Copyright 1999 The New York Times Company
July 12, 1999, Monday, Late Edition - Final
SECTION: Section A; Page 12; Column
1; National Desk
LENGTH: 1468 words
HEADLINE: Unlikely Lobbyist Will Lead H.M.O.'s Into
BYLINE: By ROBERT PEAR
DATELINE: WASHINGTON, July 11
When the Senate takes up legislation on
Monday to define patients' rights, Democrats will argue that hundreds of people
have been injured or even died because they were denied necessary care by
cost-conscious health maintenance organizations.
So it is rather
surprising to find that the chief lobbyist for the managed care industry is
herself a Democrat, a veteran of the trade union movement and a longtime
advocate of universal health insurance.
The lobbyist, Karen M. Ignagni,
has deflected much of the anger that threatened to overwhelm H.M.O.'s just a
year ago. She will lead the industry into battle this week, as the Senate holds
four days of impassioned debate on proposals to set comprehensive Federal
standards for health insurance plans.
It will be the most extensive
debate on any health care issue since President Clinton's plan for universal
health insurance died on the Senate floor in the summer of 1994.
president of the American Association of Health Plans, Ms. Ignagni leads a
nimble, quick-witted campaign to outmaneuver the Clinton Administration and
Democrats in Congress who want to enact a so-called patients' bill of
rights, enforceable by lawsuits against health plans that injure
patients by denying them care.
In a city teeming with health care
lobbyists, Ms. Ignagni is widely considered one of the most effective. She
blends a detailed knowledge of health policy with an intuitive feel for
Since taking charge of the association nearly six years ago,
she has built up a large stable of health policy analysts and has retained
pollsters and political consultants from both parties to repair the tattered
image of H.M.O.'s. She has persuaded members of the association to adopt a
voluntary code of conduct, which they use to argue that new laws are unneeded.
Ms. Ignagni (pronounced ig-NAH-nee) puts a humane face on an industry
reviled by many consumers. Old friends say they are puzzled by the transition
she has made from champion of the working class to defender of big business. She
now denounces proposals by Democratic members of Congress who were her allies
for more than a decade, when she worked at the A.F.L.-C.I.O.
Democrat on Capitol Hill said, "Karen went from God's right hand to Satan's left
hand." A labor union leader said, "She jumped to the other side." Former allies
on the left say she has sold out, abandoned principles, become a turncoat.
"She has become part of the enemy, as far as I'm concerned," said Dr.
Sidney M. Wolfe, director of Ralph Nader's Health Research Group.
Representative Greg Ganske, an Iowa Republican who supports many of
President Clinton's proposals to regulate H.M.O.'s, said: "Karen has one of the
more difficult jobs in Washington, defending an industry that has a public
relations record similar to that of the tobacco industry. In private
conversations, I sense that she is uncomfortable defending the totally
irresponsible behavior of some H.M.O.'s."
Ms. Ignagni sees no
contradiction. Even as she works to head off legislation defining patients'
rights, she insists that she is motivated by concern for low-income workers.
Proposed new Federal standards and requirements, she says, would increase the
cost of health insurance and make it unaffordable for many workers and small
Ms. Ignagni's adversaries express grudging respect for her.
"I just wish she were on our side," said Gail E. Shearer, a health policy expert
at Consumers Union. David H. Nexon, the senior health policy adviser to Senator
Edward M. Kennedy, Democrat of Massachusetts, said, "Karen has revitalized an
organization that was somewhat moribund and made it a real player on the
Lobbyists for the association have penetrated the
innermost chambers of the Health Care Financing Administration, the unit of the
Department of Health and Human Services that runs Medicare. The lobbyists often
seem to know more about what is happening at the agency than do senior officials
of the department.
The association and its business allies have flooded
the airwaves and newspapers with advertisements opposing legislation to regulate
H.M.O.'s. Through an umbrella group known as the Health Benefits Coalition, they
spent $2 million on advertising last year and have already spent more than that
this year, with a new burst of advertising planned for this week.
advertisements attack the main Democratic bill by name, but provide
justification -- and political cover -- for senators to vote against any
patients' rights legislation.
