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Jennifer
November 11, 1994
MEMORANDUM TO CAROL RASCO
FROM:
Marilyn Yager
MEETING:
Families, USA
DATE/TIME:
Monday, November 14
3:30pm - 4:30pm
LOCATION:
Room 476, OEOB
AGENDA/TALKING POINTS:
Introductions
Thank them for coming and for their
unbelievable work and support for the Health
Security Act.
Overview Comments
1. Comment briefly on the broader
Administration priorities for next year,
i.e., welfare reform, etc.
2. Comment on the new health care team headed
by you and Bob Rubin.
3. Describe how we plan to proceed on health
care, i.e. meetings with allies and key
health players before any decisions are made.
4. Indicate that we are using the next three
to four weeks to listen and learn from our
allies, hence the purpose of this meeting.
Open it up for discussion.
NOTE: When inviting groups to these meetings
I have asked them to come prepared to give us
their assessment of the new political
environment and what it means for health care
reform. To tell us what incremental reform
would they support (if any) and what
incremental reform dp they think would hurt
the system. And finally, to be prepared to
tell us what they learned about their own
membership during the past two years on what
could be sold at the grassroots level and
what could not.
You are likely to be asked whether we are
planning to propose health care reform as a
part of our FY96 budget and whether we are
planning to propose Medicare cuts.
The most important message we can send, is
that we consider these folks friends and
allies and we are demonstrating that by being
as frank as possible regarding what we are
thinking.
BACKGROUND:
Families, USA, founded in 1982, has served as
a convener of consumer groups and allied
organizations on health and long term care
(formerly the Villiers Foundation). They
issue numerous reports on health and long
term care issues, and are often asked by
Congress to testify and by the media to offer
a consumer perspective.
For their size and revenue, their support for
the Health Security Act was unmatched. They
established 30 state health care coalitions,
and in many states hired field staff to build
grassroots support for health reform. They
also published key reports that we often used
to describe the problem and what the Health
Security Act do to address the need.
Ron Pollack has been executive director of
Families USA since its inception and has been
a committed Clinton supporter since the early
days of the campaign.
Their issue priorities were long term care
and universal coverage. I have attached an
example of their early correspondence with us
on Long term care to give you a flavor of
their detailed knowledge and pragmatic
approach to health care reform. I have also
attache an example of one of their press
releases regarding building support.
ATTENDEES:
Ron Pollack, Executive Director, Families, USA
Judith Waxman, Director, Government Affairs
Phyllis Torda, Public Education
Carol Rasco
Chris Jennings
Judy Feder (tentative)
Mike Lux
Marilyn Yager
Families
USA
CONFIDENTIAL
DETERMINED TO BE AN
TO :
Mike Lux
ADMINISTRATIVE MARKING
FROM:
Ron Pollack Ronny
INITIALS: ms DATE: 4-9-14
RE :
Seeking a Bottom Line on Long Term Care
DATE:
April 29, 1993
You asked me to give you a reading about an approximate bottom
line for various senior organizations that you specified concerning
long term care in the President's health proposal. In response to
your request, I held several off-the-record conversations and --
while none of them were precise about their bottom line -- several
key points can be gleaned:
1. Due to the President's and First Lady's comments on the
subject, there is a unanimous expectation that prescription drugs
will be in the benefit package and in Medicare. While prescription
drug coverage is not their top priority -- long term care is --
there would be major disappointment if drugs are not in the
package. I am unable to glean a bottom line, however, concerning
drug deductibles and co-payments -- but, given previous experience
on this issue in the Catastrophic Health Care legislation, it is an
aspect of drug coverage that will be looked at carefully.
2. There is unanimous agreement that the first long term care
priority is home and community-based care, not institutional care.
The senior groups, more than the disability organizations, however,
are looking for some recognition about the need for protection
against expensive nursing home care. Whether phased-in coverage
(over a more protracted period of time) for nursing home care must
be in the bill, or whether it suffices to recognize the need with
a promise to deal with it sometime in the future, is unclear. For
the senior groups, however, it seems clear that they need at least
a big enough rhetorical fig leaf on nursing home protection to
assuage their memberships. It would be very helpful to enact
nursing home coverage, even if the implementation schedule is far
in the future.
3. There is every expectation that the new home care coverage
will be phased in over a period of time. I have not heard a
specific bottom line about the length of the phase-in period,
but the typical response assumes a five-year range. (These
assumptions, however, are not based on an adequate sophistication
about the fiscal difficulties the Administration has in
constructing the overall package, or the Administration's possible
decision to complete acute care universal coverage in more than
five years.) No one expects completion of home care phase-ins
prior to acute care coverage.
1334 G STREET, NW
WASHINGTON, DC 20005
202-737-6340
FAX 202-347-2417
Memo to Mike Lux
- 2 -
April 29, 1993
4. There is a willingness to see coverage phased-in on an
income needs basis. There is a very strong antipathy, however,
to an ultimate design that results in a poor people's program.
This should be clear in the legislative proposal. I believe,
however, that a progressively graduated set of co-payments and/or
deductibles -- perhaps (although I'm not sure) even a fairly steep
graduation based on economic circumstances -- might be acceptable.
5. It would be very helpful if there was a modest start on
long term care at the earliest stages. I believe that respite care
could work as the likely candidate for such a first step.
I have not seen the long term care option paper currently
before the Task Force, nor have I seen the cost estimates of the
options. From the accounts I have read, however, I believe that
the option that gradually phases a home care benefit for all is the
right direction to go for securing the organizational support from
the groups you identified. (And, if I may editorialize rather than
just report: I would add mandatory spend down protection for
nursing home care under Medicaid for the 19 states that don't
currently provide it together with modestly upgraded spousal
protection -- joined with an oral commitment to future nursing
home reform.)
TamA
Families
PRESS
FOUNDATION
RELEASE
FOR IMMEDIATE RELEASE
WEDNESDAY, SEPTEMBER 22, 1993
LEADING HEALTH CONSUMER GROUP
VOICES ENTHUSIASTIC SUPPORT
FOR CLINTON HEALTH REFORM
"It's great for American families! The President's Reform
will absolutely guarantee that you'll never lose your health
insurance, no matter what," according to consumer advocate Ron
Pollack, executive director of Families USA.
The health consumer group came out strongly in support of
the President's Health Reform.
"This plan will restore peace of mind to American families
who worry they'll be among the two million Americans who lose
coverage every month, Pollack said.
"President Clinton's Health Reform will ban the fine print
that insurance companies use to dump you or deny you benefits
you've paid for. It will crack down on insurance and drug
company overcharges. We're very enthusiastic in our support for
the reform, " Pollack said.
- 30 -
FOR IMMEDIATE RELEASE
WEDNESDAY, SEPTEMBER 22, 1993
HEALTH CONSUMER GROUP RELEASES ANALYSIS
SHOWING FAMILIES HELPED BY CLINTON HEALTH REFORM
Families USA today released an analysis showing how
Americans would be helped by Clinton's Health Reform.
[NOTE TO EDITORS: THE FULL TEN PAGE REPORT TEXT (WITH STORIES OF
REAL PEOPLE IN EACH CATEGORY) IS AVAILABLE BY FAX OR MAIL.]
- more -
CONTACT: ARNOLD BENNETT OR AVIVA SHLENSKY (202) 628-3030
1334 G STREET NW
WASHINGTON DC 20005
FAX (202) 347-2417
Page 2 of 7
The report looks at the impact of reform on ten groups:
1. Insured Americans at risk of losing their health
insurance.
2. Americans with inadequate insurance.
3. Americans with high prescription drug costs.
4. Americans who retire early and lose health benefits.
5. Americans who are job-locked.
6. Americans who own small businesses--and their families.
7. Americans who need long term care at home.
8. Americans whose employers cut back on health benefits.
9. Businesses with skyrocketing premiums.
10. Americans on Medicaid who can't get health care.
INSURED AMERICANS WHO WOULD LOSE THEIR INSURANCE
COSTS
For the more than two million insured Americans who lose
their health insurance each month, the Clinton Health Reform
guarantees that no American can lose health insurance, no matter
what. A health security card will guarantee all Americans
comprehensive health benefits, even if they lose or change jobs,
move out of state, get divorced, start a small business, or
someone in the family gets sick. FAMILIES USA RATING: Best
reason to support plan.
- more -
Page 3 of 7
INSURED AMERICANS WITH INADEQUATE INSURANCE
Millions of Americans have inadequate insurance that can
leave them with many thousands of dollars in medical bills.
About 18 million insured Americans will have to spend at least
one-tenth of their incomes on out-of-pocket health costs in 1993.
Clinton's Health Reform guarantees all Americans
comprehensive health benefits, with strict limits on out-of-
pocket costs. It bans all lifetime limits on benefits such as:
hospital care, emergency services, doctor visits, pre-natal care
and home health care for the elderly and disabled. FAMILIES USA
RATING: Important new protection for insured Americans; savings
for families hit by illness.
AMERICANS WITH HIGH PRESCRIPTION DRUG COSTS
About 72 million Americans now lack insurance coverage for
prescription drugs, and skyrocketing drug prices make it more and
more difficult for Americans to afford their medications.
The Clinton Health Reform includes an important new drug
benefit for Americans. No elderly American will ever again have
to pay more than $1,000 a year for drugs, and most will pay far
less. After meeting a $250 annual deductible, Americans of any
age will have to pay no more than 20 percent of their
prescription drug costs. Americans under 65 will have a $1,500
annual limit on what they can be charged, or $3,000 per family.
FAMILIES USA RATING: Important step forward.
- more -
Page 4 of 7
AMERICANS WHO RETIRE EARLY AND LOSE HEALTH BENEFITS
Many companies have cut back or eliminated health coverage
for their early retirees, leaving many Americans without health
protection. Clinton's Health Reform will guarantee health
coverage to early retirees, with the federal government paying 80
percent of premiums for retirees between the ages of 55 and 65.
