The Center for Public Integrity

If you wonder why the health insurance industry has to set up front groups and secretly funnel cash to industry-funded coalitions to influence public policy, take a look at the most recent results of the Kaiser Family Foundation’s monthly Health Tracking Poll.

In its November poll, KFF added a few new survey questions to find out exactly which parts of the Affordable Care Act/Obamacare are the most popular and which are the least popular. Insurers were no doubt annoyed to see that the provision of the law they want most — the requirement that all of us will have to buy coverage from them if we’re not eligible for a public program like Medicare — continues to be the single most hated part of the law. More than 60 percent of Americans have an unfavorable opinion of that mandate.

When it comes to what Americans like most about the law, the runaway winner is one of the provisions insurers most despise—the one that requires them to provide us with easy-to-understand benefit summaries. That element of the reform law was viewed favorably by a whopping 84 percent of the public.

Until now, insurers have been able to get away with providing skimpy and often incomprehensible information about their benefit plans, including what is covered and what is not and how much policyholders will have to pay out of their own pockets if they get sick or injured. The insurance firms have shown no willingness to communicate with their customers in a more forthright way, which is why an act of Congress was necessary to get them to do just that.

As I wrote a few weeks ago, the industry and its allies are lobbying the Obama administration to ignore that part of the law, arguing that to comply will cost millions of dollars that insurers would have to pass on to consumers. The companies insist that providing understandable information allowing us to compare plans serves no purpose that would justify the additional cost.

The Obama Administration will be making some important decisions over the coming weeks that will determine to a large extent whether consumers or health insurers will be the biggest beneficiaries of health care reform.

When Congress passed the Affordable Care Act last year, it included a controversial provision that insurers insisted on but which is undoubtedly the most unpopular part of the law: a requirement that all Americans not eligible for a public program like Medicare or Medicaid must buy coverage from a private insurance company.

To make that mandate fairer and more palatable, Congress also included provisions that eventually will make several of the insurance industry’s most egregious practices illegal, such as refusing to sell coverage to people just because they have a pre-existing condition. The law also prohibits insurers from selling “junk” insurance and from cancelling policyholders’ coverage at the time they need it most—when they get sick.

Just as important, the law requires insurers to spend at least 80 percent of our premium dollars on actual medical care, and it requires them to provide us with much more information—in language we can understand—to help us choose a policy that makes the most sense for us and our families when we’re shopping for coverage.

The Obama administration has the responsibility of writing rules to carry out all of the law’s provisions, and several of those rules are expected to be announced soon.

Many consumer advocates are concerned that the administration is listening more to insurers than to them. And possibly for good reason.

One of the reasons why Congress has been largely unable to make the American health care system more efficient and equitable is because of the stranglehold lobbyists for special interests have on the institution.

Whenever lawmakers consider any kind of meaningful reform, the proposed remedies inevitably create winners and losers. Physicians’ incomes most likely will be affected in some way, as will the profits of all the other major players: the hospitals, the drug companies, the medical device manufacturers, and the insurers, just to name a few. The list is long, and the platoons of highly paid and well-connected lobbyists who represent their interests comprise a large private army that conquered Capitol Hill years ago.

One has to wonder, then, how in the world Congress was able to include a provision in last year’s health care reform law to establish an independent board that would strip Congress of some of the authority it currently has — but rarely is able to exercise — over the Medicare program.

Everyone knows that without reform, Medicare is not sustainable. As the population ages and medical inflation continues, the amount of money the program will eventually have to pay out to cover beneficiaries’ health care needs will exceed revenues.

But because of the power and influence of the lobbyists and the organizations they represent, Congress has not been able to do much more than tinker around the edges. Recognizing that reality, a few lawmakers who were not so beholden to the special interests were able to insert language in the reform law to create a panel of 15 health care experts, to be appointed by the President, called the Independent Payment Advisory Board, or IPAB.

Opponents of the Affordable Care Act who believe the Supreme Court will declare the law unconstitutional are going to be disappointed next year when a majority of the nine justices vote to uphold it. It will likely be a 5-4 decision, but moderate conservative Anthony Kennedy will, I’m confident, recognize that without the law, the free-market system of health insurance, so highly valued by conservatives, will implode, sooner rather than later.

The high court announced earlier this week that it will hear oral arguments on the constitutionality of the law next March. A decision is expected in June, just a few weeks before the parties hold their conventions. Regardless of which way the justices go, the decision will ensure that health care reform will be as contentious a campaign issue as it was in 2008.

Here’s the reality. The provision of Obamacare at the heart of the constitutional challenge — the requirement that all Americans will have to buy health insurance if they’re not eligible for a public plan like Medicare or Medicaid — is a “must have” for the nation’s health insurance industry.

The plaintiffs who filed the lawsuits, including the attorneys general of 26 states, either haven’t been paying attention to what’s been happening in the private insurance market or have chosen to ignore it because of blind allegiance to ideology.    

The indisputable fact is that our employment-based system of private health insurance has been crumbling for years — to the point that potential new business for health insurers is, for all practical purposes, nonexistent. And ironically, it is their practices and policies, made necessary by profit-hungry shareholders, that have led to this state of affairs.

If there is one organization that insurers despise and fear more than any other, it surely must be Consumer Watchdog.

