“While Kansas and North Carolina have a few little rivalries going on, [Hagan and I] have had a great time working together on health care issues, and particularly for rural citizens in this country because both of us come from states with a significant rural population,” Sebelius said.

The conference call with reporters was held in conjunction with the release of a new report by Sebelius’ office. The report, titled “More Choices, Better Coverage: Health Insurance Reform and Rural America,” documents many of the challenges faced by the estimated 15 million rural residents who seek health care insurance in the current system.

“A lot of rural Americans are self-employed or work for small businesses, including family farms,” Sebelius said. “A lot of them have to buy insurance on the individual market where they don’t have many choices and they have extremely high prices and rules that don’t protect consumers. Even when they do secure insurance, many folks in rural America then have difficulty finding a doctor. Two-thirds of the under-served community in America are in rural areas.”

According to Sebelius and Hagan, reform would begin to solve many of the access and insurance problems currently faced by rural residents.

“North Carolina does have a very large sector [of population] in rural areas,” said Hagan, who serves on the U.S. Senate Health, Education, Labor and Pensions Committee that is led by U.S. Sen. Tom Harkin of Iowa. “I think one of the critical aspects of the health care reform effort in Congress right now is that it is going to improve the quality, accessibility and affordability in our rural area.”

Forty percent of self-employed workers living in rural areas are uninsured, compared to 32 percent of self-employed workers living in urban areas, Hagan noted.

“[In North Carolina], 65 percent of of the uninsured population who are full-time workers, work for small businesses — compared to about 46 percent in urban areas,” she said. “And whereas there are nine doctors for every 10,000 North Carolinians in the larger cities, there are only about six-and-a-half for every 10,000 in rural areas. People in rural North Carolina are four times as likely to live in a county with lower access to health care professionals.”

Residents who live in these rural areas, according to the report, not only have more difficulty affording and accessing care, but typically have higher rates of poverty and chronic disease such as diabetes and heart disease. Because many of these same residents work for small businesses, or work part-time or seasonal jobs, it is much less likely that they will have private, employer-sponsored health care benefits. Nationally, a third of all rural residents work for small businesses, yet less than half have health insurance — a figure expected to climb as more small business owners drop health insurance coverage in order to keep their businesses afloat.

Farmers and agricultural workers are especially challenged in today’s insurance market. A multi-state survey of farm and ranch operators found that, while 90 percent of farmers have insurance coverage, one-third purchased it directly through an insurance agent (compared to a national average of 8 percent). The other two-third likely have a spouse that is forced to work off-farm so that the family can be provided with consistent health insurance coverage through an employer.

Sebelius and Hagan also acknowledged that simply providing rural Americans a way to pay for health care doesn’t always translate into access to health care. There were only 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas. In the nation’s most isolated and small rural areas, that figure drops to 36 per 100,000. Hagan asserted that although the earlier stimulus had already addressed an expansion of the federal program for loan repayment of medical professionals who agree to practice in under-served areas, the current reform measure provides an extensive and necessary boost to further those efforts.

“There will be scholarships and loan-repayment programs for primary care providers who actually practice in these under-served areas,” she said. “The National Health Service Corps will provide grants and scholarships and loan-repayment programs to providers that’s going to include nurses, nurse practitioners, physician assistants, dentists and mental health providers who actually work in these under-served areas.

“The idea is to increase this dramatically from where it is right now, to be sure that we can get people who hopefully have lived in rural areas to actually go to these medical schools and into these medical professions and then return to their homes, or to agree to living in a rural area for a period of time.”

The current proposals would also provide payment bonuses to primary care providers practicing in under-served areas. Those who have studied ‘doctor drain’ acknowledge that the problem focuses on getting doctors and other health care professionals to begin a practice in an under-served.

“One of the things that we’ve found around the country is that once a person begins a practice, such as a practice in a rural area, [he/she] tends to voluntarily stay,” Sebelius said. “So it really hasn’t been necessarily the challenge of keeping folks there, it has been the challenge of getting them there and getting them back.”

Both women also expressed their optimism that the confirmation of Dr. Regina Benjamin as U.S. surgeon general would be forth-coming, as well as their belief that her personal experience will be a positive influence for young medical students to take advantage of incentive programs to not only serve in rural areas, but to build practices that add to the fabric of those communities.

The legislation, which is sponsored by Iowa Sen. Tom Harkin, makes it easier for labor unions to organize. Iowa Republican Sen. Charles Grassley said his party would filibuster the bill, which led Harkin to predict it would have to be altered to have any chance of passing.