The former employer or the retiree will pay the remaining 20
percent of the health premium. FAMILIES USA RATING: Protects
retirees while taking pressure off businesses.
AMERICANS WHO ARE "JOB-LOCKED"
One in five workers report they or a family member can't
switch jobs because new work offers limited or no health
insurance. The Clinton Health Reform will absolutely ban
insurance companies from excluding anyone, or any health
condition, from coverage under any circumstances by 1997.
FAMILIES USA RATING: Excellent solution to serious problem.
AMERICANS WHO OWN SMALL BUSINESSES--AND THEIR FAMILIES
Small business owners pay significantly more for health
insurance for their families and workers than large businesses
pay. Their premiums can skyrocket if an employee or a family
member gets sick or injured. Insurance companies often refuse to
cover an individual who works for a small business because of a
health condition, or refuse coverage of a business because of the
nature of the industry.
- more -
Page 5 of 7
The Clinton Health Reform will guarantee that small business
owners can buy insurance at the same--or lower--price as big
business. The Reform will also limit insurance company premium
increases, putting an end to health premium increases of 20
percent, 30 percent and more that small businesses have suffered.
Also, insurers will no longer be able to reject businesses or
individuals for any reason.
In addition, small businesses will be eligible for
significant new discounts. FAMILIES USA RATING: Tough on
insurance companies, helps most small businesses greatly.
AMERICANS NEEDING LONG TERM CARE AT HOME
Almost every American family eventually faces a long term
care crisis, and most Americans want their elderly parents to be
cared for at home, rather than in a nursing home. But, many
American families who need long term care at home receive no
professional home care services, often because they can't afford
help.
The Clinton Reform will provide home care help to Americans
who most need the help. By 1996, Americans who need long term
care will begin to be eligible for services that can keep them at
home; the program is to be fully phased in by the year 2000.
FAMILIES USA RATING: Valuable first step, an important new
benefit for older Americans.
- more -
Page 6 of 7
AMERICANS WHOSE EMPLOYERS CUT BACK ON THEIR HEALTH BENEFITS
About 40 percent of employees and their families are covered
by employer health plans that are self-insured. Self-insured
companies do not purchase health insurance from a private
insurance company, opting instead to pay the cost of their
employees' medical care directly.
Self-insured companies are now allowed to limit or eliminate
health insurance benefits at any time. Some self-insured
employers have limited employees' health coverage after sickness
strikes.
The Clinton Reform will absolutely prohibit all employers
and insurers from imposing caps or exclusions on coverage for
specific medical conditions, and will ban lifetime limits on
benefits. Comprehensive coverage will be required. FAMILIES USA
RATING: Excellent new protection.
BUSINESSES WITH SKYROCKETING PREMIUMS
Health costs are eating away at business profits and
employee wages. Today, business spending for health care nearly
equals after-tax profits, up from 40 percent in 1980.
The Clinton Health Reform will strictly limit the amount
insurance companies can raise premiums. By 1999, premiums will
not be allowed to increase faster than inflation. FAMILIES USA
RATING: Tough on insurance companies, good for families and U.S.
economy.
- more -
Page 7 of 7
AMERICANS ON MEDICAID WHO CAN'T GET HEALTH CARE
Last year, almost one of five adults on Medicaid were turned
away by a hospital or doctor. Another 20 percent had to go to an
emergency room for care because they did not have a regular
physician.
Under the Clinton Health Reform, Medicaid recipients will be
enrolled in the same health plans as other Americans, and get the
same high quality care. FAMILIES USA RATING: Ends the scandal
of Medicaid failure.
Families USA is the health consumer group fighting for
health and long term care reform.
- 30 -
UPDATED 9/21
Subject: Health Care Interest Group Watch
Subject: Health Care Interest Group Watch
Alliance for Managed Competition
American Academy of Family Physicians
American Academy of Pediatrics
American Academy of Physician Assistants
American Association of Physicians and Surgeons
American Association of Retired Persons
American Chiropractic Association
American Council for Health Care Reform
American Dental Association
AFL-CIO
American Federation of State, County, and Municipal Employees
American Health Care Association
American Health Decisions
American Hospital Association
American Medical Association
American Pharmaceutical Association
American Protestant Health Association
American Nurses Association
American Psychiatric Association
American Psychological Association
Association of Health Insurance Agents
Association of Private Pensions and Welfare Plans
Association for Worksite Health Promotion
Bazelon Center for Mental Health Law
Blue Cross and Blue Shield Association
The Building and Construction Trades Department
The Business Roundtable
Campaign for Quality Health Care
Campaign for Women's Health
Also found
Catholic Health Association of the United States
Catholics for a Free Choice
Children's Defense Fund
this. Notsum
Citizen Action
Citizens Against Rationing Health
16 you redit.
Citizens Commission on Human Rights
Citizens for a Sound Economy
Please toss
The Coalition for Consumer Protection and Quality
Coalition for Equal Access to Medicines
it do you
MEVP
The Coalition for Family Privacy
The Coalition for Managed Competition
Coalition for Oral Health
Consortium of Citizens With Disabilities
Consumer's Union
Council of Medical Specialty Society
The Council for Affordable Health Insurance
The Distilled Spirits Council
Families U.S.A.
The Farmers Union
Federation of American Health System
Generic Pharmaceutical Industry Association
Group Health Association of America
Health Care Choice Project
Health Care for All
Health Industry Manufacturers Association
Health Insurance Association of America
Health Care Leadership Council
The Health Project
Independent Insurance Agents of America
Industrial Biotechnology Association
International Brotherhood of Teamsters
Labor Management Discussion Group on Workers' Compensation
Long-Term Care Campaign
Mental Health Liaison Group
Minority Contractors Association
Monmouth County Mental Health Board
National Association for Home Care
National Association for the Support of Long Term Care
National Association of Children's Hospitals & Related Institutions
National Association of Counties
National Association of Manufacturers
National Association of Private Enterprise
National Association of Retail Druggists
National Association of Social Workers
National Business Coalition on Health
National Association of Women Business Owners
National Committee to Preserve Social Security
National Conference of State Legislators
National Congress of American Indians
National Council of Churches of Christ in the U.S.
National Council of La Raza
National Council of Senior Citizens
National Governors Association
National Health Care Coalition
mbb 3/25
National Hospice Organization
National Institute for Health Care Management
National Medical Association
National Medical Liability Reform Coalition
National Retail Federation
National Restaurant Association
National Small Business United
National Urban League
National Wine Coalition
The National Wellness Network
Pharaceutical Partners for Better Health Care
Pharmaceutical Manufacturers Association
Public Citizen's Congress Watch
Religious Coalition for Abortion Rights
Roman Catholic Archbishops
Rx Partners
San Diego Rehabilitation Institute
Service Employees International Union
Small Business Legislative Council
United Auto Workers
United States Cathlic Conference
U.S. Chamber of Commerce
U.S. Conference of Mayors
Universal Health Care Action Network
Washington Business Group on Health
Wellness Councils of America
Worksite Health Promotion Alliance
mbb 3/25
Subject: Health Care Interest Group Watch
Alliance for Managed Competition
Represents: Aetna, CIGNA, MetLife, The Prudential, Travelers. (Collectively provide health
care coverage to more than 60 million Americans.)
Goal: Managed competition.
Concerns: Wage and price controls.
American Academy of Family Physicians
Represents: National association of family doctors with chapters in all 50 states. (More than
74,000 members.)
Strategy: Do not have a PAC. Building a grassroots network. Sophisticated press office. Good
reputation in Congress.
Goal: Universal coverage through employer-based system within a global budget. The Academy
is one of the two large medical specialty organizations to come forward with a reform plan that
endorses a global budget as part of cost containment. Cost containment through the use of a
global budget determined by a national health board. Specific strategies to move toward a
generalist-oriented health care system, including reforming medical school admission criteria and
curriculum, changing Medicare support of graduate medical education, and reforming physician
fee schedules.
Concerns: Worried about mismatch between infrastructure and expanded coverage. Concerned
that will be disproportionately affected under a wage freeze because of current disparities
between generalists and specialists. Concerned that short term cost containment will diminish
immediate investment in primary care training.
Other: The AAFP does not specifically endorse managed competition, but would allow for it
and encourage managed care. Working on ideas for "managed cooperation" in rural areas.
American Academy of Pediatrics
Represents: Pediatricians nationwide whose goal is advocacy for children and youth. (45,000
members.)
Strategy: Not strong lobbying force, but because of "white hat" public reputation opinion
important. Active coalition participant.
Concern: Nervous about global budgets (concerned that, absent guarantees, children's access
will be diminished first).
Goal: In last Congress, endorsed Matsui bill (pay or play for women and kids) that included all-
payer rates for pediatric and obstetric services. Their priority is universal access for children;
any coverage phase-in should begin with children and pregnant women. Benefits package should
be child sensitive, recognizing the particular needs of all children including children with special
health care needs. Must be one-tier system--"Medicaid doesn't work". Should address future
demand for primary care physicians through: flexible loan policies, expansion of the NHSC;
incentives to increase number of minority primary care physicians; and development of pediatric
RBRVS to guarantee adequate reimbursement. Cost-containment proposals must include
emphasis on preventive care and income-adjusted cost-sharing.
mbb 3/25
American Academy of Physician Assistants
Represents: 22,000 practicing physician assistants and 3600 students enrolled in the country's 55
accredited physician assistants programs. Academy chapters located in all 50 states. Members
provide medical treatment for 150 million patient visits per year.
Strategy: Sway in rural settings where Physician Assistants are more often utilized.
Goal: Increased utilization of physicians assistants and other non-physicians. Want health care
reform to provide incentives for increased use of physicians assistants (PAs): recognize PAs and
other non-physicians as authorized providers under new system, encouraging states to enact more
flexible laws and regulations for PAs, transfer Medicare GME dollars from resident training to
support the training of non-physicians, provide appropriate reimbursement for PAs in all settings.