At 45, Ms. Ignagni is younger, more
informal and more direct than most lobbyists who run big trade associations. Her
talk is breezy, but it serves a purpose, frequently disarming her opponents.
Most H.M.O.'s are operated by profit-making companies like Aetna, Cigna
and Pacificare, but Ms. Ignagni rarely talks about their profits or losses. She
prefers to talk about the quality of health care, the concerns of consumers, the
work that H.M.O.'s are doing to detect breast cancer and treat asthma.
As consumer groups, labor unions and doctors press Congress for
legislation to define patients' rights, the position of the managed-care
industry has been continually evolving.
Two years ago Ms. Ignagni said
her members saw no need for legislation. Now, she said, they strenuously oppose
the main Democratic bill and have not endorsed the Republican bill, although
they see it as "less undesirable."
Explaining why she was now willing to
consider legislation, Ms. Ignagni said, "If we want to influence the discussion
in Congress, we can't oppose everything."
Provisions of the Republican
bill allowing patients to appeal the denial of care are "a good starting point
for bipartisan discussion," she said. But, she added, "We dislike provisions of
the Republican bill that micromanage our activities and dictate the design of
Ms. Ignagni's presence is a reminder of the history of
H.M.O.'s. They have their roots in labor union health plans and in the idealism
of the health cooperatives that were formed in the 1940's and 50's to obtain
better health care at the lowest possible cost.
For years, the United
Automobile Workers, the United Mine Workers and other labor unions had seats on
the board of the Group Health Association of America, established in 1959. In
1996, the organization changed its name to the American Association of Health
Ms. Ignagni has combined policy and politics throughout her
career. After graduating from Providence College in Rhode Island in 1975, she
worked as a research analyst at the Social Security Administration, analyzing
data on health spending.
She moved to the Committee for National Health
Insurance, formed by Walter Reuther of the auto workers' union, and then worked
for Senate Democrats before taking a job at the A.F.L.-C.I.O., where she held
senior staff positions from 1982 to 1993.
Ms. Ignagni did not seek her
current job; she was recruited by an executive search firm. She received a
salary of $300,000 last year, plus a $100,000 bonus for her performance.
When the House passed a Republican bill to regulate H.M.O.'s last
summer, Ms. Ignagni complained that "the debate has been defined by politicians,
pollsters and Hollywood producers." But she herself has used the techniques of a
political campaign in trying to fend off Government regulation of managed care.
For example, the association says it has developed a database with the
names of millions of patients, H.M.O. employees and allies who can be dispatched
at a moment's notice to answer critics of managed care. The group boasts that it
"helped generate thousands of letters to the editor" last year.
made a real effort to take our message, our campaign, to voters, physicians,
Medicare beneficiaries and opinion leaders around the country," Ms. Ignagni
The association is running advertisements in Iowa and New
Hampshire to persuade Presidential candidates that they cannot win many votes by
Ms. Ignagni hired an economic consulting firm, the
Barents Group, a unit of KPMG, to estimate the local costs of Federal mandates,
and she has publicized the results in news conferences around the country.
Even as Federal auditors contend that H.M.O.'s are overpaid by the
Medicare program, Ms. Ignagni is asking Congress to increase those payments. She
commissioned a study by the accounting firm PricewaterhouseCoopers to support
her case. And she has recruited elderly people as lobbyists, urging Congress to
increase reimbursement so health plans will not drop out of Medicare.
all of this, Ms. Ignagni seems untroubled by the apparent contradictions between
her old and new roles. "I've never had a sense that I was advocating something I
didn't believe in," she said.
GRAPHIC: Photo: Karen M. Ignagni, president of the
American Association of Health Plans, in her office in Washington. (Shana Raab
for The New York Times)
LOAD-DATE: July 12, 1999