Since its founding in 1985, Los Angeles-based Consumer Watchdog has dogged insurers relentlessly and played a key role numerous times in forcing them to change business practices and price their policies more fairly. I first heard of the organization in 1996 when I was still an insurance industry spokesman. Consumer Watchdog seemingly came out of nowhere to take the lead in trying to put a halt to a new practice in the insurance industry: requiring women to be discharged from the hospital within a day after delivering a baby or undergoing a mastectomy. Largely because of Consumer Watchdog’s efforts, insurers had to rewrite their discharge policies.

The organization’s first major attack on the insurance industry — a ballot initiative in California (Proposition 103) require auto insurers to seek prior approval from regulators before increasing rates — has saved drivers in the Golden State more than $62 billion over the past two decades, according to an analysis by the Consumer Federation of America.

The insurance industry spent nearly $63 million to defeat Proposition 103 back in 1988, but that was no match for the indefatigable founder of Consumer Watchdog, Harvey Rosenfield. Rosenfield, a lawyer who helped write the proposition, proved that a David can still bring down a Goliath, or at least reduce Goliath’s power and profits, with the modern-day equivalent of a slingshot — savvy media relations skills.

Rosenfield enlisted the support of consumer advocate Ralph Nader, and the two of them crisscrossed the state demanding that local TV and radio stations present their point of view on Proposition 103 to balance out the massive advertising campaign insurers were waging to kill it. It worked.

The special interests seeking to gut those portions of the health reform law that  would be of greatest benefit to consumers clearly believe there is no such thing as historical memory in Washington.

Why else would they bring one of their old front groups out of the storage locker, with just a single new word added to its name? A front group designed to persuade Americans that what they might have thought was in their best interests really isn’t after all.

In the late 1990s, health insurers and their most reliable business allies — including the U.S. Chamber of Commerce and the National Federation of Independent Business (NFIB) — set up a front group called the Health Benefits Coalition. Back then, the industry’s target was the Patient’s Bill of Rights, which would have made insurance firms behave in a more consumer-friendly way. Among other things, the bill of rights would have forced insurers to make an external review process available to health plan enrollees who were denied coverage for doctor-ordered treatments. It also would have given enrollees an expanded right to sue their insurers for wrongful denials of coverage.

The Patient’s Bill of Rights was popular with the public, health care providers and members of Congress on both sides of the aisle. It attracted bipartisan support in both the House and Senate. The sponsors of the Senate version of the bill, in fact, were none other than Republican John McCain of Arizona and Democrat Ted Kennedy of Massachusetts.

Insurers hated it, of course, but knew they would not be able to kill it without the support of other powerful groups. They set out to persuade the Chamber, the NFIB and other groups with clout in Washington, including the National Association of Manufacturers, to join them in creating a new front group that would be operated out of a big PR firm in Washington, Porter Novelli.

Support for ObamaCare has fallen to just 34 percent of the American public, according to the Kaiser Family Foundation’s most recent tracking poll. That’s down from 41 percent in just one month.

Can’t say I’m surprised. Just as they did during the debate on health care reform in 2009 and 2010, the special interests who profit from the status quo have been winning the messaging battle in their ongoing effort to scare people away from the new law. They have a well-planned and executed strategy to mislead people so thoroughly they will vote next year for candidates who promise to repeal the law, even if that means they will be voting against their own best interests. The strategy of the law’s backers — if indeed there is one — is simply not working.

One reason reform advocates cite for the decline in support: relentless attacks on the law by GOP presidential candidates, especially during those free-for-all debates. At one of the recent get-togethers, Newt Gingrich even resurrected the biggest of the big lies — that the law creates government-run death plans that will decide when to pull the plug on sick Medicare beneficiaries. Supporters can’t expect debate moderators to challenge the candidates on such baseless accusations, and they don’t have comparable forums to communicate how the law is helping millions of Americans. At least not yet.

Another factor in falling support for ObamaCare is that opponents are outdueling supporters in placement of op-ed commentaries and letters to the editor. While I haven’t seen detailed analyses of the op-ed placement war, my own observation, as someone who reads a lot of newspapers, is that the critics have gotten way more ink than the fans.

That doesn’t surprise me, either. During my years as a health insurance industry PR guy, I helped craft and implement plans that involved recruiting seemingly ordinary folks to send letters and op-eds that had actually been written by industry flacks.

I have no inside information about the nature of GOP presidential candidate Herman Cain’s relationship with two women who claimed Cain made unwelcome advances toward them when he headed the National Restaurant Association in the 1990s. I do, however, have first-hand knowledge of a mutually beneficial affair Cain was engaged in around that same time — with the health insurance industry.

Soon after President Bill Clinton unveiled his health care reform proposal in October 1993, the nation’s big insurers and other special interests joined forces under the auspices of the Healthcare Leadership Council to develop a strategy to kill it. I made several trips to HLC meetings in Washington as a representative of CIGNA to participate in the planning sessions. 

One of the outcomes of those brainstorming meetings was a nationwide health care reform videoconference, sponsored by the leadership council and underwritten by CIGNA, at which Cain, virtually unknown to the public at the time, played a key role.

Although it was billed as a forum “in which experts will examine the provisions of President Clinton’s health care proposal against the major alternative plans,” the real purpose of the 20-city videoconference was to turn the country’s business leaders against the Clinton blueprint.  

The event cost hundreds of thousands of dollars, some of which was used to hire 60 Minutes correspondent Lesley Stahl to moderate the program. One of my colleagues who worked with Stahl told me she complained afterwards that she had been led to believe that the video conference would be a balanced pro and con discussion of the Clinton plan, which in fact it was never intended to be.