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Copyright 1999 Times Mirror Company  
Los Angeles Times

August 8, 1999, Sunday, Home Edition

SECTION: Part A; Page 1; National Desk

LENGTH: 1589 words




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 recesses.

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 managed care.

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 malpractice laws.

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.

"It's a permanent campaign," said Mark Merritt, the chief strategist for the American Assn. of Health Plans, which represents about 1,000 managed health care plans nationwide.

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.

By contrast, 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.

Business 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."

"There's an 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."

Lobbyists are 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 approved.

"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."

LOAD-DATE: August 8, 1999

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