Also support basic benefit package, universal access, cost controls should focus on prevention of
inappropriate cost shifting, elimination of excess bureaucracy, malpractice reform.
Concerns:
Licensure, empowerment, reimbursement issues
American Association of Physicians and Surgeons
Represents: The Association is a national, not-for-profit physician and osteopath membership
corporation. (Represents 35,000 members)
Goal: Preserve private medicine. Medical savings accounts. Proposals include establishing
medical savings accounts, insurance reforms, reducing regulations and mandated benefits, and
development of private alternatives to Medicare. Believe health care cost escalation due to: tax-
subsidized prepaid insurance; regulations; and legal overhead.
Concern: Managing system will lead to rationing.
Other: Group has little influence.
American Association of Retired Persons
Represents: 34 million Americans over age 50. Has chapters in all 50 states.
Strategy: Has financial strength, huge membership base, influential in media and on hill
(although damaged somewhat by their strong backing of catastrophic). Lack of unifying
principles of membership undermines their effectiveness.
Goal: Blended approach of single payer, employer based and tax incentives. Remain open. Four
goals for reform: universal access to affordable quality health care and long-term care, system-
wide cost containment, prescription drugs, and fair and affordable financing. Benefits package
should include preventive, primary, acute, transitional and long term care. Cost containment
through global budget.
Other: Open to Administration plan, as long as comprehensive.
Concerns: Long term care and prescription drugs, seniors bearing financial burden without
added benefits.
American Chiropractic Association
Represents: 22,000 chiropractors and students at the accredited chiropractic colleges. The
Nation's 45,000 chiropractors serve over 19 million patients annually and are licensed as primary
care in fifty states.
Goal: The purpose of the ACA is to seek to advance and protect the patient's access to
chiropractic services and promote the drug-free, non-surgical care doctors of chiropractic provide
a healing art.
mbb 3/25
Strategy: Fairly effective grassroots network. Important in certain states (e.g. Iowa, New
Hampshire)
Goal: Chiropractic services included in the basic core benefits package. Encourage use of
chiropractors as primary care providers, and gatekeepers under managed care plans.
American Council for Health Care Reform
Represents: Drawn from the general public--consumers. A grass roots consumer association to
protect and inform consumers.
Strategy: Grass roots at the Federal level
Goal: The council supports eliminating administrative red tape, changing insurance reform,
reforming malpractice issues, and providing quality of care to all Americans.
American Dental Association
Represents: The American Dental Association (ADA) represents a total of 139,620 dentists,
with 73% of U.S. dentists members of the ADA.
Strategy: Grass roots, active, strong advocacy.
Goal: The primary criteria for the ADA is universal access and inclusion of dental benefits in the
core package. Their financial package is employer based, provides coverage for indigents, small
employer relief through HIPCS and risk reinsurance pools, and co-payments. The ADA is for
the protection of all working people from financial ruin as a result of illness, education services
and access to preventive dental services for children. The ADA believes dental services are not a
cost problem. If there is not a problem, don't change us.
Concern: Inclusion of dental services in the benefits package
AFL-CIO
Represents: 88 unions, 14 million members. Unions representing individuals employed in
manufacturing, the public sector, service and building and construction.
Strategy: Strong effective grassroots network; influential with Congress; large campaign
contributors.
Goal: Support establishment of purchasing cooperatives. Support universal access through
regional purchasing and delivery system with enforceable budget. Community rating for all.
Consumer choice among plans. Quality assurance system including development of practice
guidelines, health outcomes, research and technology assessment. Finance retiree health care by
unified purchasing and delivery system. Medicare eligibility to 60. Finance system through
broad and equitable mechanisms.
Concerns: No employers can opt out of HIPCs; no taxation of employer-provided benefits.
American Federation of State, County, and Municipal Employees
Represents: More than 1.3 million public employees and health care workers throughout the
U.S. Employees of state, county, and municipal governments, school districts, public and private
hospitals, universities and non-profit agencies who work in a cross section of jobs ranging from
blue collar to clerical, professional and paraprofessional. White collar employees account for
one-third of the membership. The largest and most influential AFL-CIO union
Goal: Single payer but are willing to work with us and AFL-CIO. Very concerned that public
sector not be used to create "critical mass" for HIPCs.
mbb 3/25
American Health Care Association
Represents: 51 affiliated associations and 11,000 non-proprietary and proprietary long term care
providers that care for one million nursing facility and long term care residents nationwide.
Primarily proprietary nursing homes.
Strategy: Powerful lobby at federal and state level, particularly in certain states.
Goal: AHCA has developed "Quality Care for Life", a long term care financing reform plan
which includes nursing home care, consumer choice, quality incentives,
and cost containment through public and private resources. Long term care needs also include
respite care, adult day care, home and community-based care.
Concerns: Concerned about their members ability to provide care in the new system. Long term
care in benefit package.
American Health Decisions
Represents: 16 affiliate state citizen organizations organized to solve current health care
issues/concerns through grassroot community meetings and issue groups.
Concerns: To make sure the American public, on a citizens level, is involved in the health
reform process.
American Hospital Association
Represents: (5,300 hospitals) Umbrella organization for hospitals of all sizes and ownership
types nationwide. It is the largest hospital trade association in the country.
Strategy: Individual hospitals are major employers and therefore have substantial influence in
districts.
Goal: Coverage through a core benefit package in a pay-or-play system. Delivery reform
through community care networks similar to managed care. Concerned that managed
competition will drive hospitals to be the lowest price vendor and threaten their mission
orientation. Do not support a global budget but might support a "bottom up" budget through
capitation of payments. Advocate antitrust reforms to permit easier coordination/collaboration
between hospitals.
Concerns: Universal access. Cost controls which shift costs
Other: As of 7/1 have made not commitment to The Health Project and will not unless it is
clearly a bipartisan initiative and with support from all sectors, particularly substantial business
community backing.
American Medical Association
Represents: Approximately 300,000 physician members. Federation of 50 state medical
associations and the District of Columbia, county, metropolitan societies and over 80 national
medical specialty societies
Strategy: Influential with Congress; large campaign contributors; able to generate significant
press coverage; major grassroots network.
Goal: Universal access to care through an employer mandate and Medicaid reform, insurance
market reforms, particularly community rating, and elimination of preexisting condition
restrictions. Want the right for organized medicine to negotiate with federal agencies and
regulatory programs and at the local level with managed competition entities. Want professional
MBB 3/25
liability reform; freedom of patients to choose their physician and system of health care delivery;
quality assurance through practice parameters and outcomes research; administrative cost
reduction; establishment at the federal level of a minimum benefits package (with repeal of state
mandates); and decreased regulation.
Concerns: Cost and Price controls, Restricted physician choice, Loss of professional autonomy
American Pharmaceutical Association
Represents: APhA represents more than 195,000 pharmacy practitioners, scientists, and
pharmacy students. The interests of professional pharmacists in academic settings, in
pharmacies, and in institutional settings such as hospitals and nursing homes.
Strategy: The third of the three most influential pharmacy groups on Capitol Hill -- (the
National Association of Retail Druggists and the National Association of Chain Drug Stores are
the other two).
Goal: Strong supporter that prescription drug coverage be included in the basic health care
package. Similarly supportive of a Medicare Rx drug benefit. Wants Rx drug coverage to pay
for the professional patient counseling done by pharmacists. Believe that such utilization review
services are extremely cost effective.
American Protestant Health Association
Represents: 200 Protestant church-related health care institutions.
Strategy: Community hospitals can be influential in local district.
Goal: Seek fundamental reform of health care system making universal coverage at reasonable
coat a reality. Develop incentives, built upon capitated payments for population groups, to
change corporate and individual behavior. Move from disease treatment to health improvement.
Community based servant leadership is key to universal and affordable coverage.
American Nurses Association
Represents: 2.1 million registered nurses through its 53 constituent state and territorial
associations and its more than 200,000 members.
Strategy: Effective lobbyist on nursing issues, strong grass roots efforts at both the Federal and
state levels, and ability to mobilize quickly, forefront on political and legislative issues.
Goal: The ANA supports health care system that assures access, quality and services at
affordable cost. The financing mechanisms must be employer based with minimal co-payments.
The benefit package must provide prevention, health screening, extended and long term care, and
mental health benefits. Nurses want to be "empowered." Believe they need to be protected in
managed competition system.
American Psychiatric Association
Represents: (38,000 members) National medical specialty society specializing in the diagnosis
and treatment of mental illness (including substance abuse). Comprise over 70 percent of the
nation's psychiatrists.
Strategy: Active PAC. Focused on mental health issues.
Goal: Support nondiscrimination between mental health and other health benefits for patients.
Focused on eliminating what they feel are artificial limits (e.g. 20 visits, etc.) on services.
Guaranteed benefits package must include appropriate mental health benefits (inpatient care,
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outpatient treatment, and partial hospitalization and ambulatory care). Also support coverage of
psychopharmacological treatments under drug benefit. Want to ensure that innovative state
efforts to expand mental health coverage can continue.
Concerns: Concerned about consumer protections, reimbursement of providers, and oppressive
utilization review. Nervous about state and federal efforts to reimburse non-physician mental
health providers.
American Psychological Association
Represents: APA represents more than 74,000 members nationally and around the world;
40,000 students, foreign, and high school teacher affiliates; divisions in nearly 50 areas of
psychology; and affiliations with state and Canadian psychological associations.
Strategy: Grassroots network.
Goals: The priorities of the APA include mental health benefits, universal coverage, cost
containment, rehabilitation services. Quality assurance provisions necessary for persons with
disabilities. Want to be treated as functional equivalents to psychiatrists.
Association for Health Insurance Agents
Represents: (8000 members) Individuals engaged in sales or field management positions for
health insurance.
Goals: To look out for insurance agents - more info is on file.
