Copyright 1999 Times Mirror Company
August 8, 1999, Sunday, Home Edition
SECTION: Part A; Page 1; National Desk
LENGTH: 1589 words
BUSINESS JOINS FIGHT AGAINST HEALTH REFORM;
LEGISLATION: LAWMAKERS CAN
EXPECT A FULL-COURT PRESS BY LOBBYISTS WHO FEAR PASSAGE OF A PATIENTS'
BILL OF RIGHTS IN CONGRESS.
BYLINE: ALISSA J.
RUBIN, TIMES STAFF WRITER
Lawmakers are getting out of
Washington for the rest of August, but the struggle by business and insurance
interests to avert tighter government regulation of the managed health care
industry will dog their every step.
Buttonholing lawmakers in the
corridors of the Capitol is a time-honored practice, but the people's
representatives usually could count on getting away from it all during their
Not this year. Business leaders will grill them at town
meetings. They will be barraged by radio and TV ads. Irate constituents who call
the toll-free number they hear on those ads will reach lobby-supported phone
banks, whose operators will patch them through to their representative's office.
And, mobilized by the lobbying campaign, business executives who have
long known particular lawmakers will visit with their old friends to press the
business community's agenda.
White House officials have been stunned by
the size of the business investment to defeat a patients' bill of
rights, which is one of Clinton's health care priorities.
Business feels like it's war, and they are reaching for their pocketbooks big
time," said a senior White House official. "There is a massive effort underway
to try to defeat the bipartisan bill, but the intensity of how much they fight
reflects how close we are to getting something."
At stake is the
leverage that the insured public will be able to exert against managed care
plans. About 160 million Americans carry private health insurance, and about 3
in 4 are enrolled in health maintenance
organizations or other forms of
Yet the insured public has had little say in the debate in
Washington, although some consumer groups are aligned with the medical
profession in favor of tighter federal regulation.
President Clinton and
the Democrats put the issue on the congressional calendar. But last month the
Republican majority in the Senate beat back the minority party's far-reaching
patients' bill of rights and instead pushed through a bill
offering more limited rights to a smaller number of managed care participants.
The issue will move next month to the House, where a bill sponsored by a
bipartisan coalition of House members would guarantee all patients in privately
insured health plans access to specialists and emergency care and permit them to
appeal a health plan's denial of care to an independent board of medical
experts. Those who were harmed because care was denied could sue under state
Insurers resent the heavy hand of government
regulation that they see in such proposals, and employers, who pick up most of
the tab for their workers' insurance, fear that reform could drive costs up.
So while fighting for lower health care costs has long been a priority
for business, the patients' bill of rights has escalated its
campaign from an occasional skirmish to a year-round crusade.
permanent campaign," said Mark Merritt, the chief strategist for the American
Assn. of Health Plans, which represents about 1,000 managed health care plans
Marshaling the troops is the Health Benefits Coalition, a
highly organized amalgam of about 35 business and insurance groups with deep
pockets and even deeper passion against any new government regulation of the
health care system.
The biggest players in the coalition include the
Business Roundtable, which represents the interests of 200 multinational
companies; the National Federation of Independent Businesses, which represents
small business; the National Assn. of Manufacturers; and the U.S. Chamber of
Commerce. Another participant in the coalition's three-times-a-week strategy
sessions is the Health Insurance Assn. of America, known for the "Harry and
Louise" advertising campaign that helped doom Clinton's plan five years ago to
overhaul the nation's health care system.
The insurance industry and
employer groups that make up the coalition spent at least $ 53 million lobbying
Congress last year, a substantial share of it on fighting regulation of managed
care, according to the Center for Responsive Politics. With large doses of
advertising and polling, their campaign against the patients' bill of
rights is a particularly expensive one.
physicians' groups, which support strict regulation of managed care, spent about
half as much, $ 27 million, lobbying Congress.
