairman Mike Pence said in an interview. “When we speak more in concert, our message tends to break through more effectively.”

Time is running out for Republicans to derail the legislation as Democratic leaders in both chambers work to merge the three House bills and two Senate bills. While Republicans in the Senate hope to slow the debate and use amendments to alter the final bill, procedural rules in the House make Republicans there virtually irrelevant.

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Insuring Difficulty for the White House



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USA Today:

WASHINGTON — Seven months ago, insurance companies vowed to be allies in President Obama’s effort to revamp health care, with one industry leader later telling Congress that “health insurance reform needs to be done this year.”

But as an $829 billion, 10-year health care bill approved by the Senate Finance Committee moves toward debate by the full Senate this month, the insurance industry and the Obama administration are increasingly at odds over key provisions in the bill.

Recent squabbles between the White House and the industry, which intensified over the weekend, underscore the potential pitfalls for Obama’s broad plan to reshape health care. Insurers helped kill a similar effort 15 years ago with the “Harry and Louise” advertising campaign.

Look for the Left to Up the Public-Option Pressure



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As the White House downplayed it this weekend; in the Washington Post today:

Obama continues to support the concept of a government-sponsored insurance option, but “he is not demanding that it is in” the final legislation, Valerie Jarrett, a senior White House adviser, said on NBC’s “Meet the Press.” “He thinks it’s the best possible choice.”

White House Chief of Staff Rahm Emanuel, in two television appearances, noted that the public option could provide much-needed competition, but that “it’s not the defining piece of health care.”

Dem Governor vs. “Reform”



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From Tennessee:

In a break with most of the governors in his own party, Democrat Phil Bredesen is saying publicly that the legislation that currently serves as the framework for reform shifts too much of the financial burden to state governments.

Bredesen estimates that the Senate Finance Committee bill that passed last week would cost Tennessee $735 million over five years once the plan is in place
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New Rule: Back Up Your Health-Insurance Horror Story



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Comedian Bill Maher has a shtick where he imposes “new rules” on people and things of which he disapproves. Well, here’s mine: When you have a health-insurance horror story, I think you should have to post all communications from the evil, profiteering, health insurer(s) on a public website for all to see.  Furthermore, you should release the accused health insurers from their legal obligation of confidentiality.

Health insurers are covered by HIPAA, the Health Insurance Portability & Accountability Act, and cannot discuss policyholders’ cases. Policyholders who allege insurers’ bad faith, on the other hand, are free to make claims that emotionally sway the public, but leave those of us acquainted with health-insurance regulations utterly baffled.

Take, for example, the famous fat baby of Colorado, a 4-month old who was reportedly denied health insurance because he is in the 99th percentile, weight-wise, of babies that age. The boy’s family, whose premiums went up 40 percent after the baby was born (itself a mysterious event, because every other family with the same policy would have had the same rate increase, under HIPAA), searched for another policy.

The non-profit insurer which denied the baby’s application, Rocky Mountain Health Plan, later changed its mind and issued a press release explaining its reversal. To anyone who researches health policy, but doesn’t work inside the industry, it is mysterious. To wit: “The trend in health care has been for more and more families with small children to seek individual coverage for their children from health insurers. . . . Underwriting for this age group is a relatively new process.”

This is baffling: Why would a family with group coverage seek separate coverage for their baby? It makes no sense to me, and a responsible investigative journalist would figure this out, instead of just trumpeting another horror story about the cracks in the facade of health insurance.

(While you’re at it, you might also check the archives as far back as, say, last August, when President Obama went to Grand Junction, Colo., the home of Rocky Mountain Health Plans, to praise them for their high standard of care. Check out the CEO of Rocky Mountain Health Plans at the time, championing his “universal pre-natal care,” where “every woman in the community who is pregnant gets pre-natal care — period.” Got it? That’s “in the community,” not “in our health plan.” Another little factoid that contributes to the subsequent story just not adding up.)

But the chubby baby and his family are private citizens. An even more egregious example comes from U.S. Representative Jane Harman (D., Calif.) who wrote an op-ed in the Sacramento Bee, in which she asserted that her 27-year-old son was “dropped” by his health plan because of a torn eardrum.

Of course, this would also be illegal under federal and state law, unless her son had misrepresented his health status when he applied for individual health insurance. I e-mailed and telephoned Ms. Harman’s office to request that she make public the letter(s) from her son’s health plan, in which it “dropped” him. The lady who answered the telephone told me firmly that no such correspondence would be forthcoming, because it was a “private matter” between Ms. Harman and her son.