Specter, who once supported the measure (and even sponsored it), came out in opposition to it in March. Most believe the about-face was due to a strong challenge in the Republican primary. Since that time, however, Specter has become a Democrat. U.S. Rep. Joe Sestak, a retired Navy Admiral, has publicly expressed an interest in challenging him in the 2010 Democratic primary, pressuring Specter from the left.

Specter’s speech this weekend in Pittsburgh appears to signal another change in opinion that could give the Democrats the votes needed to overcome a filibuster and make Harkin’s bill a reality.

“If you want to be elected in this state, you have to come to labor,” he said. “I know that. I owe my re-election in part to the endorsement the AFL-CIO has given me in the past.”

Specter was then interrupted by a man in the crowd who declared “you want my vote, I want yours,” referencing Specter’s position on the bill.

“I understand your job’s on the line,” Specter said. “I think you’ll be satisfied with my vote on this issue.”

The contentious portion of the bill involves language that would allow unions to be certified by the National Labor Relations Board if a majority of workers sign cards designating the union as their bargaining representative. It would not do away with secret ballots for union organizing, but they would no longer be required. Union activists and anti-labor groups both agree that the change would make it easier for unions organize.

Opponents say that without a secret ballot, workers will be intimidated into joining a union. Supporters of the bill counter that employees already face intimidation from their employer when contemplating a union vote. Under the current law employers can veto workers’ decision to organize through majority signup and force them into the election process where, according to a recent study, a pro-union worker is illegally fired in a quarter of all organizing drives.

U.S. Sen. Tom Harkin (Lauren Victoria Burke/WDCPIX.COM)

Iowa Sen. Tom Harkin told the National Journal Tuesday that if those who currently oppose the Employee Free Choice Act are not willing to work with him on a compromise, he will will try to force a vote on the original bill.

Republicans have said repeatedly they will filibuster the bill. Earlier this month, Harkin said he didn’t believe he had the 60 votes needed to overcome a filibuster and that the most controversial portion, giving workers the right to unionize as soon as a majority of employees in a workplace signed cards saying they want a union, would likely be eliminated.

Now, Harkin says that while he is still working to get 60 votes, he is willing to put the original bill on the floor of the Senate and let lawmakers vote their conscience. As Talking Points Memo writer Brian Beutler points out, doing so would put two of the bills most high profile opponents — Sens. Arlen Specter, D-Penn., and Blanche Lincoln, D-Ark. — on the hot seat.

Specter, who tacked to the right and came out against EFCA before becoming a Democrat, is facing pressure from the Democratic base and Rep. Joe Sestak (D-PA) to move left or face a primary challenge.

And at least one high level union official has suggested that if Lincoln doesn’t come around and support an EFCA compromise, she may face a green party challenger, in addition to a Republican challenger, in the general election.

Specter told the Associated Press last week that “prospects are pretty good” for a compromise.

Harkin told Bloomberg News that the provision of the bill that would give workers the right to unionize as soon as a majority of employees in a workplace signed cards saying they want a union would likely be eliminated.

“Compromises are going to be made,” said Harkin, an Iowa Democrat. “It probably won’t be card-check because too many people are opposed to it now.”

Republicans were joined by several Senate Democrats in opposing the bill, which has drawn the ire of the business community who say that without a secret ballot workers will be intimidated into joining a union.

Supporters of the bill counter that employees already face intimidation from their employer when contemplating a union vote. Under the current law employers can veto workers’ decision to organize through majority signup and force them into the election process where, according to a recent study, a pro-union worker is illegally fired in a quarter of all organizing drives.

In March, Iowa’s senate delegation split on the issue, with Sen. Charles Grassley threatening a filibuster and Harkin saying he was confident he could reach 60 votes to overcome it.

Harkin told Bloomberg a softened version of the bill could garner more support.

“Many do feel there is an imbalance” in current laws that favors business over labor, Harkin said.

“They may not be for the card-check, but they are for changing election process and procedures and shortening the period of time for elections” to form unions in a company.

Two weeks ago, Iowa Republican Sen. Charles Grassley said the bill, known as the Employee Free Choice Act (EFCA), would never become law because his fellow Republicans would filibuster it. That contradicted Iowa’s Democratic senator, Tom Harkin, who said the measure would have the 60 votes necessary to overcome the filibuster.

Many believe the Democrats’ hopes of passing EFCA rested with Specter, a moderate Republican who has long been seen as essential to reach the magic number of 60 votes needed to overcome Republican filibusters. Specter was one of three Republican who supported President Barack Obama’s economic stimulus package and one of eight to support the federal omnibus appropriations bill.

Grassley said there are “41 Republicans sticking together against it,” and Specter’s change of heart seems to have made that statement a reality.

