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Who’s trying to kill health reform: Winter 2010 edition

kill bill parody

It’s been a while since we last checked in with all the different lobbying groups that are trying to kill (or at least gut) health care reform.  Let’s see what they’ve been up to since this summer…

The Insurance Industry Lobbyists: America’s Health Insurance Plans (AHIP)
The last major news we heard about AHIP was back in October, when they released a report claiming that health care reform would cause premiums to go up.  Shortly after the report was released, bloggers pointed out major flaws in the study, destroying it’s credibility.  The fallout was so bad that the next day the consulting firm that had produced the report released it’s own statement, explaining that AHIP had asked them to produce a report ignoring huge portions of the bill.  Meanwhile, outraged liberal members of Congress started talking about taking away the insurance companies’ antitrust exemption, and the public option was suddenly back on the table.

AHIP apparently realized that it had made a mistake, and since then has more or less faded into the background of the healthcare debate.  In their few public statements since then, they’ve expressed general support for health care reform, while criticizing certain provisions they didn’t like.  In her statement on the Senate’s Bill, AHIP President Karen Ignagni said:

“These issues need to be resolved if the country is to make health care coverage more affordable and put the system on a sustainable path.  Health plans will continue to work to solve the problems that have been identified.”

Apparently, “working to solve problems that have been identified” meant funneling tens of millions of dollars to the U.S. Chamber of Commerce, a lobbying group representing  business interests, so that they could run ads like this:

According to a report in the National Journal:

Between $10 million and $20 million, came from Aetna, Cigna, Humana, Kaiser Foundation Health Plans, UnitedHealth Group and Wellpoint, according to two health care lobbyists familiar with the transactions. The companies are all members of the powerful trade group America’s Health Insurance Plans.

The funds were solicited by AHIP and funneled to the U.S. Chamber of Commerce to help underwrite tens of millions of dollars of television ads by two business coalitions set up and subsidized by the chamber. Each insurer kicked in at least $1 million and some gave multimillion-dollar donations.

In October, Ignagni wrote a letter to the Washington Post, stating “Let me be clear and direct, health plans continue to strongly support reform.”At the same time, money was already being funneled to Chamber of Commerce ads:

The fundraising started last September and continued through December using AHIP as a conduit to avoid a repeat of the political flak that hit the insurance industry after it famously ran its multimillion-dollar “Harry and Louise” ads to help kill health care reforms during the Clinton administration.

“AHIP wanted to do this through a third party because of what happened with the Harry and Louise ads,” said a lobbying source. “The goal was to get a message out there to make sure the public understood the serious shortcomings of the legislative proposals.”

Wendell Potter, a former Vice President at Cigna, now working as a Senior Health Fellow with the Center for Media and Democracy is calling for a Congressional investigation to determine how much money the insurance industry has spent trying to defeat health care reform and whether any laws were broken.

Doctors: American Medical Association (AMA)
Like most of the groups with a stake in health care reform, the AMA broadly supports the health care reform bills, but has been working furiously behind the scenes to defeat any provisions that could in any way reduce the amount of money doctors make.  In general the AMA is behind any part of health care reform that would put more money into the health care system, and will fight tooth and nail against any effort to control costs on their end.

Their Health System Reform Bulletin on December 23, lists dozens of key provisions in the Senate bill that they helped block.  Some of the bigger ones include:

  • Blocking a proposed Medicare buy-in. You might remember that this was the compromise worked out in the Senate in exchange for removing the public option (although it was still killed by Joe Lieberman).  According to their bulletin:
    • “The AMA mobilized media, grassroots and lobbying efforts that were a key factor in preventing the Medicare buy-in proposal for individuals ages 55-64.”
  • Eliminated a proposal to impose a 5 percent cut in Medicare payments to the 10% of physicians who charge Medicare the most.
    • This was another good proposal- there’s been a lot of talk about how Medicare spends much more per patient in certain parts of the country.  The biggest reason, is that some physicians just order way too many tests and procedures.  This tax would have removed their incentive to overtreat patients.
  • Provisions had been created to establish an independent comparative effectiveness research body. The AMA had the provisions modified to not allow the establishment of practice guidelines or to make coverage, payment or policy recommendations.
    • Comparative effectiveness research would help identify treatments that are expensive but don’t work.  The bill would create a government body to do this kind of research, but thanks to the AMA it wouldn’t be allowed to make policy recommendations. In other words it could say that “Treatment X is expensive and kills 50% of the people who take it, while Treatment Y is cheap, works just as well, and doesn’t kill anybody,” but it couldn’t say, “We don’t think that Medicare should cover Treatment X.”
  • Eliminated the proposed tax on elective cosmetic surgery.

Hospitals: American Hospital Association (AHA)
Remember that back in July, the AHA cut a deal with the Obama administration. They agreed to accept $155 billion in payment cuts over the next decade, less than the $220 billion Obama originally proposed, in exchange for supporting health care reform.  Why voluntarily agree to any cutbacks?  Health care reform will expand coverage to tens of millions more Americans- hospitals hope to make up for lost payments from the government with increased volume.

Still the AHA is concerned with various provisions in the bills.  In a January 7th letter, the AHA described its preferences as the House and Senate work to merge the two bills.  As you can imagine, they support anything that weakens the insurance industry, while expressing “concern” over anything that would reduce payments to hospitals.  In particular they’re worried about the proposed Independent Patient Advisory Board, which would make recommendations on how to save money in Medicare.

It’s a little unclear what the AHA is doing behind the scenes- whether they’re actually supporting health care reform as they agreed or working actively to weaken it.  We would like to note though that on the AHA’s website, everything is open to the public EXCEPT the health reform update, which is password protected and members only.  Somewhat suspicious for a group that says it supports health care reform.

Drug Companies: PhRMA
The drug company lobby, PhRMA, is another group that cut a deal with the White House at the start of the health care reform negotiations.  PhRMA agreed to $80 billion in reduced payments over the next 10 years in exchange for protection from further cuts.

This agreement has already paid off for the drug companies.  When Senator Byron Dorgan (Dem, ND) introduced an amendment that would allow the importation of U.S.-approved medication from Canada, Europe, Australia, New Zealand and Japan, where drug costs are far lower because of price controls, he got no support from President Obama.  Instead the Food and Drug Administration, which is overseen by the executive branch, sent senators a letter saying the plan would be “logistically challenging” to implement and raises “significant safety concerns.”

As a senator and as a candidate, Obama supported drug importation, and even co-sponsored Dorgan’s original importation bill in 2007.  But in the end, Dorgan’s amendment to the health care reform bill was defeated.  Apparently Senators were convinced to vote against it, in exchange for a deal that would close the gap in Medicare drug coverage for seniors.

Right-wing bloggers AND some left wing bloggers (???)
Gotta admit, we didn’t see this one coming.  Conservative bloggers and pundits have been pretty consistent in their opposition to the bill- no surprise there.  And we knew progressives would be upset to see the public option stripped out of the Senate bill.  But some progressive bloggers, like Jane Hamsher at firedoglake, have mounted an all out attack on the Senate’s bill.  Howard Dean has even suggested that the bill isn’t worth passing.  Other liberal bloggers believe that these criticisms are off base or misleading and ignore the good that the bill would likely do.  Regardless, the disagreements revealed a major split in the progressive community.

It seems like the “kill bill” crowd took a deep breath and calmed down a bit over New Years, and has instead decided to focus on ways to improve the bill in committee.  But it will be interesting to see what happens when the merged bill is finally released.

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