Fighting for Our Health
Two security guards in dark suits towered over Mary Carol Jennings, a spiky-haired medical student wearing a white doctor's coat, as she and some fifty others tried to enter DC's Ritz-Carlton Hotel one morning in early March. The contingent included representatives of the AFL-CIO, MoveOn and the Campaign for America's Future. Jennings was flanked by two members of the National Nurses Organizing Committee who held a giant certificate for the head of America's Health Insurance Plans, the trade group meeting inside the hotel.
"We hereby present Karen Ignagni, CEO [of] AHIP, with this award for Best Protector of Health Insurance Industry Profits at the Expense of Our Health," read the mock certificate, which they decided to leave on her car after being denied entrance to the Ritz. "We are confident that Karen Ignagni will continue to protect profits while paying lip service to 'health care reform.'"
This showdown was organized by a nine-month-old coalition known as Health Care for America Now, which claims more than 850 affiliate organizations. Having learned from the mistakes made by reformers in 1993 and '94, HCAN is launching an early assault on the organization that led the crusade against President Clinton's proposal. According to HCAN spokeswoman Jacki Schechner, "There was no organization on the left" during the Clinton fight, a time when insurers "talked nice about reform until it got down to the nitty-gritty" details of the plan.
"What we expect [from AHIP] is that there's going to be a lot of yes up front and a lot of no behind the scenes," she says. "We know [what] we're seeing this time around is a coordinated effort to say we're not going to buy it--this is not to be left in the hands of DC lobbyists and special interests anymore."
Though AHIP is publicly espousing cooperation--Ignagni told President Obama at a March 5 healthcare summit that "You have our commitment to play, to contribute and to help pass healthcare reform this year"--the group has already staked out its opposition to one of the planks of the president's proposal that progressives regard as most essential: giving the American people the choice of a public insurance plan alongside a range of private ones. Iowa Senator Chuck Grassley, the ranking Republican member of the Finance Committee, who also claims to be seeking a bipartisan compromise, has joined AHIP in drawing this line in the sand. HCAN has responded to Grassley's statements by broadcasting television ads in his state featuring a Des Moines nurse endorsing the choice of a public plan.
The public plan is important to many on the left as a fallback from the single-payer system many would prefer. But in practical terms, the public plan may be a crucial cost-containment measure--if it can run more efficiently than private plans, it can force costs down across the system through competition. So the debate over this provision is part of a much more fundamental question: can Washington summon the will to squeeze savings from insurers and providers and raise the revenues needed to cover the uninsured?
A showdown over the public plan looms when Congressional committees begin writing healthcare reform legislation this summer, but the funding fight that may determine the outcome of the reform effort began in March when Congress started working on the budget. HCAN and some other reform advocates say they are "comfortable" with the healthcare provisions in the budget resolutions just passed by the House and Senate, but these are not as favorable to healthcare reform as they might have hoped. Both chambers rejected President Obama's plan to set aside $634 billion as a "down payment" on his healthcare reform proposal--an amount that would have covered only about half the plan's expected cost--refusing to commit any dollar amount to healthcare reform. When Congress takes up reform legislation, advocates will not only be fighting to pass a bill that restructures the healthcare industry; they will also have to persuade legislators to raise more than $1 trillion with a single vote.
If Congress cannot come up with the money, it is clear who will pay for the shortfall: the people who must give up care because they cannot afford it. As HCAN director Richard Kirsch told me last month, to get truly universal coverage, "we've got to be sure there's enough money."
HCAN organized a "grassroots army" to greet members of Congress who returned home for the April recess, planning ninety-six events in forty-four states, which organizers expected to turn out 15,000 to 20,000 people nationwide. Residents of Pennsylvania and New Jersey are showing their unity by rallying on a bridge that connects their states; in Colorado something called a "move-a-thon" is scheduled; and more than a dozen town-hall meetings are planned in rural states like Arkansas and Montana. The organizers' top priority is to ensure that a final budget, which Congress will vote on after the recess, retains a provision of the House version that would prevent healthcare reform legislation from being blocked by a Senate filibuster. This would not only protect it from Republican opposition but also from fiscally conservative Democrats who might balk at its large price tag.
"It's fair to say that our entire effort is informed by what went wrong last time" a president tried health reform, says Kirsch. One lesson HCAN learned was not to advance a particular plan--many groups in the '90s broke with President Clinton to promote a single-payer proposal--but instead to drive a debate around the principles of choice, affordability and universality, that can shape legislation as it moves forward. HCAN has the advantage of being far better financed than the activists going up against health-industry lobbyists during the Clinton effort, with perhaps ten times the operating budget of the labor-backed coalition of the '90s. It has been building an activist network and hiring organizers for more than a year.
Obama has studied the failures of the Clinton effort, which downplayed the need for additional funding, and is tackling the money problem upfront. James Mongan, a former Senate Finance Committee staffer and Carter administration official who now heads a Boston hospital network, thinks this is a wise idea. "I think Obama's done exactly the right thing by showing he's willing to put money on the table," he explains. "In my own experience in about forty years of working on this...the sticking point has always been the financing."