Executive Director: E.Dawn Lindsey - (202) 331 -2160
Association of Private Pensions and Welfare Plans
Represents: Companies and individuals concerned about federal legislation and regulations
affecting all aspects of private sector employee benefits. APPWP members include employers of
all sizes--principally Fortune 500 major companies--as well as insurance carriers and employee
benefits consulting firms.
Goal: In December, the APPWP adopted a new stance, becoming the first employer organization
to support an employer mandate and a limitation of the employee tax exclusion for employer-
paid health coverage. Employer mandate coupled with tax credits and subsidies for low-income
individuals and employers with large numbers of low-income workers; also individual mandate
to accept or acquire health care coverage. Limitation of employee tax exclusion for employer-
paid health coverage to the cost of the basic benefits package. Integration of managed care
systems in all health care systems, both public and private, to curtail the practice of cost-shifting.
Support health care expenditure targets for all health system payers.
Association for Worksite Health Promotion
Represents: Employers/Employees who provid, manage and participate in Health Promotion
programs.(Tenneco, Coors, Johnson&Johnson, Du Pont, The Travelers) - also see the Worksite
Health Promotion Alliance.
President: Janet Edmunson
Bazelon Center for Mental Health Law
Represents: Various Psychiatric hospitals/professionals.
Concerns: To enclude a comprehensive Mental Health benifits package in the Health Reform.
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Blue Cross and Blue Shield Association
Represents: 71 Independent Blue Cross and Blue Shield Plans. Coordinating organization for
BC/BS Plans throughout the nation. Collectively, the Plans provide health benefits protection
for nearly 70 million people, and serve an additional 34 million people through the Medicare
program where Plans administer 70 percent of all the program's claims.
Strategy: Viewed as moderate voice among insurers; widely consulted.
Goal: Do not believe HIPCs are necessary, just larger pools. Because of their history, they
believe they will be at a competitive disadvantage in a managed competition system and will be
looking for some assurance of risk adjustments and standardized benefits. Support insurance
reform (rating/pre-existing condition bans), increased managed care, and administrative
simplification. Would move the market to community care networks with obligations that the
percentage of people in AHPs increase each year. Would require employers to continually
increase percentage of employees in AHP each year in order to keep their deduction.
The Building and Construction Trades Department
Represents: (5 million members) 15 affiliated international unions in the construction industry.
Goal: Same position as AFL-CIO generally. Believe Taft-Hartley plans should continue to
perform administrative functions.
The Business Roundtable
Represents: (200 Chief Executive Officers) Association of business executives of Fortune 500
companies in all fields
Goal: Pure managed competition. Creation of group purchasing arrangements for small groups
and individuals. Large employer opt-out. Standard benefit package, income-based subsidies for
individuals, limits on tax free portion of health benefits for employees, outcomes research and
medical malpractice reform. Pre-emption of state laws that mandate specific benefits and restrict
managed care.
Other: Scope of influence is significant, but frequently overestimated.
Campaign for Quality Health Care
Coalition: (nationwide) consumer groups and malpractice victims.
Goal: Oppose anti-consumer restrictions on the rights of malpractice victims. Say, "The
problem is not that there are too many malpractice lawsuits. The problem is too much
malpractice." Say, "An alarm bell went off when Hillary Clinton made a promise to the AMA to
'solve your malpractice problems' in return for doctors support for national health care.
Strategy: Organizing consumer, labor, senior citizen and other groups in more than 20 states to
stop the administration from "treating our legal rights like bargaining chips in a high-stakes
political poker game."
Campaign for Women's Health
Represents: 8 million members nationwide representing women's groups, unions, and health
care organizations and including Older Women's League, Planned Parenthood Federation of
America, YMCA of the USA, NARAL, and Black Women's Agenda.
Strategy: Active grass roots, hot issue in Congress, and political clout.
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Goal: Universal access and a comprehensive benefits package that meets the needs of women,
including maintenance and promotion including primary and preventive services and primary
and preventive reproductive health care; long term care--respite, spend down, effective
immediately, home care; health care delivery in a variety of settings; health care delivered by a
variety of providers; community based programs; financing and accountability.
Catholic Health Association of the United States
Represents: (1200 health care facilities) Nation's largest organization representing not-for-
profit, single-sponsor, health care institutions.
Strategy: Community hospitals can be influential in local district.
Goal: Unified and comprehensive health care system. Through "Integrated Delivery Networks,
all persons are provided a comprehensive benefits package. Networks are owned and operated
by a variety of entities including former insurance companies, hospitals, and physicians.
Networks compete for customers on basis of quality and service and receive risk-adjusted
capitated payments from independent "State Health Organization." National Health Board sets
overall budget. Employer-based financing supplemented by public funds.
Catholics for a Free Choice
Concern: Say bishops were attempting to unfairly influence the decision of individual women
on the basis of economics.
Other: Claim most American Catholics support government funding of abortion services. (Cite a
'92 CBS/N.Y. TIMES poll showing that 62% of Catholics support federal funding of abortions
for poor women.)
Children's Defense Fund
Represents: Organization's interested in Children's issues. Fund research for children. (50 states)
Strategy: Respected in media, effective lobbying group on children's issues, strong grass roots
Goal: The priorities of the CDF are as follows. Child health benefits, including mental health
universal access; access to medical care; comprehensive coverage-primary and preventive
services; phase in first, pregnant women and children; affordable premium based of family
income with no cost sharing; continuity of coverage-portable; ensure availability of services,
invest in public health; Medicaid, poor peoples program; transition into a new system takes a
number of years to put in place, put children first.
Concerns: Children benefits, primary and preventive services.
Citizen Action
Represents: 5 million consumers. In 32 states, membership comprised of working class, middle
class, employed in white collar and service industries, activists, cross generation lines and half
are below the age of 45.
Strategy: Some strong state affiliates, broad based canvassing efforts, ability to mobilize,
although not as powerful or influential nationally as numbers might indicate.
Goal: Supports single-payer approach because of its ability to meet principles of affordability,
universality, comprehensiveness, choice and public accountability.
Concerns: Views managed competition as approach which will shift costs to their own families
while limiting their choice of providers. Fear of being forced into a substandard plan. Middle
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class families think they will have fewer choices than low income persons.
Citizens Against Rationing Health
Coalition: Five conservative and GOP groups (American Conservative Union, Citizens for a
Sound Economy, American Legislative Exchange Council, The United Seniors Council, and
Citizens United). Headed by Don Devine, former OPM director under Reagan and currently an
American Conservative Union board member, and former Representative Beau Boulter (R-TX),
Vice President of the United Seniors Association.
Strategy: Will release a detailed health care reform package and launch an intensive lobbying
and grassroots effort, as well as plan a national media advertising campaign. Says they will
generate 15 million pieces of mail from citizens to the White House, buy TV and radio spots,
hold rallies and recruit thousands of citizen lobbyists.
Finances: Will carry a $10 million campaign against Clinton's plan.
Goal: Will try to build support for an alternative: medical savings accounts. Wants to change the
tax code to allow individual deductions of up to $4,800 for health insurance premiums; add new
deductions for the uninsured -- including refundable tax credits for the poor and for those with
pre-existing conditions;" and create medical IRAs. Medicare/Medicaid recipients would have the
option of converting their coverage into a medical savings account or private insurance plan.
Citizens Commission on Human Rights
Represents: Established by the Church of Scientology (69') - contact: June Parks
(Recently) Urged congress to Not push for mandate mental health coverage as part of the
"standard" comprehensive health benefits package - Also pressed to spearhead psychiatric
insurance fraud reform.
Citizens for a Sound Economy
Coalition: 250,000-members who promote market-based solutions to policy problems.
Coalition for Consumer Protection and Quality
Represents: Health care consumer organizations including: American Association of Retired
Persons, California Advocates of Nursing Care Reform, Center For Medicare Advocacy,
Coalition for the Rights of Infirm Elderly, Families USA, the Gerentological Society of America,
Medicare Advocate Project, National Committe to Preseerv Social Security and Medicare,
National Council on the Aging, National Citizens Coalition for Nursing Home Reform, National
Indian Council on Aging, National Seniors Citizens Law Center, Older Women's League.
(See filed pamphlet for list of Endorcing and Colaborating organizations)
Goal: Protecting the quality of American Heealthcare throughout the reform.
Coalition for Equal Access to Medicines
Coalition: NY Times call an "unusual union" of poor people, minority groups and public health
advocates. Organizing members of the coalition include officers from the following groups, all
of which are members: National Rainbow Coalition, American Legislative Exchange Council,
National Depressive and Manic Depressive Association, National Medical Association, National
Black Caucus of State Legislators, Institute for the Puerto Rican/Hispanic Elderly, National
Multiple Sclerosis Society, National Black Nurses Association, People's Medical Society, Lupus
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Foundation of America, California Hispanic-American Medical Association, National Urban
League, Allergy and Asthma Network, National Kidney Cancer Association and the National
Council on the Aging.
Strategy: The coalition will lobby against Medicaid formularies which have already been
approved by both the House and Senate and are likely to be included in the deficit-reduction bill
that emerges from conference committee.
Finances: Created and financed by the prescription drug industry.
Goal: Wants to ensure that Medicaid formularies do not deny access to medicine "crucial" to the
health of their members.
Other: The coalition has "enlisted" black clergy in its campaign. The drug industry fiercely
opposes formularies: They say state officials will select drugs on the basis of cost, not quality
and fear that Medicaid formularies will set a precedent for similar restrictions under any national
health insurance plan that Congress might enact.
The Coalition for Family Privacy
Concern: Claim registries would pose a "major threat to family privacy." Charge that the bill
would impose a federal vaccination mandate that would supplant parents rights to make vaccine
decisions for their children.
The Coalition for Managed Competition
Coalition: Consists of the big five insurers (Prudential, Cigna, Aetna, Metropolitan Life, and
Travelers).
Concern: Say that many traditional indemnity insurers have looked to insure only the healthiest
customers.
Strategy: Massive ad campaign.
