Elbows out in health fight

The battle over healthcare entered a new, more frenzied stage Wednesday, as lawmakers and powerful interest groups jockeyed for advantage now that most believe some form of an overhaul will ultimately be signed into law.

The Senate Finance Committee’s passage Tuesday of a sweeping healthcare bill -- with the support of all of its Democratic members, plus Republican Olympia J. Snowe of Maine -- offered powerful evidence that a moderate legislative blueprint can command a majority in the Senate with at least token GOP support. Passage of a major bill by the House also is considered increasingly likely.

But that success has spawned a furious scramble among insurers, labor unions and others to protect their interests in the weeks before the House and Senate begin voting on their final healthcare bills. The maneuvering increasingly has turned into a zero-sum game among groups that for much of the year had appeared to work together to advance the healthcare overhaul. Now, any financial gain by one group will likely correspond with losses by the others.


The Senate Finance Committee bill established a 10-year price tag of $829 billion, a figure considered unlikely to grow substantially in whatever bill ends up going to President Obama for his signature.

“This is now roller derby. It’s very fast, lots of elbows, and people are playing for keeps,” said Nancy LeaMond, an executive vice president of AARP, the seniors group that has been deeply involved in pushing for health legislation.

“Every group now [is thinking about] what must be in there at the end of the day. It’s a crowded field,” LeaMond said.

The Senate committee vote was a triumph for Obama and the Democrats. But on Wednesday, a coalition of 27 labor unions signaled the beginning of a more bruising, unpredictable phase of the healthcare battle when it took out a full page-advertisement in Washington newspapers that demanded the removal of a proposed tax on “Cadillac,” or high-end, insurance plans.

The tax, which is a cornerstone of the Senate finance panel’s bill, is bitterly opposed by the unions. Over the years, they have negotiated more generous health plans for their members in lieu of higher wages.

“Our union and other unions worked like hell to elect Democrats to the House, Senate and White House,” said American Federation of State, County and Municipal Employees President Gerald W. McEntee, explaining why the labor groups defied a request from White House Chief of Staff Rahm Emanuel not to run the ad.

At the same time, the insurance industry is intensifying its campaign to head off proposed taxes on its members and proposed cuts to the federal Medicare Advantage program -- two of the other main sources of proposed funding for a health overhaul.

America’s Health Insurance Plans, the industry’s Washington-based lobbying arm, has started running television ads in six states targeting senior citizens, millions of whom rely on the extra benefits provided at taxpayer expense by commercial insurers that offer Medicare Advantage.

Those ads come on top of a series of U.S. Chamber of Commerce commercials that criticize proposed new fees and taxes on the healthcare industry that lawmakers have said are necessary to offset the cost of an overhaul.

The Pharmaceutical Care Management Assn. -- a group whose members administer prescription plans for more than 200 million people -- also joined the fray. The group is targeting drug makers that earlier this year pledged to provide $80 billion in savings to the federal government over the next 10 years.

Critics say that is far less than the pharmaceutical manufacturers should contribute, given how much they stand to gain.

The drug industry’s lobbying arm, the Pharmaceutical Research and Manufacturers of America, quickly struck back Wednesday, charging that its critics “put their narrow interests before the common goal of ensuring that all Americans have access to affordable, high-quality healthcare coverage and services.”

“People are very nervous,” said Chris Jennings, a healthcare consultant who worked on the Clinton administration’s healthcare campaign in the early 1990s.

“They understand that [an overhaul] is almost inevitable, so this is their last chance to get on the train. . . . If they are not proactive now about what they want, they will lose their opportunity.”

That dynamic could strengthen the hands of the White House and senior Democrats as they work to complete legislation to bring to the floors of the House and Senate later this month, said Ralph Neas, chief executive of the National Coalition on Health Care, an amalgam of union, health and medical groups.

“Congressional leaders have much more leverage today than they did before the finance committee’s vote. There is more maneuvering room,” Neas said.

Many believe the insurance industry’s recent attack on the healthcare overhaul has weakened its bargaining position by antagonizing Democratic leaders, who now are pushing to revoke the insurers’ longtime exemption from antitrust law.

On Wednesday, Obama moved to capitalize on the legislative momentum, publicly dispatching a group of senior deputies to Capitol Hill to meet with lawmakers after months in which the White House played down such contacts.

“There is a sense of . . . historic opportunity here, that we can’t miss this opportunity,” said Illinois Sen. Richard J. Durbin, the No. 2 Democrat in the Senate. “We have to find a way to come up with an agreement that brings in 60 votes. I think people are more positive [about] that outcome than I’ve heard before.”

But the jockeying also is creating a less stable political environment.

Many lawmakers are stepping up their demands for changes in the healthcare legislation and questioning agreements with drug companies, hospitals and other industries that have helped sustain the overhaul campaign all year.

“Everybody makes deals all the time. Deals are not made to be broken, but deals are broken,” said Sen. John D. Rockefeller IV (D-W.Va.), a leading advocate of a healthcare overhaul. “Nobody gets a safe haven.”


Janet Hook and Peter Nicholas in The Times’ Washington bureau contributed to this report.