With a new year just beginning and federal budget negotiations in their final phase, it's time to evaluate how the healthcare lobbying groups fared in 1995 in the battle to influence the outcome of Washington events. These are mid-term grades since the final budget has yet to be completed.
American Hospital Association4 Grade: C+
If ever a group was dealt a crummy hand, it was the AHA. Starting the process with more than $430 billion in Medicare and Medicaid reductions on the table is the budgetary equivalent of playing seven-card stud with six cards, all face up. Given that, the AHA made something of a bad situation.
Ideally, the AHA wanted to steer a middle course between both parties. But that just wasn't possible. Several early stumbles, most notably running ads attacking several vulnerable GOP freshmen, moved the AHA near the top of House Speaker Newt Gingrich's "en emies of the revolution" list.
Furthermore, AHA leaders have been justifiably squeamish about hitching their wagon to a White House that is on its third budget plan and whose only real budget goal is to get re-elected.
he AHA, whic h rightfully thinks of itself as the industry's unifying force, allowed the hospital community to become divided at a time when a mass show of force was needed. The lead dog has to keep everyone mushing in the same direction.
In hindsight, the AHA probably put too much emphasis on provider-sponsored networks. In the end, many AHA members will judge success or failure on whether the AHA "wins" on PSNs even though it will be impossible to tell for several yea rs whether these untested organizations can even work.
Federation of American Health Systems
The federation's hand was only slightly better than the AHA's, primarily because the group had a leader with a proven GOP pedigre e in Thomas Scully. During the periods when GOP leaders were throwing temper tantrums over the AHA's failure to jump on the reform bus, Scully was able to carry the hospital message.
Like the AHA, the federation put too much emphasi s on PSNs, but it also got several provisions it sought. One of these provisions redistributes capital payments to reflect taxes paid by for-profit healthcare providers. Federation members also have been attacking the GOP Medicaid plan, which has the potential to be far more disastrous than the Medicare plan.
The federation made several missteps. Most of them can be attributed to Scully's being new to the Machiavellian world of association politics, which mak es the situation in Bosnia look stable.
As a leader in the hospital community, Scully also must take his share of the blame for the fracturing of the hospital coalition, primarily because he did not support the move by the AHA (and most of the other hospital groups) to oppose the GOP plan. The federation eventually sent a letter to Capitol Hill that was similar to the AHA letter, but by then the damage was done.
Group Health Association of America, Health Insurance Association of America, and the Blue Cross and Blue Shield Association
These are three very different groups, but you would never have known it in the past year.
If the AHA and the federation were dealt a bad hand, the insurers started with four of a kind. Willis Gradison, head of the HIAA, is a former GOP leader. Charles "Chip" Kahn III, the House Ways and Means health subcommittee aide who wrote a significant part of the GOP plan, was Gradi son's second in command at the HIAA before moving to Capitol Hill. The Republicans owed the insurers big-time for leading the opposition to the Clinton healthcare reform plan last year. And they came armed with well-funded politica l action committees.
With a great opening hand, the insurers did a good job of holding their coalition together. They also made clear to GOP leaders what their bottom line was and what was needed to keep them from opposing the bill. If you are going to make a threat, it had better be credible.
American Medical Association
The AMA endorsed the GOP budget early on, then watched as the issues they supported got dumped one by one.
Sure, the new payment pol icy is a vast improvement over the current one, but the surgeons aren't happy with it and there are grumblings from other sectors as well. Antitrust relief, malpractice reform and a provision that would gut the unpopular clinical l aboratory rules were all stripped from the final GOP plan. Gingrich & Co. have vowed to try to reintroduce those measures, but the White House is against them and that doesn't bode well in the long run.
American Healthcare Systems
With the AmHS Institute not known as a high-profile lobbying shop, President Jim Scott was one of the first to understand that hospitals were going to have to do business differently in the new Medicare environment. Scott i s another hospital executive with a certified Republican pedigree. He is known to pick and choose his battles carefully.
Catholic Health Association
Right or wrong, good or bad, the CHA is one of the groups most cl osely aligned with the Democrats. The CHA has not really been a major factor in the Republican deliberations for obvious reasons, but now that the Clinton administration is entering the picture, the group's time has come.
American Health Care Association
Another bad hand. Medicaid cuts are significant, the Boren Amendment is on the ropes, and the prospective payment system for skilled-nursing facilities could create severe payment problems. When your major victory is the reinstatement of federal Omnibus Budget Reconciliation Act of 1990 nursing home standards you never liked in the first place, things are not going your way.