Coalition for Oral Health
Goal: Wants basic dental care in the reform plan.
Consortium of Citizens With Disabilities
Represents: Coalition comprised of over 75 consumer, service provider, and professional
organizations which advocate on behalf of persons with disabilities and their families. Over 42
national organizations are members of CCD's Health Task Force including many disease
organizations. The Consortium represents more than 43 million Americans with disabilities
include individuals with physical and mental impairments, conditions, or disorders, severe acute
or chronic illness which limit or impede their ability to function.
Strategy: Significant grassroots potential
Goal: Acute care benefit should be comprehensive and include long-term care services.
Significant concerns regarding the responsiveness of managed care to people with disabilities.
Reform must ensure non-discrimination and fully participation by people with disabilities,
appropriateness of available services (particularly for younger disabled individuals) and equal
access to health services.
Concerns: Non-discrimination of benefits, Special needs of population.
Consumer's Union
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Represents: 5 million members. Membership includes magazine subscribers in all 50 states.
Advocacy offices in Washington D.C., Austin, TX and San Francisco, CA.
Strategy: Readership among middle and upper middle class. Viewed as authority on value for
the dollar. No real grassroots operation or cohesive grassroots constituency.
Goal: To meet needs of consumers, reform plan must provide universal quality health care
regardless of age, income, employment or health status; contain costs with a national budget and
administrative simplification; fair financing; public accountability and maintain consumer
choice.
Concerns: Concerned that managed competition will not work to control costs and could lead to
a multi-tier health system with restricted consumer choice and large out-of-pocket expenses.
Reform plan should allow states sufficient flexibility to experiment with single-payer approach if
they so desire.
Council of Medical Specialty Society
Represents: Jerome H. Shapiro, American Acadamy of Allergie and Immunology, American
Acadamy of Dermatology, American Acad (List of others filed)
Concerns: Thank you. Also sent an article talking about the SOCIAL nature of medicine
relating to health care and Economic reform.
The Council for Affordable Health Insurance
Coalition: A group of 30 small indemnity insurers. Includes: American Chambers Life,
American Republic Insurance Co., Central States Health and Life of Omaha, Design Benefit
Plans, Equitable Life and Casualty, Florida Employers Life, Golden Rule Insurance Co.,
Garentee Trust Life Insurance Co., Inverstors Insurance Corp., Mega Life Insurance Co.,
National Health Insurance Co., National Travelers Life, PFL Life Insurance Co., Transport Life,
United American, Universe Life Insurance Co., Western Fidelity Insurance Co., World Insurance
Co. - (Associate Members: American Travelers, Chubb Life, First National Life, Health Starr,
J.B Johnson Intermediary, Lautzenheiser & Associates, Life of America insurance Co., Mark
Litow - Millman & Robertson, National Foundation Life, W.H. Odell Associates
Position: Paints a bleak picture of the future if most consumers have to buy their insurance
through health alliances. "All other plans flawed"- Their plan is based on market principles -
they don't believe business should be required to pay for insurance - Individual shop for your
self, market competion for doctors services - tax deductions for the middle class - poor get Gov.
vouchers or "pooled" money.
Distilled Spirits Council
Represents: the Nations Distillers" - President: F.A Meister - Contact: Eron Shosteck
Concern: That an increase in excise tax not be encluded in the President's reform package.
Families U.S.A.
Represents: American families--Families USA is a liberal health care consumer group working
for affordable, high-quality health care and long term care.
Strategy: Combines sophisticated grassroots activism with media savvy. Reports well reported
in Media and on Capitol Hill (effectively promotes agenda while maintaining non-partisan,
quasi-academic stance). Active coalition builder.
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Goals: universal coverage; basic benefits comparable to those of most Americans; quality
standards; cost-containment; long term care.
The Farmers Union
Represents: (250,000 farm families) Rural farmers in 26 states, a general purpose national farm
organization.
Strategy: Grass roots at Federal, state and local level, mobilizes quickly, and influential in key
agriculture states
Goals: The Farmers Union supports state flexibility so the states can adopt a single payor
system. Supports universal coverage. They support a plan that meets the needs of rural
America--access, choice and quality. The group recognizes that they share the President's
objectives and will set aside their ideology to support the President so long as their objectives are
not abandoned.
Federation of American Health System
Represents: 1400 Investor owned hospitals and several managed care companies
Strategy: Major campaign contributors. Very effective lobbying organization.
Goals: Managed competition. Proposal would provide universal access to coverage through
income-related subsidies; cap tax-free portion of employers and employees health premiums;
create Accountable Health Plans which cannot exclude based on pre-existing condition and must
community rate; and establish National Health Board to set standard benefits package and
facilitate health outcomes data.
Concerns: Very wary of cost and budget controls.
Generic Pharmaceutical Industry Association
Represents: Composed of the leading U.S. manufacturers of generic prescription drugs, was
established in 1981 to foster knowledge of the safety, efficacy, equivalency and quality of
generic drugs and to promote their increased acceptance and use.
Strategy: Influence at both the national and state levels, but do not come close to matching that
of the name brand manufacturers.
Goals: The Association supports the following principles for health care reform, universal access
and expansion of Medicare to include outpatient drug benefits. To control costs, true
competition should be returned to the pharmaceutical marketplace through the establishment of a
single reimbursement price for multi-source drugs and establishment of a national open
formulary for multi-source products. They argue that they are not contributing to drug price
inflation. The generic industry is already cost-competitive and should not be burdened with
rebates similar to those imposed on the high priced innovator products. Their primary request is
to insure that they be treated differently than the name brand manufacturers. Theoretically, they
should support price controls, because they would not lose as substantially as the commercial
manufacturers, but they have yet to take this position. Reform Medicaid law to eliminate
mandatory rebate provision, which they argue unfairly hits them because they do not have profit
margins.
Group Health Association of America
Represents: 323 member HMOs, enrolling more than 27 million people. Largest trade
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association for organized prepaid
health care systems.
Strategy: Legislative representation at the federal and state level, legal counsel, education
programs, and
research, and wide
distribution of
publications.
Goals: Managed competition. Basic benefits package must be comprehensive, with reasonable
cost sharing. "Managed care" should be defined in statute and should include an HMO
component, selective contracting with providers, quality assurance and utilization review
programs, and financial incentives for enrollees to use the plan's providers and procedures.
Exclusive HIPCs for small employers. Tie tax deductibility of health benefits to lowest priced
plan. Risk adjustment for premiums. Concerned about capacity of plans to absorb large new
populations.
Concerns: Long term care, prescription drug benefit
Health Care Choice Project
Goal: Advocates market-based health care reform.
Health Care for All
Coalition: 87 civil rights, unions and abortion rights supporters.
Goal: Push for inclusion of abortion services as part of the basic benefit package.
Health Industry Manufacturers Association
Represents: 300 Associations. Manufacturers of medical devices, diagnostics, and health care
information systems.
Strategy: Influential. Major industry group employing a significant number of individuals.
Goals: Market-based approach. Believe malpractice/ tort reform should apply to them through
policies restricting product liability. They generally feel wary of budgeting mechanisms and
resource evaluation/planning, fearful that diagnostic services and medical equipment and devices
may be restricted. They were very concerned with Oregon's waiver plan.
Concerns: Budget, caps, technology assessment activities
Health Insurance Association of America
Represents: (270 Members) Trade association for nation's commercial health insurance
companies.
Strategy: Gradison is well respected on the Hill, but has lost the 5 big insurers recently.
Goals: Support general managed competition framework. After regularly opposing any kind of
comprehensive reform, now in a negotiating position. On access, would require employers to
offer, but not pay for, a plan, and offer a payroll deduction so that employees can purchase the
coverage. On cost containment, would require uniform rate setting for providers, but managed
care should be primary vehicle for achieving sustained systemwide cost savings. Insurance
reform, including no pre-existing condition limits. On HIPCs, HIAA likes existing association
type schemes. Believes HIPCs should be tried but should compete against other pooling
arrangements. Want federal preemption of state anti-managed care laws. Support a tax cap.
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Opposed to global budgets. No monopoly power for HIPCs--allow employer opt-out; Extent of
community rating mandated; caps on premiums; allow supplemental insurance. Pushing choice,
not just in doctors and hospitals, but in insurance plans as well.
Concern: Argue that the number of competing health plans would dwindle after the first year or
two of Clinton-style managed competition because no new organizations could afford the costs
of entering the market."
Other: Industry's reform plan would limit government's role to requiring an end to
discrimination in coverage; mandate employers to provide minimum benefits, and subsidize
coverage costs for small employers and the unemployed.
Strategy: Has a month long, $4 million ad campaign underway with TV ads on CNN and print
ads in 10 newspapers. Ads package highlights maintaining the private insurance market and
promoting a wide choice of insurance plans and doctors. Running a half-hour infomercial. The
ad ran 5/16 in New York City, Los Angeles, New Orleans, Indianapolis and Wichita (5/13).
Emphasize support for doctor choice. More than 40,000 people have called their hotline. Use
800 calls to demonstrate grass root support. Spending $1.5M to organize a grassroots campaign
to include nationwide meetings and distribution of a film about health reform.
Health Care Leadership Council
Coalition: Paul Tsongas will be spokesperson. Is a Washington group composed of 50 of the
largest insurance companies, pharmaceutical manufacturers, medical clinics and hospitals.
Goal: Against price controls in the Clinton health plan. Favors managed competition.
Strategy: Tsongas will meet with editorial boards nationwide to make the HLC case. Efforts
include proselytizing among employees, and having industry executives visit local editorial
boards and Rotary Clubs.
Other: Aides say Tsongas will receive a "moderate to large" retainer.
The Health Project
Coalition: Includes more than a dozen organizations, including health associations, advocacy
groups and unions. Senator Rockefeller urged the creation. Members include: AARP,
AFL-CIO, AHA, AAFP, ANA, Families USA, the National Association of Social Workers and
two unions.