No, no, no! Ms. Harman, uninvited, chose to throw her son into the public debate on health reform. I think she is obliged to give us all the facts of the case. There are simply too many unsubstantiated health-insurance horror stories floating around there that make no sense, and cloud, rather than illuminate, the discussion.

— 
John R. Graham is director of Health Care Studies at the Pacific Research Institute.

Gregg: None of the Goals of Health-Care Reform Are Met by the Harkin or Baucus Bills



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From Senator Gregg’s floor speech on health-care reform:

The purpose of health care reform should be to make health care insurance affordable for everyone, while in the out-years reduce the rate of growth of health care costs, and allow people who have an insurance policy today to keep their policy. Those were the goals which we set up here when we stepped into this arena of trying to change health care delivery systems in this country. Unfortunately, neither the now Senator Harkin-led bill, originally authored by Senator Dodd and Senator Kennedy, nor the Baucus bill accomplish any of those three goals. Let’s take, for example, the goal that everybody should be able to have access to affordable health care. The Harkin bill, as scored by CBO, said that of the 47 million people who don’t have health care today, approximately 34 million would still not have health care after this bill is fully phased-in. The Baucus bill, which came out of the Finance Committee, varies. We haven’t seen a final score on it, but it looks like it’s going to be somewhere in the vicinity of about half of the people who don’t have health care today will still not have health care after you finish phasing in that bill.  
As to the issue of controlling out-year costs, neither the Harkin bill nor the Baucus bill control out-year costs. In fact, the costs go up rather dramatically in the area of health care. And as to the issue of letting people keep their insurance if they like it — no, that doesn’t happen either. In fact, large numbers by the millions — according to CBO — would migrate off of their private system into a plan directly subsidized by the federal government to some extent because basically their employer would drop their plan. Under the Baucus plan, when you set the penalties for an employer at a level that basically says it is fiscally prudent for the employer to pay the penalty rather than to insure people, many employers are unfortunately going to give up the insurance they provide and push people into the subsidized program which is called the exchange. Thus, a lot of people will lose the insurance that they have today which they like. So none of these goals are met by these bills. . . .
  So in the end, people’s premiums are going to go up. Private insurance premiums are going to go up. Well, you might say, you know, why would somebody do that? Why would somebody drive up the premiums on people? Well, I’ll tell you why. Because the goal here is to basically eliminate private insurance. The goal here is to create a structure where essentially people who get private health care through private insurance will be on a public plan when this is all over. And the government will essentially absorb all insurance. This is not a good idea. Why isn’t it a good idea? Because the government, basically in order to control costs, can only do two things. It can limit access or control prices. Either way, it significantly undermines the quality of health care. And there are about 180 million people in this country or more who already have health care and are fairly comfortable with the health care they’re getting under the private system. But they’re going to be at deep risk.

MassCare



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Michael Graham warns:

As Michael Tanner of the Cato Institute pointed out, “The cost of the [Massachusetts] program has exploded; it’s running $150 million above the original projection for this year alone.” And that was in 2007 – the first full year the plan was in place. This year, according to Rep. Jeff Perry (R-Sandwich), the total “health reform” cost will be $1 billion.

Liberals whined that the Bush administration was anti-science. Well, we’ve got a health-care experiment going on in Massachusetts, and it’s going horribly wrong. And yet, as this massive, taxpayer-killing monster lurches off the lab table, Dr. Obama is still planning to use the same formula.

Time to grab the pitchforks, folks.

Old ‘New Democrat’ Speaks



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Al From says “no” to the public option in a Wall Street Journal piece today:

Now that the Senate Finance Committee has voted for a health-care bill that does not include a government-run plan, it would be a mistake for Democrats to insist on adding the public option to reform legislation this year.

By insisting on the public option, liberal Democrats will allow the Republicans, who have no ideas of their own, to cloud the prospects for reform. If this happens, Republicans will be able to divert attention away from reforms most Americans want and instead focus on what Americans disagree on—whether we need a new government-run health plan.

A USA Today Delivery Disservice



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USA Today has a piece today on the nation’s Catholic bishops threatening to outright oppose health-care legislation.

But from the top, the story just adds to confusion. It states:

The U.S. Conference of Catholic Bishops, which supports universal access to health care as a “basic human right,” had been supportive of efforts to reform the health care system, but is concerned about taxpayer-funded abortions.

