A senator with staying power

A U.S. senator for 31 years and the author of more than 2,000 sometimes hard-to-decipher Twitter messages, Chuck Grassley also has had a long run on the annual 100 Most Influential rankings.

While he finished No. 56 this year, the lowest placement for the 78-year-old Republican lawmaker from Iowa, he remains the only elected official to make the list in all 11 years of its existence.

Grassley, who had his highest placement at No. 5 in 2009, credits his longevity on the rankings to a number of factors, including his seat on the Senate Finance Committee, his championing of equal pay and quality for rural healthcare, his advocating for medical malpractice reform and his role in Medicare and Medicaid program oversight where he works to make sure “bureaucrats are enforcing the law as intended.”

He also cites his cooperative role in the committee's leadership with Sen. Max Baucus (D-Mont.), the panel's chairman. He said that for more than a decade, the two have been able to reach consensus on all but three or four bills (with the Patient Protection and Affordable Care Act included in that total).

“That stems from the fact that he and I for that length of time would meet every Tuesday from 5 to 6 (p.m.) to go over the agenda,” Grassley said. “Our staffs have also met and developed even closer relationships.”

If Mitt Romney wins the presidential election and Republicans take control of the Senate, Grassley said the Affordable Care Act will be repealed and replaced.

“It's going to be just like it was in 2009—only with a different outcome,” Grassley said, adding that if President Barack Obama is re-elected, there will be less work and more oversight. He also predicted that there will be a “tremendous shortfall in revenue,” which will require amending the law. “We're going to find a lot of things that will have to be redone,” Grassley said. “There will be a call for some changes in the bill that will save money.”

The other perennial names on the annual rankings are: Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation,

No. 55; Rose Ann DeMoro, executive director, National Nurses United/AFL-CIO, No. 36; Thomas Dolan, president and CEO, American College of Healthcare Executives, No. 89; Trevor Fetter, president and CEO, Tenet Healthcare Corp., No. 30; Karen Ignagni, president and CEO, America's Health Insurance Plans, No. 72; Chip Kahn, president and CEO, Federation of American Hospitals, No. 33; and Wayne Smith, chairman, president and CEO, Community Health Systems, No. 25.