Health Care’s ‘Wild West’

Despite spending millions of dollars on television commercials opposing the legislation, business groups lost their effort to kill the House’s health care reform bill.

Now they’ll focus their attention on a handful of senators who will determine what kind of health care reform legislation—if any—can squeak through the Senate.

“Everyone is talking to the same six moderates,” said James Gelfand, a health care lobbyist for the U.S. Chamber of Commerce. Gelfand didn't identify the Gang of Six by name, but the number of perceived middle-of-the-roaders is slim: Democrats Ben Nelson of Nebraska, Mary Landrieu of Louisiana, and Blanche Lincoln of Arkansas; Republicans Olympia Snowe and Susan Collins, both of Maine; and Independent Joe Lieberman of Connecticut.

At this point, business lobbyists aren’t trying to kill the Senate bill—no one, not even Senate Majority Leader Harry Reid, knows yet what will be in the final Senate version.

“It’s the Wild West—anything can happen,” Gelfand said.

Business groups are trying to make sure key senators know what employers need from the bill: more cost containment, including medical malpractice reform; and more insurance competition, including the ability to buy insurance across state lines. They’re also emphasizing what can’t be in the bill: a government-run plan and taxes on insurance companies, medical device companies, and pharmaceutical companies, which could lead to higher insurance costs.

With the exception of Small Business Majority and the Main Street Alliance, two groups that supported the House bill, most business groups oppose the public option. They contend it would pay hospitals and doctors below-market rates, which would lead these providers to charge private insurers more for their services. These higher costs would then be passed on to employers who purchase this insurance.

Many business lobbyists dismiss a possible compromise that would provide a public option in new insurance exchanges only if private insurers failed to offer affordable coverage. Gelfand said this so-called trigger is “preposterous” since the Congressional Budget Office has concluded the two health care reform bills passed by Senate committees would raise health insurance costs. A trigger would at most delay the public option, he said.

“I’m just sort of mystified whether it is even going to see the light of day at this point,” said Amanda Austin, the Senate health care lobbyist for the National Federation of Independent Business.

The narrow 220 to 215 victory for health care reform in the House should give Senate moderates even more leverage as they press for changes to address employer concerns, business lobbyists contend.

But Karen Kerrigan, president and CEO of the Small Business and Entrepreneurship Council, said the Senate would have “to take out the mandates and taxes and pass a scaled-down reform effort” in order for the legislation to be acceptable to her members.

“That means they would have to start over,” Kerrigan said.

Starting over isn’t an option, however, at least for President Obama.

He praised the House for passing its bill and said it’s now the Senate’s turn “to take the baton and bring this effort to the finish line.”

The relay race analogy is flawed, however. There’s no baton to pass from the House to the Senate. The only thing we know about the Senate bill at this point is that it won’t be the House bill.

Even if the Senate passes a bill, it would have to negotiate with the House to hammer out the differences in the two bills and then bring the final bill back to each chamber for a vote.

We’re talking pinball here, not a relay race.

We have weeks, if not months, left of lobbying, TV commercials, town-hall meetings, presidential photo ops, tea parties, sit-ins—every type of public persuasion imaginable. Business groups are well armed for this fight, but so are proponents of the public option and the other aspects of health care reform that trouble employers.

It is the Wild West, and the guns will be blazing.

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Kent Hoover is the Washington bureau chief for bizjournals.