Goal: Will coordinate a nationwide campaign to promote the outlines of President Clinton's
health care reform package.
Finances: It has an initial budget of $150,000.
Independent Insurance Agents of America
Represents: 280,00 insurance agents and their employees. Largest national trade association of
independent insurance agents, who are located in virtually every town and city in the country.
Strategy: Large PAC campaign contributions, very influential at the state legislative level.
Visible in local communities.
Goals: Support cost containment measures including administrative simplification, managed
care and utilization review. Tax incentives for self-employed individuals and small businesses to
provide health care coverage. Insurance reform including elimination of risk exclusions, and
guaranteed portability. Reinsurance mechanisms for insurers. Pre-emption of state mandated
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health benefits. Medical malpractice reform.
Industrial Biotechnology Association
Represents: More than 150 companies (small and entrepreneurial firms) that are responsible for
more than 85 percent of the sales, revenues and research and development expenditures in the
biotechnology industry. Three out of four biotech companies have fewer than 50 employees, and
990 out of 100 have fewer than 300 employees. Most firms are less than ten years old.
Strategy: The 1 of 2 associations for the biotech community. Their influence is growing, but
still young. Plans are to merge with the Association for Biotechnology Companies this summer
will add even more. Not much on advocacy, but could rally with the right issue.
Goals: The primary criteria for the IBA is strong drug benefit package (including medication,
prevention, immunization), outpatient drugs, cost containment for overall health care costs, and
HIPCS. IBA says regulating drug prices won't be enough. Any regulation will not only constrict
but may eliminate biotech industry. Under a managed competition system could succeed at
keeping the price of drugs fairly low, except for new drugs or current drugs for which there is no
therapeutic alternatives, and then the IBA would be hurt in this effort. Willing to negotiate plan,
to limit future price increases in exchange for the right to continue to set introductory prices.
Concerns: Price controls on new drugs, expansion of the current medicaid rebate program,
therapeutic substitution, and global budgeting.
International Brotherhood of Teamsters
Represents: 1.4 million workers and 400,000 retired workers. Very diverse union representing
people in private industry and state and local government including trucking, brewery, food
processing, clerical work and health care.
Strategy: Large union with significant political clout, increased since Ron Carey became
President.
Goals: Single payer supporters who have seen major labor-management disputes arise due to
rising health care costs. They are supportive of systemic reform and will likely accept an
employer-mandate construct, but could be concerned about any tax-cap provision that limits their
ability to negotiate for a rich benefits package, or that results in reduced benefits for their
members.
Labor Management Discussion Group on Workers' Compensation
Coalition: The group is co-chaired by James Ellenberger of the AFL-CIO and Alan Strohmaier
of General Motors who represents the National Association of Manufacturers.
Represents: includes representatives of business, labor, the insurance industry and the medical
profession.
Long-Term Care Campaign
Represents: 138 national organizations representing 60 million people. Large coalition
representing a diverse range of interests including religious denominations, business, labor
unions, racial and ethnic groups, youth, people with disabilities, elderly, veterans, nurses and
consumer groups.
Strategy: Huge grass roots network. Ability to pull large crowds. Media savvy.
Goals: Non-ideological on approach as long as long-term care is included as benefit. Dedicated
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to enacting comprehensive long-term care benefit which provides full range of services but
particularly home and community-based care. Eligibility based on determination of disability
rather than age or ability to pay.
Mental Health Liaison Group
Represents: Coalition of more than 33 national organizations across the United States that share
concern for mental health issues including National Mental Health Association, National
Alliance for the Mentally III, American Psychiatric Association. Grassroots, Consumers, Family
Advocacy, and Providers Organizations in 50 states.
Strategy: Coordinated message provides relative influence.
Goals: The Mental Health Liaison Group seeks to promote a plan that supports mental health
services, including both acute and rehabilitative services, in a system which provides access for
all Americans.
Concerns: Discrimination in benefit package against mental illness
Minority Contractors Association
Represents: Construction builders with small contracting businesses across the United States.
Strategy: Much influence in black community.
Goals: Play or pay. Contain a high percentage of very small and financially vulnerable
businesses. Organization opposes employer mandates and feel that those businesses who do not
pay for insurance don't pay for it because they can't afford it. Stand to benefit from insurance
reforms such as community rating, insurance pools, as well as cost controls. Employer mandates
especially if imposed without subsidies for at risk enterprises.
Monmouth County Mental Health Board
Represents: New Jersey Mental Health groups
Concerns: The possible elimination psychiatric rehabilitation from the health benifits package.
National Association for Home Care
Represents: The purpose of NAHC is committed to assuring the availability of humane, cost-
effective, high-quality home care services to all individuals who require them.
Goals: Supportive of change in system, advocate of a national plan. Home care is the best way
to reduce costs and increase health care. Home care and hospice services in both acute and long-
term care settings. Acute care basic benefit package--home care and hospice services. Access
based on need and not age. Provider participation. Safeguards for quality assurance and cost
containment. Financing must be progressive and broadly based. Benefits.
National Association for the Support of Long Term Care
Coalition: a broad based coalition of providers and suppliers of products and services to
Medicare beneficiaries who reside in nursing facilities or are homebound.
Goals: Oppose efforts to reduce the Medicare reimbursement for clinical laboratory services.
National Association of Children's Hospitals & Related Institutions
Represents: 131 member hospitals. Represents free-standing, acute care children's hospitals,
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pediatric departments of major medical centers, and specialty children's hospitals devoted to
rehabilitative and chronic care for children. Children's hospitals represent 1% of the nation's
hospitals, and care for more than 12% of all hospitalized children and 24% of hospitalized
children with chronic and congenital conditions.
Strategy: Influential in children's health community
Goals: Managed competition. A national health care plan needs to meet the needs of children
through the following principles. Health care reform is accountable for children's health care
needs. Employer-financed health care insurance. Minimum benefits package for children.
Availability of pediatric trained care. Cost containment. Recognition of the special funding
requirements for providers who serve a disproportionate share of low- income children.
Administrative simplification.
Concerns: Benefit plan and cost containment strategy without tailoring to children's special
needs.
National Association of Counties
Represents: Over two-thirds of the 3044 county governments in the United States belong to
NACo, ranging in size from Los Angeles County (pop. 8 million) to Loving County, Texas (pop.
100). The county governments themselves are the actual members, and county membership
allows its elected and appointed officials to participate in NACo. 13,000 elected county officials;
2 million county employees
Strategy: NACo is the only national representative of counties in the U.S. and its member
counties will be critical to the implementation and success of a health care reform package.
Goals: NACo supports the general managed competition framework of managed care systems,
with an emphasis on preventive and primary care; federal government should work with states
and counties to develop purchasing cooperatives; federal government should develop rates and
benefit package that includes coverage for mental health, substance abuse and long term care;
financing should come from a national tax; federal government should reduce administration.
costs through simplification. NACo opposes capping federal health care entitlement programs.
National Association of Manufacturers
Represents: More than 12,000 member companies and subsidiaries. Industries of all sizes
located in every state. Many mature industries with older workers. NAM member companies
employ 85 percent of all workers in manufacturing and produce more than 80 percent of the
nation's manufactured goods.
Strategy: Influential with both Congress and the media.
Goals: Managed competition. Conducted survey of members in 1992 which found that NAM
members are more receptive to reform approaches they previously opposed, provided these
approaches are part of a comprehensive health care reform package. Reform must include:
universal coverage, medical liability tort reform, administrative and quality initiatives,
mechanisms to measure and disseminate health care outcomes, cost containment measures to
address corporate cost increases and cost-shifting, integration of Medicare, maintain self-
insurance option, and broad-based financing mechanisms.
Concerns: Concerned about further tax on top of energy tax in economic package.
National Association of Private Enterprise
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Represents: NAPE has over 50,000 members nationwide. NAPE's members are primarily
unincorporated mom-and-pop businesses with fewer than 10 employees.
Strategy: NAPE has attempted to take a more low key approach to legislative issues, than its
larger rivals like the NFIB. It has recently raised its profile in Washington and around the
country by holding "speak out" town meetings with local and congressional politicians on
various small business issues. NAPE has avoided taking any public position on health reform
until they know more details.
Goals: NAPE supports strong cost containment measures, including global budgeting and
malpractice reform. They support the 100 percent deduction and any additional tax incentives
for small businesses. Generally, they do not support mandates, but they are taking a wait and see
attitude to see what financial support might be provided. NAPE would like to continue to
provide health insurance benefits for its membership. Since most of their members have
insurance coverage, they are concerned that market reform might actually raise the cost of health
insurance coverage for its members.
Concerns: NAPE's hot buttons are cost containment and maintaining their ability to provide
health insurance to its members.
National Association of Retail Druggists
Represents: 40,000 independent retail pharmacies, including more than 60,000 pharmacies and
employing more than 112,000 community pharmacists who dispense over two billion
prescriptions annually. Represent the economic interests of drug store owners (either individual
owners or corporate).
Strategy: Strong grassroots, generally effective lobbying.
Goals: Concepts fundamental to any reform of health care. Pharmacy Services and prescription
drugs must be cost-effective methods of providing quality health care and serves as a cost
containment tool for reducing overall health care expenditures; outpatient pharmacy services
benefit; streamline administration in third-party prescription drug programs; free access and
choice in pharmacy services; eliminate pharmaceutical manufacturers' discriminatory pricing
practices; pharmaceutical products included in core benefit package; cost containment; pharmacy
services benefits; health education benefits
Concerns: Discriminatory pricing, Drug manufacturers practices.
National Association of Social Workers
Represents: 145,000 professional social workers. 55 chapters in the U.S. 80,000 clinical social
workers provide over half of the mental health counseling in the U.S.
Strategy: Strong grassroots, mobilize quickly, protect consumers, in all states.
Goals: Strong single payer to middle range (anything else will lead to two tier system and poor
people will lose out). Provide flexibility to states. Health care financed through dedicated
federal tax on personal income and an employer-paid payroll tax. Single comprehensive set of
health care benefits. Mental health benefits must be included in plan.