That under- and mis-states matters.

The website of the U.S. Conference of Catholic Bishops does, in fact state, in a health-care Q&A that: “The bishops believe access to basic, quality health care is a universal human right not a privilege.” Their most recent press release, titled “U.S. Bishops: Current Health Care Bills Violate Essential Principles; Will Seek Changes Or Have To Oppose” reiterates: “Catholic moral tradition teaches that health care is a basic human right, essential to protecting human life and dignity. Much-needed reform of our health care system must be pursued in ways that serve the life and dignity of all, never in ways that undermine or violate these fundamental values. We will work tirelessly to remedy these central problems and help pass real reform that clearly protects the life, dignity and health of all.”
           
And while the precepts of the faith aren’t exactly governed by press release or the legislative activities of even a national episcopal body, no one familiar with the history of the most extensive health-care network in the United States, the Catholic Church, would question that Catholics do, in fact, believe that the sick should get care. The question is: Does that translate into a moral obligation to support government-provided universal access as a fundamental human right for the government to dole out?

In a letter on health-care reform, R. Walker Nickless, the Catholic bishop of Sioux City, Iowa, very helpfully and healthily addressed this. From his letter:

in that category of prudential judgment, the Catholic Church does not teach that government should directly provide health care.  Unlike a prudential concern like national defense, for which government monopolization is objectively good – it both limits violence overall and prevents the obvious abuses to which private armies are susceptible – health care should not be subject to federal monopolization.  Preserving patient choice (through a flourishing private sector) is the only way to prevent a health care monopoly from denying care arbitrarily, as we learned from HMOs in the recent past.  While a government monopoly would not be motivated by profit, it would be motivated by such bureaucratic standards as quotas and defined “best procedures,” which are equally beyond the influence of most citizens.  The proper role of the government is to regulate the private sector, in order to foster healthy competition and to curtail abuses.  Therefore any legislation that undermines the viability of the private sector is suspect.  Private, religious hospitals and nursing homes, in particular, should be protected, because these are the ones most vigorously offering actual health care to the poorest of the poor.

For a very helpful treatment of what the Catholic bishops have been saying, follow the editorials that have been running in The Anchor, the archdiocesan paper of the Fall River, Mass., diocese on health-care policy. Nickless’s letter — his four “goal posts” for reform — is discussed here.

To say that the U.S. Catholic bishops would support the bill so long as the president pinky swears about abortion, which I think is probably the common conventional assumption that this USA Today piece feeds, is simplifying things direly, doing the whole current health-care debate, not just Catholic social-teaching conversations, a disservice.

Poised to Go Nuclear



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Fox reports:

A key House committee on Thursday quietly altered its health care legislation in a way that could allow the Senate to mow over Republican opposition to Democratic reforms by exploiting a budgetary loophole.

The Ways and Means Committee adjusted its health care overhaul package so that the Senate, down the road, could avoid a filibuster and pass health care reform with a smaller number of votes than normally required. 

The long-discussed process, nicknamed the “nuclear option,” is known as reconciliation. It’s coming into potential play after the Senate Finance Committee on Tuesday became the last of five committees to approve health care reform legislation, sending the overhaul proposals a big step closer to the president’s desk. Before it gets there, though, the bill has to pass from the committees to the floors of the House and Senate.

Ari Was Right



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Sonny Bunch has a good piece in the Washington Times about the controversy over Bill Maher spreading misinformation regarding the flu vaccine.  Maher told former Majority Leader Bill Frist that “I would never get a swine flu vaccine or any vaccine,” and refused to accept Dr. Frist’s assurances that the vaccine was safe and effective.  Maher was demonstrably wrong on some of his assertions.  As the New York Times’s Tara-Parker Pope pointed out: “Mr. Maher questioned letting someone stick ‘a disease into your arm,’ wrongly implying that the flu shot contains a live virus. The flu shot is a killed vaccine.”

Maher’s false statements add to unsupported fears about flu vaccines, which constitute an important part of our nation’s pandemic preparedness plans.  In the period after 9/11, Ari Fleischer got a lot of flak for saying, also regarding Maher, that “There are reminders to all Americans that they need to watch what they say, watch what they do.”  I understand why Fleischer’s statement, coming from the White House podium as it did, caused such a negative reaction.  But perhaps Ari was just premature — Bill Maher really does need to watch what he says about the flu, as it’s extremely irresponsible.