Though the majority of the Democratic Party backs Sen. Barack Obama, an undercurrent of staunch and loyal [Sen. Hillary] Clinton supporters say they’ll fight all the way to the national convention, which begins in Denver in 18 days, to put her name on the ballot.

They are working to garner the 300 signatures from national delegates to complete DNC rule requirements to put Clinton’s name back on the convention ballot. Clinton, however, would have to agree to this before her name is placed on the ballot.

“I will come on board the unity train with a first class ticket if, before doing so, I get the opportunity to vote for my candidate,” said Daniel Kagan, a property developer and lawyer from Arapahoe County. “On Aug. 28, when Obama accepts the nomination, I will be there cheering along with the rest of them, but only if I have had the chance to vote first.”

Not everybody is as willing to accept Obama’s nomination as Mr. Kagan from Araphoe County, Colo. The Iowa Independent reported in June that several leaders of the Iowa College Democrats who supported Clinton in the nomination fight publicly endorsed Republican Sen. John McCain and called on other Clinton supporters to do the same.

The Washington Post’s Anne Kornblut reported this morning that Obama and Clinton advisers are working to find a way to appease her supporters and find roles for her and her husband.

The Obama and Clinton camps said this week that they agree on a central point: They would like to avoid an embarrassing display of discord from Clinton’s most ardent backers when the national convention begins in just over two weeks.

On top of it all, MSNBC is reporting this morning that former President Bill Clinton will get a prime-time speaking slot at the Democratic Convention. He will speak Aug. 27 before the address by the party’s vice-presidential nominee.

“You’re just not getting the fair shake you deserve,” Rathje said.

When asked by Iowa Independent to get specific about western Iowa being something of a red-headed stepchild, Rathje said U.S. Highway 30 should be four-laned “all the way to the river,” referring to the the Missouri River.

“We at this side of the state have fallen short for a long time,” Rathje said.

Why has western Iowa been neglected?

“I can’t answer that,” Rathje said.

Doesn’t Congressman King rightly shoulder some of the responsibility for his constituents not getting the fair shake, as Rathje alleges?

“Congressman King has been a great asset to this side of the state,” Rathje said.

But according to a leading watchdog organization, King this year has been the runaway least effective member of Iowa’s federal delegation in bringing money home.

Rathje, an eastern Iowa businessman, faces Christopher Reed, another businessman from Cedar Rapids, and George Eichhorn, an attorney and former Iowa legislator who lives in Hamilton County, in the primary Tuesday.

Beau’s words, prefaced with a common Biden family phrase “mark my words,” recently hit home in Iowa a few days ago when four members from the Ottumwa-based 833rd Engineer Company were wounded by a roadside bomb in Iraq. While patrolling an area near the Iraqi city of Samarra, an improvised explosive device (IED) detonated next to their vehicle. Two of the soldiers were seriously injured and flown to a military hospital at Landstuhl, Germany, while the other two were treated and returned to duty.

“They were in an RG-31 armored vehicle,” Lt. Col. Gregory Hapgood, chief spokesman for the Iowa National Guard told the Des Moines Register. “If they’d been in a Humvee, they would have been killed. A Humvee couldn’t have withstood the explosion.”

Biden’s Democratic rivals, Sens. Hillary Clinton of New York, Chris Dodd of Connecticut, and Barack Obama of Illinois, voted against the bill but have stated they support appropriations for the MRAP–just not when it is specifically tied to an Iraq war funding bill that has no timelines for bringing the troops home. There’s the political rub that Beau alluded to in August. By voting against the funding bill, the Democratic candidates chose to send a political message to President Bush while simultaneously garnering support from the anti-war voting contingency.In doing so, they risked the possibility of delaying production of vehicles that will protect the troops in what soldiers on the ground call “real-time”- meaning the next five minutes of their lives, which could be their last. In the war zone, there is no such thing as political time, and Beau, whose unit is scheduled to deploy to Iraq early next year, understands this difference. Beau also understands how the Republicans operate and how they will use such a vote against the Democrat who wins the nomination. Now that the MRAP issue has hit home in Iowa, Beau’s prediction has moved from the abstract to the concrete, something that may resonate with Iowa voters.

Asked about his differences with Clinton, Edwards and Obama on when to end the war in Iraq and bring our troops home, Senator Biden was quick to highlight this distinction at a campaign stop in Cedar Rapids today. “Clinton, Edwards and Obama say they cannot commit to bring our troops home until 2013. How can they say that, when they and the rest of the candidates ripped the skin off my back in May, when I was the only Senator running to vote to fund the troops?” Biden asked 150 people gathered at the 238 Teamsters’ Union.