Concerns: Comprehensive parity for mental health benefits with physical health issues. Don't
believe co-pay should be different for mental health.
National Association of Women Business Owners
Represents: NAWBO is the only national organization representing the interests of all women
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entrepreneurs in all types of businesses. NAWBO's first chapters were formed in 1978; today the
organization has 50 chapters and is affiliated with the World Association of Women Business
Owners in 23 countries.
National Business Coalition on Health
Represents: A set of "non-profit" Cooporatives owned and operated by businesses from around
the country.
Position: Most likely against the Presidents plan. Sean Sullivan the organizations Pres. has gone
out of his way to bash the administration on health care. - BELIEVE IN PURE MANAGED
COMPETITION with minimal 3rd party intervention.
President: Sean Sullivan 202-775-1569
National Committee to Preserve Social Security
Represents: Six million members and supporters. Grassroots senior citizens' advocacy and
education association. It is the nation's second-largest senior lobbying group and is dedicated to
protecting the entitlements which older Americans rely on.
Strategy: Working to overcome poor image created by tactics used to encourage membership
and financial contributions by vulnerable seniors. While not particularly respected on the Hill,
they are feared for their PR apparatus and their ability to generate tremendous volumes of mail.
Goals: Flexible. The National Committee supports the goals of the health care reform to cover
all Americans for acute and long-term care. Their main priorities are the inclusion of long-term
care and prescription drugs in the benefits package. Other issues of interest include coordination
with Medicare, cost containment, broad based financing, maintaining quality care and preventive
services.
Concerns: Being asked to help finance health reform without expanding their benefits.
National Conference of State Legislators
Represents: Legislatures of 50 states, territories & possessions. 7400 individual state legislators
and staff.
Strategy: NCSL has a well organized bipartisan membership; it is very influential in state
legislation and reform policy; its lobbying arm represents interests of state legislatures before
Congress and Administration.
Goals: Managed competition/HIPC model. Supports universal coverage; encouragement of
purchasing cooperatives; establishment of minimum benefit package with emphasis on
preventive and primary care; national health care budget; state regulation of allocation of
technology; administrative simplification; malpractice reform
Other: Very supportive of plan with two exceptions:
(1) NCSL stopped short of endorsing "managed care" because of concerns by rural
legislators and inner city legislators about the possibility (impossibility?) of managed care
working in undeserved areas; and
(2) NCSL feels that the federal government should develop an expedited waiver process
by which states can receive waivers (for 3 - 4 years) of requirements under Medicaid,
Medicare, ERISA and other federal laws to implement state enacted programs that
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expand access to health care.
National Congress of American Indians
Represents: 144 member American Indian tribes and Alaska Native governments. Nation's
largest and oldest national inter-tribal organization representing tribes in 33 states.
Goals: Improve access to health care for Native Americans (over 50% not serviced by the three
Indian health care service systems) while maintaining consumer choice. Possible limitations of
managed care to service very poor and rural areas necessitates the coordination between Indian
Health Service and local health networks. Subsidies for small employers. Improve availability
of primary care providers. Benefits should include long-term care and health promotion and
disease prevention.
Concerns: Preserving tribal government/local community health care provision options included
in 638 programs (want less IHS domination) (culturally sensitive and relevant health
care).
National Council of Churches of Christ in the U.S.
Represents: 45 million Christians in the US. 32 member church bodies, including Protestant,
Orthodox and Anglican churches. Of the 141,000 congregations across the country, the
membership includes 6 historic black churches, Quaker meeting houses, Korean-Americans, and
Orthodox churches. Member of the Interreligious Health Care Access Campaign.
Strategy: Found in practically every community, strong grassroots network, they link in the
nation's ecumenical network--working relationships with Roman Catholic Church, Evangelical,
Pentecostal communities, Jewish and Muslim groups, foundations and other nonprofit groups.
Goals: Single payer, shifted positions to look at a variety of approaches. Criteria for support on
any health care program includes universal access and a comprehensive package of benefits.
Publicly-financed through income and corporate taxes; quality of care; comprehensive benefits
package including preventive care, health promotion, education; primary and acute care;
extended care and rehabilitative services at home and in institutions; mental health; cost savings;
simple financing; patient choice; state flexibility.
National Council of La Raza
Represents: Umbrella organization for 150 affiliated Hispanic Community-based organizations.
Largest constituency-based national Hispanic organization which improves life opportunities for
Hispanic Americans through applied research, policy analysis and advocacy, capacity building
assistance for community organizations, public information and special projects. Their programs
reach over 2 million Hispanics annually.
Strategy: Strongest in CA, AZ, TX, IL, respected on data collected
Goals: Favored single payer. Health care reform must address demographic and socioeconomic
conditions of Hispanic Americans. Should reduce structural elements and policies that create
barriers to access to both the private and public insurance systems for Hispanic Americans.
Universal access is key but special outreach efforts are necessary to ensure real access for this
population which often shies away from contact with official offices.
Concerns: One size fits all plan insensitive cultural and socioeconomic differences. Concerned
about lack of research into Hispanic health issues.
National Council of Senior Citizens
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Represents: Over 5 million Older Americans. 5,000 affiliated clubs and State Councils
nationwide. Mostly retired union members.
Strategy: Very organized grass roots organization, influence and ability to mobilize quickly.
Goals: Single payer, but flexible. The NCSC supports the following items for health care
reform; prescription drug benefit; long term care benefit; retiree benefit; cost sharing; quality
assurance; cost containment; health planning; patients rights; program Administration; payment
mechanism; no opt out of HIPCS; system leading to 2 Tier system.
National Governors Association
Represents: Governors of the 50 states, American Samoa, Guam, Northern Mariana Islands,
Puerto Rico and the Virgin Islands.
Strategy: NGA represents the Nation's Governors collectively and in a bipartisan manner before
Congress and the Administration.
Goals: managed competition/HIPC model. NGA supports state-organized purchasing
cooperatives; core benefits package; federal minimum tort reform standards; limitations on tax-
deductibility of health insurance; single claim form/electronic billing; established goals for
growth of national health care expenditures; annual report to the states by the federal
government.
National Health Care Coalition
Coalition: A San Fernando Valley-based group of senior citizens comprised of 800-900 people.
The coalition was developed two years ago.
Goal: Supports a single-payer system.
Other: Expect a single-payer system would cost more money, but it's a price group is willing to
pay to see that everyone in the country can get health care.
National Hospice Organization
Represents: 1400 provider members, 2,000 professional members with the mission to advocate
for the needs of the terminally ill and promote the philosophy of hospice care.
Goals: Home care benefits. Benefits package. Incentives for provider networks to contract with
existing community-based health care providers.
National Institute for Health Care Management
Represents: The CEO'S of nine major health insurers: (Leonard Schaeffer Chairman of NIHCM
and CEO of Blue Cross Ca. -other companies include Arkansas Blue Cross and Blue Shield, The
Associated Group, Community Mutual Insurance...)
Goal: To conduct research into health care management issues. They contracted the services of
Louis Harris and Associates to survay Health Care Policymakers, and find out exactly "how
informed policymakers are" on key issues central to the health care reform proposals.
- MORE INFO AVAILIBLE
National Medical Association
Represents: More than 16,000 physicians. Physicians in all 50 states, Puerto Rico and Virgin
Islands, most of whom are minority and of those most are African American.
Strategy: May be influential with Congressional Black Congress.
Goals: Single payer but flexible. Universal access, including subsidization of coverage for the
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low-income. Comprehensive package with emphasis on prevention; freedom of choice between
provider and patient; government assurance of quality medical care with representative minority
participation; and compliance with Title VI of Civil Rights Act. Address shortage of minority
physicians. Build incentives for minorities to enter medical profession.
National Medical Liability Reform Coalition
Coalition: 60 Organizations (includes AMA)
Other: Met with the malpractice subgroup of the task force.
National Retail Federation
Represents: 1.3 million retail establishments. The nation's largest trade group encompassing the
entire spectrum of retailing including department, chain, discount, specialty at independent stores
and associations. Their membership employs nearly 20 million people and had registered sales
in excess of $1.8 trillion in 1990. The large retailers (Sears, Penny's) drive the organization.
Goals: Support managed competition. Oppose:
1) mandated coverage of part-time and
seasonal employees; 2) restricted employee freedom to select where they purchase health care
coverage (i.e. through employer, spouse's employer, or private insurance); 3) required stated
percentage contribution from employers (prefer to allow the free market to set employer
contribution levels.
National Restaurant Association
Represents: 710,000 foodservice operations. Nine million foodservice employees with a large
number of entry-level and part-time employees. Founding member of the Health Care Equity
Action League (HEAL), designed to find market-based solution to healthcare crisis.
Strategy: Large organization. Influential and conservative.
Goals: Managed competition. HIPCs no larger than necessary to spread risk equitably.
Continuation of self-insurance for large employers. Insurance reforms including community
rating with risk adjustment factors, elimination of pre-existing condition clauses once coverage
initially established. Standard benefit package. Limits on employees tax exclusion for health
benefits. Federal clearinghouse on technology assessments. No global budgets. No employer
mandates - very concerned about part-time workers.
Concerns: Employer mandate, particularly coverage of part-time employers
National Small Business United
Represents: 65,000 small business owners. NSBU represents small business owners in many
service and industrial sectors. NSBU places a major emphasis on small business advocacy,
taking a bi-partisan approach to working with Congress and other elected officials.
Strategy: Limited influence on Congress. Good with media.
Goals: Individual mandates; individual responsibility as the cornerstone of any health care
reform effort. In the past, they have been the more liberal, progressive group (more open to
discussing employer mandates as long as cost containment and individual responsibility are
addressed). Within the last year, however, they have become more adamantly opposed to an
employer mandate. NSBU's membership includes several models for small employer purchasing
cooperatives. They support the right for small business to organize their own HIPCs and to
manage their own health care activities. Streamlining of delivery system necessary, not just
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refinancing and containing costs. Contain costs with emphasis on universal coverage and
through provider/payor interactions at community level not federally imposed restrictions.