‘We aren’t going to give low-income Americans more choices or options for better health coverage



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John McCain on Baucus “budgetary gimmickry”

“Americans must understand the smoke and mirrors used to make the Democrat proposal appear to improve the budget over the next ten years. 

“The following taxes start next year:  if you have insurance, $201 billion is raised in excise taxes on health plans.  If you don’t buy a plan or buy one that the government doesn’t think is good enough, the concept proposal raises $4 billion in fines on the uninsured.  If you are an employer who today can’t afford to provide health insurance to your employees, the concept proposal raises $23 billion in employer penalties and contributions.  If you use medical devices like hearing aids or artificial hearts, the concept proposal raises taxes by $38 billion on medical device manufacturers.  If you take prescription drugs the concept proposal raises $22 billion in new taxes on medicines. 

“The Congressional Budget Office (CBO) estimates that Americans will face higher health insurance premiums while waiting four years for the much hailed reform proposals to begin.   This budgetary gimmickry is how the President and the Senate Democrats claim the proposal is under $1 trillion and slightly reduces the deficit over ten years.  This is a joke: ten years of taxes but only five and a half years of implementation.  To get the true ten year cost of implementation, you must look at the ten years beginning 2013.  Using the CBO numbers, we are told that the proposal spends $1.8 trillion. 

“You might be justified in wondering what Americans get for $1.8 trillion.  The answer is more government with 13 million more people placed into the failed Medicaid program.   Medicaid is a program that is busting federal budget and state budgets all over America.  Medicaid is a program that fails in patients having access to physicians: 40 percent of doctors will not see Medicaid patients.  Medicaid is a program that fails in health outcomes for low-income Americans.  We aren’t going to give low-income Americans more choices or options for better health coverage – we are just giving them status quo. 

“It’s bad enough that the proposal massively increases government regulation of health care and insurance, massively expands the government-sponsored Medicaid program, massively cuts Medicare and drives up insurance premiums in the process.  But, the proposal completely ignores what Americans want – less government, less taxes, more freedom and more choices.  Instead, the bill… no, excuse me.  The concept paper in the Senate Finance Committee – it’s not even a bill – slams Americans with an entitlement program that will grow faster, according to the CBO, than the economy while at the same time dramatically increasing the tax burden on all Americans.” 

Pelosi Pushes Public



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AP:

House Speaker Nancy Pelosi said Thursday that the case is growing stronger for allowing the government to sell health insurance in competition with private companies, contending recent attacks from the industry should dispel any doubts.

“The need for a public option is very clear,” the California Democrat told reporters at her weekly news conference, making the argument as lawmakers on both sides of the Capitol worked to finalize sweeping legislation extending coverage to millions of the uninsured.

“Anyone who had any doubts about the need for such an option need only look at the behavior of the health insurance industry this week,” Pelosi said.

Beware of Union-Boss Crocodile Tears During the Health-Care Debate



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News stories report that union officials are opposing the Baucus version of government-run health care. However, a look at that proposal suggests that such protests are merely political theater intended to build broader support for the federal takeover of medicine.

 

Sure, union bosses may demand even more than the Baucus plan offers — greater costs offloaded onto the taxpayers, a more generous bailout of their underfunded union health plans, bigger numbers of health-care workers pushed into forced-dues-paying union ranks, and stiffer penalties for companies that don’t do business with organized labor. But it’s all posturing. The reality is that the bill that will actually be introduced in the Senate already contains such giveaways, and either it or the Baucus plan will be just fine with them.

 

Remember, the so-called “Baucus bill” is just a starting point for floor debate, a summary without any actual text. The legislation that we’re told will be offered in the Senate is the House bill. That legislation includes $10 billion to bail out bankrupt union health-care plans, massive authority for the HHS secretary to force health-care workers into union ranks, forced unionization of millions of home-health-care aides, and huge new training grants that will only be available to union-run programs.

 

Further, indications are that the Baucus plan will have heavy penalties for businesses that fail to provide the government-determined level of care, but it will exempt health plans that are “collectively bargained” by union officials. This effectively creates a non-union tax of many thousand dollars per worker, and it gives union bosses another tool to pressure employers to corral their employees into forced unionism.

 

With so many provisions of government-run health care written specifically to benefit Big Labor, are we supposed to believe that union bosses are somehow outraged at the current proposal? Make no mistake, Big Labor would be thrilled with passage of the Baucus plan, the House bill, or anything similar.