“I voted to give our troops all the protection they needed. How can the three leading candidates, one of whom took out advertising in Iowa saying we need to vote “no,” say they’re going to keep troops there until 2013, yet they’re not going to fund them?” Biden asked. “Folks, that’s what I mean when I say we need to start telling the American people the truth. They’re telling you what you want to hear: End the war. But they are acknowledging they can’t end the war with any plan they have.”

Related reading: John Carlson’s column, “Biden Takes a Hit by Funding Vehicle That Saved Iowans” (Des Moines Register)

“After returning from serving in Iraq, I quickly grew frustrated by my impression that leaders in both political parties did not understand the fundamental challenges to ending the war in Iraq,” Bailey said in a press release. “When I first learned of Senator Biden’s plan, I realized that was the ticket – a political solution, not a military one. I am endorsing him because from day one, our next president must make decisions on the direction in Iraq and I am convinced Senator Biden has the knowledge and experience to bring our troops home without leaving a situation that requires another generation of Americans to return in a decade.”

Biden noted in a press release, “McKinley is one of Iowa’s most promising political leaders, and I am proud that he has pledged to support my campaign. I am in awe of all that he has already accomplished, including his exemplary work on behalf of his fellow veterans.”

Bailey is a veteran of five years of service in the United States Army. Bailey was a paratrooper with the elite 82nd Airborne Division and led his Tactical Signals Intelligence Intercept Team on more than 100 combat missions in Iraq and Afghanistan. At the University of Iowa, where he earned a BA in International Studies, McKinley founded and served as President of the University of Iowa Veterans Association.Elaborating on his frustrations with the political parties, Bailey was quick to point his finger at the Republicans and their handling of the war in Iraq. “They did not understand the situation at all,” Bailey told the Iowa Independent. “The strategies they were using when they sent us over was to treat the civilians like a hill that you had to walk over to get to the enemy. That just doesn’t work. Iraqis are an extremely complex culture with lots of different religions, ethnic groups, and beyond that you have tribes, clans and lots of  other divisions. If you want to win, you have to understand that.”

“I work in military intelligence and we sent reports stating that we were going about this all wrong, but we kept getting ignored over and over,” Bailey said during a telephone interview. “I think that the Bush administration still does somehow think that they will one day kill all the bad guys and that will be the end of it. It’s far more complex than that.”

Despite being a Democrat, Bailey was not willing to let his party’s leaders off the hook so easily, in particular those members calling for a quick withdrawal. “Some Democrats are guilty of thinking we can just pack up and leave, and that’s just not feasible,” Bailey said. “There’s a lot of good people in Iraq who are on our side, and they and their families will be killed if we pack up and leave. They’ve trusted us and done everything we’ve asked of them, and we can’t abandon them.”

“We can’t stay there forever either. We have to have a rational and reasonable plan to get us out of there without leaving Iraq in a state of chaos, and that’s where I think Senator Biden steps in,” Bailey said. “When I first read Biden’s plan for Iraq over a year ago, I wasn’t thinking in terms of a presidential context, but I do remember thinking that somebody in D.C. finally gets what is going on.”

Asked what other reason, besides the Iraq war, as to why he’s endorsing Biden, Bailey responded that it’s too hard for him to separate the war from any of the other issues. “This is what really matters to me. I’ve been there, I’ve lost friends there, and ultimately the Iraq war was one of the guiding factors in my decision to endorse Senator Biden,” Bailey said.

Another important factor behind Bailey’s endorsement decision was Biden’s vote in March to supplement the funding in Iraq, which included Biden’s MRAP (Minde Resistant Ambush Protected vehicles) amendment. “When you’re running in a Democratic primary, that certainly was not the most popular vote, politically, and as a legislator, I genuinely appreciated Biden’s courage to vote for what’s right and not what’s politically expedient,” Bailey said. “With Biden as president, I think we will see this courage applied in lots of other areas. I don’t want to sound like a one-issue voter, but I think most of Democratic candidates share fairly similar stances on the issues. It’s Biden’s experience, leadership, institutional knowledge and ability to get things done that separates him from the rest of the pack.”

Elected in 2006, Bailey defeated three-time Republican incumbent George Eichorn by a 10-point margin and represents District 9, which covers all of Wright County and parts of Hamilton and Webster Counties. Bailey is the eleventh Iowa legislator to endorse Biden, including his leader, House Majority Leader Kevin McCarthy of Des Moines. “We are excited to have McKinley join the Biden team here in Iowa,” McCarthy said in a press release. “His work with veterans as well as his own service to our country will prove invaluable to helping Joe Biden win the Iowa caucuses.”

I’m with Joe: Rep. McKinley Bailey