WASHINGTON — As President Barack Obama tries to regain control over the health care debate, one challenge is holding together the massive roster of organizations that support an overhaul of the system, or at least some parts of it.
While the half-dozen or so major groups that actively oppose Obama's efforts share common themes of free-market, anti-tax advocacy, the hundreds of groups that put their money and names behind the overhaul effort are harder to label. Some have been at odds in the past and could turn on one another as congressional negotiators try to hammer out legislation this autumn.
These diverse supporters agree that the federal government should help pay for more Americans to get health coverage and help contain health care costs.
However, they don't agree on whether the federal government should offer a public alternative to private insurance, whether nonprofit regional cooperatives might work better, or what concessions Obama should give doctors, drug makers or insurers in exchange for their support.
Many also have direct financial interests in the outcome.
Supporters include groups with names such as PhRMA, AHIP, SEIU, AMA and AARP. Others are Health Care for America NOW, Americans for Stable Quality Care, Divided We Fail, Better Health Care Together and Partnership for Quality Care.
Here's a look at who's behind them and what they want:
PhRMA: The trade group for the nation's drug and biotech firms could spend $150 million selling its message. It's led by former Rep. Billy Tauzin of Louisiana, a Democrat-turned-Republican and a longtime chairman of the House Energy and Commerce Committee.
The group committed to providing $80 billion in cost savings over a decade if an overhaul is enacted, including halving the drug costs for seniors in the current "donut hole" coverage gap under Medicare Part D. The price of PhRMA's support was that the Obama administration wouldn't use Medicare's leverage to negotiate lower drug prices or import drugs from Canada to reduce prices here.
"I can't speak for the White House, I can only tell you that, in the beginning, when we were asked to be partners in health care, we said we'll do everything that we can to help, but the line in the sand for us is price controls," said senior vice president Ken Johnson. "We really passionately believe health care reform has to happen, we really believe there has to be shared sacrifice."
PhRMA hasn't taken a stand on a public option, but it opposes driving people currently insured by employers out of the private system.
AHIP: America's Health Insurance Plans, which also sponsors a group called Campaign for an American Solution, doesn't support the public option and says it wants "bipartisan" reform.
Insurers want the government to mandate coverage for all Americans. To accomplish that through private insurance, AHIP would agree not to deny coverage for pre-existing conditions and not to base premiums on health status or gender.
However, AHIP spokesman Robert Zirkelbach said, "The only way that works is if everyone participates in the health care system." AHIP supports tax credits or other assistance for people who make too much money to qualify for Medicaid but can't afford coverage on their own.
SEIU: The Service Employees International Union has 2 million members and bills itself as the largest, fastest-growing labor organization in North America. It has 400 staff dedicated to the pro-overhaul campaign and has spent upward of $10 million, said its health care chairman, Dennis Rivera.
More than half of SEIU's members work in health care as nurses, doctors, lab techs, or in nursing homes and as home health care providers. Many earn less than $40,000 a year and some have no health insurance coverage.
The union supports the public option. Insuring more Americans could mean coverage for its members and also could increase demand for health care workers, expanding SEIU membership.
Rivera insisted that SEIU's motives aren't business driven, and said that some provisions the union backs could hurt its members. For example, as hospitals increase use of electronic medical records, less staff would be needed to manage files and bills.
"This is a social mission," Rivera said. "If we just could have the peace of mind that nobody's going to lose their home, that they'll have access to health care independent of their economic situation. That's what's important . . . We're not doing this because of the future growth of our union."
AMA: The American Medical Association represents about 250,000 physicians. Members support universal coverage but not necessarily a public option.
The group endorsed overhaul legislation proposed by Democrats in the House of Representatives, in part because it changed a Medicare payment formula that had threatened to cut doctors' payment rates. Doctors also want changes to liability laws.
AMA president-elect Cecil Wilson said the Medicare payment fix, dubbed the "doc fix," is "not just about doctors, it's about access to care for senior citizens. Physicians are increasingly finding they cannot afford to take care of Medicare patients. They're having to limit the number of Medicare patients they see."
As for a public option, Wilson said, "It's not clear what that's going to mean. This is such a loaded term. The longer we focus on this and our efforts on it, the more risk we run of losing a lot of things that are actually more important. Not doing something is not an option."
AARP: The multimillion member organization for people age 50 and up has spent undisclosed sums on ads and lobbying on behalf of expanding health insurance. It's open to but not insistent on a public option.
Spokesman Drew Nannis said a key goal for AARP is expanding affordable coverage for people who are over 50 but too young for Medicare.
AARP and PhRMA are at odds on some key points; for example, AARP wants the government to negotiate lower drug prices through Medicare and to allow drug reimportation.
AARP, meanwhile, partners with insurance companies to offer health care coverage to its members. It has coverage for ages 50-64 as well as various Medicare-related subsidy plans.
Nannis said that AARP would support trimming Medicare overpayments even if that cost its programs. "Our advocacy always drives our private-market solutions," he said.
Health Care for America NOW: This huge umbrella organization, which claims more than 1,000 member groups, supports a public option, and doesn't think that nonprofit co-ops are a satisfactory alternative. Its Web site urges citizen involvement so that "private insurance companies will have to put our health before their profits."
Its steering committee includes a range of liberal-leaning groups, from ACORN to various unions, the NAACP and MoveOn.org. The SEIU is also a member.
HCAN's $35 million budget includes $500,000 from each group on its steering committee. It also got $10 million from the Atlantic Philanthropies, an organization dedicated to health care and human rights causes founded by duty-free shopping billionaire Chuck Feeney. HCAN touts 120 organizers spread across all but a handful of states, and $11 million spent on ads this year.
The group wouldn't confirm or deny reports that billionaire liberal philanthropist George Soros would give it $5 million. Soros and his clients have invested millions in health care ventures, Securities and Exchange Commission records show.
Americans for Stable Quality Care: Includes PhRMA, Families USA, SEIU, the AMA and the Federation of American Hospitals.
Better Health Care Together: This coalition includes various corporate and union interests, including Wal-Mart, Intel, and SEIU. It also includes the Center for American Progress, a Soros-backed policy organization that's influential in the Obama administration.
Divided We Fail: This is a partnership of the AARP, SEIU, Business Roundtable (chief executives of leading U.S. corporations), and National Federation of Independent Business, the small-business trade association.
Partnership for Quality Care: This is a coalition of various SEIU chapters and hospital and health care groups including Catholic Healthcare West, Group Health Cooperative, Kaiser Permanente and the Greater New York Hospital Association.
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