 

The union bosses know their opposition makes the current proposal appear more moderate, and it may lure more members of Congress into supporting the federal takeover. The union bosses are licking their chops, as Detroit-style forced unionization of the entire health-care field is within their grasp.

 

– Stefan Gleason is vice president of National Right to Work.

AHIP/PriceWaterhouse Blowback?



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Full disclosure (in the spirit of James C. Capretta): I don’t do consulting work for private health insurers, and I doubt they’d have me. I share Benjamin Zycher’s frustration with the various corporate interests, including AHIP (the health-insurers’ trade association), which have managed to get the enemy (government) “exactly where they want us,” with their eager appeasement of the ruling faction.

All intellectual capitalists since Adam Smith have known that we cannot rely on business to carry our philosophical water for us, but even I’m amazed that AHIP has waited so long to release a report (so ably summarized by Mr. Capretta), that describes how the Baucus memorandum (it’s not a “bill”) will destroy Americans’ access to private health care. Indeed, they waited so long that the PriceWaterhouseCoopers report has revived the so-called “public option.”

The health insurers have become so committed to the idea of the federal government ordering people to buy health insurance, that the media and most laypeople are convinced that the “public option” is the only way to prevent insurers from gouging beneficiaries.

The government is not going to change tack as long as the corporate interests are encouraging it to assume greater power over Americans’ access to medical services. Instead, it’s time for AHIP to change tack, abandon the ill-founded notion of mandatory health insurance, and adopt a policy advocating individual choice and responsibility.

— John R. Graham is director of Health Care Studies at the Pacific Research Institute.

Snowe Backlash on the Left



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Kos is furious:

So once again, Reid is complaining that he doesn’t have 60 votes, which is why they need to anoint Olympia Snowe as de facto President of the United States. Maybe SHE will get us to 60! But we all know Snowe has no intention of voting for real reform, and yet Reid (with White House backing) continue to let themselves get played. It’s all a farce.

So much for 60. Still, don’t ask Harry Reid, Democratic Leader, Senate Leader, and the party’s #3 leader to actually start leading.

Let’s Lower Costs



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Sen. John Cornyn in the Statesman:

I believe health care reform should focus on lowering costs, which have more than doubled over the past decade. We can lower costs by realigning incentives for providers, so they focus on value instead of volume. We can create incentives for patients to make healthier choices. We can reform the private insurance market in every state to encourage greater competition and more choices, without denying anyone coverage because of a pre-existing condition. We can lower costs by cutting waste, fraud, and abuse in our current entitlement programs. And we can reduce costly defensive medicine by reforming our medical liability laws like we’ve done in Texas.

The bill we voted out of the Finance Committee, unfortunately, will only increase costs for everyone. The nonpartisan Congressional Budget Office said it will cost $829 billion, but when it’s fully implemented, the Senate Budget Committee estimates the real cost to be $1.8 trillion. Either way, it would still leave 25 million Americans uninsured, impose billions of dollars in new taxes and mandates, and cut more than $400 billion from Medicare. It would take away Medicare Advantage benefits from seniors, and make Medicaid the only option for 14 million Americans.

The bill also imposes hidden costs on states. The Texas Health and Human Services Commission estimates that the bill would cost Texas more than $20 billion over 10 years, and add 2.5 million Texans to Medicaid. That would mean billions in new state taxes, or draconian cuts in education, law enforcement, and other Texas priorities. According to one survey, 91 percent of Texans who buy insurance in the individual market will see their premiums go up, because Washington will force them to buy more expensive policies.

It’s Ba-a-a-ck



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The public option, aka a new government-run insurance plan, was deemed doomed just a few short weeks ago. However, some Democrats, buoyed by their ability to add just one Republican to the Baucus proposal in the Finance Committee, now want to bring back the government-run plan, even though it lost in two test votes in the Finance Committee. According to Senator Schumer in the New York Times, “moderate members are open to a public option.” Perhaps some are. But liberal insistence on the public option risks upsetting the Baucus bill’s delicate balance. Democrats held together in committee, but might not do so if the public option were forced back on to the bill, despite two clear votes against such an approach.

Snowe Worries the Left



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Katrina vandenHeuvel tweets:

KatrinaNation I got same worry: “I think administration has put her in driver’s seat; it’s very disconcerting.” – REP GRIJALVA (D) Arizona on Sen Snowe

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