Including workers' compensation with health care reform could be valuable to small business
owners and employees, but there are concerns about how it will be implemented. Oppose payroll
taxes financing prefer broad-based taxes, including consumption. They have expressed support
for an increased income tax to help finance coverage.
National Urban League
Represents: Constituent organization with 113 affiliates. Grassroots affiliates in urban areas as
a civil rights and advocacy basis mainly focused on African-Americans.
Strategy: Solid, credible organization annually produces report on the State of Black America.
Goals: The Urban League supports the goals of health care reform to provide universal coverage.
Their priorities are ensuring that the most vulnerable, minorities and the poor,are not further
disadvantaged by a new system.
Concerns: Medicaid benefits tax, which has disproportionate impact on poor; increasing age for
Medicare eligibility, which causes African-American (who die younger) to contribute to a system
they are less likely to collect from; and new system which may hurt health care providers who
are from and care about their community or will put health care workers, who are not culturally
sensitive into communities.
The National Wellness Network
Represents: Companies such as:Aveda, Patagonia, Esprit, Reekok, the Timberland Company
Committed to transforming health priorities of the country from treatment to prevention in
the workplace - Associated with the Worksite Health Promotion Alliance.
National Wine Coalition
Represents: the Wine industry
Concerns: "Sin Tax"
Pharmaceutical Manufacturers Association
Represents: More than 100 firms that produce drugs in the U.S., including Mercke, Searle,
Bristol-Myers Squibb, Pfizer, Inc. Is a nonprofit scientific and professional organization.
Strategy: Ability to mobilize quickly, powerful lobbyist, advocates for the drug manufacturing
industry, effective grass roots, significant financial resources and substantial clout in Congress.
Goals: Noncommittal, but anti- government involvement. The PMA Board supports a managed
competition approach to comprehensive healthcare reform including the following: inclusion of
prescription drugs; prescription drug benefit to Medicare beneficiaries; Medicare prescription
drug coverage to at least 100% of poverty level. In principle, managed competition is bad for
them because of the formulas, but they could get drug benefits. The industry has come around
towards our plan. Supports global budgeting, fee for service option, and antitrust relief. Opposes
everything in cost control package both in the short and long term. Wants voluntary price
controls.
Pharmaceutical Partners for Better Healthcare
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Represents: 40 nation and internationally based research based pharmaceutical companies
companies include: Merck, SmithKline Beechham, Allergan, American Home Products, Johnson
and Johnson, Lilly, Marion Merrell Dow, Pfizer, Proctor and Gamble, Schering-Plough, Searle,
Stearling Winthrop, Syntex, Warner-Lambert, UpJohn
Goal: Are striving for a health care reform separate from the President's proposal. Their main
points are 1) competative insurance markets - 2) Individuals pay a two part premium, one based
on income and the other RISK based. - 3) Self inforced universal coverage
Contact: Henry Wendt, chairman - 215 - 751 - 4211
Public Citizen's Congress Watch
Goal: Back the California standard.
Other: The '75 California law caps pain and suffering awards at $250,000, imposes a two-year
statute of limitation for bringing a suit, prohibits "lump-sum" payments for damages over
$100,000 and sets a sliding scale for atty. fees.
Religious Coalition for Abortion Rights
Goal: Support government funding of abortions.
Roman Catholic Archbishops
Other: The bishops are torn between mounting a blanket opposition to such a proposal,
bargaining for a version that at least minimizes their moral concerns or withdrawing from the
public debate. Concerned with whether or not catholic hospitals (approximately 10 percent of all
hospitals) would be forced to offer abortions.
Rx Partners
Coalition: drug companies (organized by G.D. Searle & Co., includes Searle and Upjohn Co.,
Bristol-Myers Squibb Co., Hoffman-La Roche Inc., Eli Lilly and Co., Warner-Labert Co., and
Glaxo Holdings PLC).
Strategy: Hired Washington, DC, public relations firm Powell Tate. The group will reportedly
launch a grass-roots campaign through editorial page articles, direct approaches to select
journalists, and efforts to get drug company executives on non-traditional forums such as talk
radio and television shows. Concern: "Drugs provide relief, not just profit." Argue drug prices
"are quite reasonable," noting: while the cost of a coronary bypass operation averages $40,000,
drug therapy treatment for the same problem costs $1,000; only 3 out of 10 new drugs pay for
their R&D costs; and average drug spending is $210/American compared with $225/person in
other industrialized countries.
Other: Some of the industry's most prestigious and powerful members such as Merck, Pfizer,
American Home Products and Johnson & Johnson have declined to join the group, partly
reflecting conflicts among drug makers over initiatives put forth by the Clinton administration.
In the past, the industry has relied on PMA to argue its case to government officials and the
press. However, many of the PMA's members have been upset of late that the PMA has been
unable to keep the industry image from being tarnished. PMA downplayed the coalition's
independent campaign.
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San Diego Rehabilitation Institute
Represents: Local doctors/health care organizations
Message: Thank you for speaking, accept gift?
Service Employees International Union
Represents: More than one million members in U.S., Canada, and Puerto Rico. Public
employees make up one-half of membership. With more than 400,000 members working in
hospitals, nursing homes, and HMOs, largest union of health care workers.
Strategy: Large, fairly influential. Largest union is in California.
Goals: Same as AFL-CIO (Support universal access through regional purchasing and delivery
system with enforceable budget. Community rating for all. Consumer choice among plans.
Quality assurance system including development of practice guidelines, health outcomes
research and technology assessment)
Small Business Legislative Council
Represents: Coalition of 100 small business trade associations. Council organizations represent
at least 1.6 million small businesses in diverse economic sectors (manufacturing, retailing,
distributing, professional and technical services, construction, transportation and agriculture).
Strategy: Newsletter widely distributed. Well liked by key congressional members.
Goals: Their health care reform proposal does not include an employer mandate, but have
signaled their willingness to discuss if the cost issue is adequately addressed and small
businesses are not unduly burdened. They developed a reform proposal about two years ago.
Establishment of global spending goals and rate structures that reflect local circumstances.
Recently released statement supportive of price controls. Encourage creation of voluntary small
business "buying groups." Limits on employee tax exclusion for employer-paid health coverage.
Reform of small group case market should recognize importance of association insurance plans
(including MEWA's) as a means of providing coverage and relevance of workers compensation
as a large component of the health care debate.
Concerns: Cost control, employer mandate.
United Auto Workers
Represents: 1.4 million. Active and retired workers throughout the U.S. Automobile, Aerospace
& Agricultural implement and parts industry.
Strategy: One of the largest and most powerful unions. Particularly influential in industrial
midwest.
Goals: Single payer union, but willing to work with us. Very concerned about retirees health
care coverage.
U.S. Chamber of Commerce
Represents: 215,000 businesses and organizations. The U.S. Chamber of Commerce is the
largest organization of businesses. Over 90 percent of Chamber members have less than 100
employees.
Strategy: Strong Grassroots network, influential with Congress
Goals: Managed Competition. The Chamber's "Guidelines for Health Care Reform" support:
employer "contributions" only if there is an appropriate subsidy for low-wage workers and their
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employers; comprehensive managed competition strategies, covering both private and public
programs; national core benefits package, stressing individual cost sharing; regional purchasing
groups for small businesses and individuals, with flexibility to allow business coalitions to serve
this function and insurance market reform; and cost containment to limit cost increases to the
growth of GNP. Limit tax deductibility of premiums for employees (but not for employers).
HIPC participation limited to firms of no more than 100 employees. Mandate without subsidy;
Undercutting self-insurance option; Destructive regulation of premiums; Scale, timing, and tax--
look at in context of whole economic package.
United States Cathic Conference
Represents: Nations Roman Catholic bishops
Request: To enclude Drug and Alcohol treatments in the Health Reform.
U.S. Conference of Mayors
Represents: Mayors of cities with a population of 30,000 or more. There are over 1,000 of such
cities in the country.
Strategy: USCM is a nonpartisan organization that calls national attention to the problems and
potentials of urban America. USCM represents the nation's cities before Congress and
the Administration.
Goals: USCM supports designing a basic benefits package that includes preventive services;
developing an information base that will allow consumers to choose among plans; reforming the
tort system for malpractice suits; developing standardized claims forms and electronic billing
systems; and the training and placement of culturally competent health professionals in areas of
local need. Health services now rendered at local health departments must continue with a new
system.
Universal Health Care Action Network
Goal: Will advance the single-payer cause once the Clinton plan is introduced.
Washington Business Group on Health
Represents: 180 Fortune 500 members
Strategy: Influential on health policy matters in Congress. Well known to trade press as well as
Washington-based media.
Goals: Managed competition. Very comprehensive benefit package. Allow HIPC opt out for
the self-insured. Believe managed care and managed competition have great potential to manage
costs. Unlike many business groups, very supportive of mental health benefits (President Mary
Jane England, not surprisingly, is a psychiatrist). Considered one of more progressive large
business groups.
Wellness Councils of America
President:Harold Kahler
Goals: An association dedicated to promoting healthy lifestyles for all Americans especially
those on worksite health promotion. - Also associated with the Worksite Health Promotion
Alliance.
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Worksite Health Promotion Alliance
Alliance Coordinator:R. William Witmer
Represents: Washington Business Group on Health (Rep.by- Mary Jane England), Wellness
Councils of America(Rep.by-Harold Kahler), Association For Worksite Health
Promotion(Rep.by-Janet Edmunson), The National Wellness Network(Rep.by Jeremy Rifkin).
Goals: To ensure company provided health promotion programs remain in existance by striving
to retain "corporate incentives" in Health Care Reform- Believes in "experience-rated" insurance.
MORE INFO IS AVAILIBLE
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