No longer are the most
well-heeled pressure groups content to confine their lobbying to knocking on
doors in congressional office buildings, said Mark A. Peterson, a political
scientist at UCLA. Now they also run expensive advertising campaigns and ferry
lawmakers' friends from back home to lobby them.
"When you put those
three things together, you're going to be quite effective before you even get to
campaign contributions," said Peterson, who is editor of the Journal of Health
Politics, Policy and Law. And the coalition's members are heavy hitters in this
department too, having contributed tens of millions of dollars to last year's
congressional election campaigns, according to the Center for Responsive
Politics, a nonpartisan research group in Washington.
interests' No. 1 concern in the patients' bill of rights is the
provision that would allow patients to sue their health plans under state laws
that now govern negligence and malpractice suits.
About 48 million
Americans get their health care from employers that assume the risk of costs
themselves rather than passing it on to an insurance company. Under the House
bill, these employers fear that they could be held legally responsible for harm
done to patients as a result of decisions by their managed care companies.
"If there's a law that makes us liable, we will actively encourage
businesses to drop health coverage for their employees," said Bruce Josten,
executive vice president for government affairs at the U.S. Chamber of Commerce.
Last week, the Business Roundtable sponsored rallies in Long Beach and
Nashville featuring Latino and African American small-business owners. They
warned lawmakers that strict regulation of HMOs would raise the cost of health
insurance, cementing the inability of these small businesses to afford insurance
for their workers.
Rep. Zach Wamp (R-Tenn.) remains uncommitted on the
issue, but he was clearly unsettled by the lobbying in his community. "Some
organization in Tennessee called the Business Roundtable is ginning up
businesspeople," said Wamp, who represents the Chattanooga area. "They are
taking every opportunity to derail managed care reform."
enormous lobbying effort against reform from health care groups, and I never
know who's behind it," he said. "The latest is this Business Roundtable. But to
my constituents and my personal family, it's real."
privately betting that business' high-pressure tactics will at least make Wamp
think twice before supporting a measure that would make health plans liable in
state court for their actions.
On the other side of the issue, medical
groups are running their own advertising campaign and conducting grass-roots
lobbying, but on a far smaller scale.
"We haven't seen anything like
this since President Clinton's health care reform," said Joanne Hustead,
director of legal policy for the National Partnership for Women and Families,
which supports strict regulation of the managed care industry. "We are concerned
about the millions of dollars they are going to be putting into advertising and
lobbying over the August recess."
Business' sophisticated saturation
lobbying was already a winner last month when the Senate voted down a tough
bill, sponsored by Sen. Edward M. Kennedy (D-Mass.), to regulate managed care in
much the same fashion as the bill that will go before the House in September.
The business coalition used polls by Bill McInturff, a Republican
pollster, to focus its message on how federal regulation of managed health care
firms would raise the cost of health care.
The message was paired with
studies by economists showing that higher health insurance costs mean more
people without insurance.
Then, in a key step, the results were broken
down to the state level so that lobbyists could hammer home the effect Kennedy's
bill would have on each senator's constituents.
"There are already
655,000 in the state of Washington without health insurance. . . . If costs go
up, 41,000 more people will be without health insurance," said a 60-second radio
ad broadcast in Seattle.
That message revealed a weak point in the
Democrats' armor. The sponsors of a tough patients' bill of
rights, unable to dispute the projections of higher costs, had to fall
back on the argument that not many people would lose insurance as a result.
The coalition focused its message on about 10 wavering Republican
senators. In the end, only one voted against the Republican bill that the Senate
"We found that when we argued the big numbers . . . people
were kind of unimpressed," said Johanna Schneider, director of communications
for the Business Roundtable. "But when we started breaking things down into the
impact on individual states and individual districts, we had much more impact."
The business lobbyists will face a tougher test in the House, where
Republicans have only the narrowest of majorities.
"We are fixated on
pounding away during the recess on a host of members on both sides of the
aisle," the Chamber of Commerce's Josten said. "We are going to pile on."
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