Healthcare lobbying groups seeking payment or regulatory concessions from Congress are peddling noble causes on Capitol Hill to soften their image as they beg for relief.
The cause in vogue: the uninsured.
At least five lobbies representing the interests of hospitals, physicians and insurers have touted plans to expand coverage and access to care for more than 43 million Americans without health insurance.
Much of this comes as providers beg lawmakers to relieve them from some of the Medicare spending limits imposed by the Balanced Budget Act of 1997. For insurers, the hot-button issue is defeating or watering down patient-protection legislation.
"Everyone's always trying to wear the white hat," said Robert Castro, vice president at Luntz Research Cos., an Arlington, Va.-based polling firm. "Campaigning for the uninsured reminds people that (hospitals) are providers of health services, not just businesses."
Consumer groups are hip to the lobbying tactic.
"Each of these associations (is) most focused on its members' bottom lines, and to talk about the need for increased income is not exactly something that opens the tear ducts for the American public," said Ron Pollack, executive director at Families USA. "They obviously want to join their bottom line concerns with some vow to altruism."
The giant Health Insurance Association of America is the latest to jump on the uninsured bandwagon.
Just two weeks ago, the group unveiled a plan that includes a $23 billion government subsidy and tax credits for small employers (May 24, p. 4).
But the plan doesn't help only the uninsured. It suggests that market deregulation would be a way for insurers to make their products more affordable.
"The issues (of the uninsured and patient protection) are related indeed," HIAA spokesman Richard Coorsh said. "It gets to the notion of how patient protection would increase costs and lead to more uninsured. Our take on this is, why add to that? The uninsured should be the first problem we address."
Pollack, of Families USA, said some lobbying groups, such as the insurance industry, use the uninsured "as a shield rather than a sword."
He said the insurance industry was absent from the debate or leading the opposition during past legislative efforts to improve access to coverage.
But as patient-protection legislation looms, the industry is talking about coverage. Some believe that's a smoke screen to dissuade Congress from passing any managed-care legislation (March 8, p. 38).
The Catholic Health Association is another group that recently made a public show of its efforts to jump-start the healthcare reform issue and extend coverage to the uninsured.
At an April press conference in Washington, the Rev. Michael Place, the CHA's president and chief executive officer, told reporters his group wanted to start the dialogue about healthcare reform so year-2000 presidential campaign candidates would tackle the issue (April 26, p. 9).
During a Capitol Hill press conference earlier this month, the CHA challenged candidates to make "accessible and affordable healthcare for all a priority" in any administration they lead, according to a press release from the event.
Jack Bresch, director of legislative affairs for the CHA, said it's typical to lobby across a spectrum of issues of interest to CHA members.
"We've always formulated an advocacy agenda on what we have been told are the interests of CHA members-and the interests run from coverage issues to payment issues," Bresch said. "There have been times when we have stressed one more than the other, but usually our advocacy agenda has included both payment policy issues and access."
Pairing the two is not uncharacteristic, he said.
"I'm denying it's a strategy predicated on 'We have to trick them (members of Congress),' " Bresch said.
One group out in front of the CHA is the American Medical Association. In December 1998, the AMA declared itself the "national champion" of universal access and announced its highest priority was to make sure every person has access to care and a way to pay for it (Dec. 14, 1998, p. 20).
The AMA is no stranger to hooking up with high-road issues. In the past, it has campaigned against cigarette makers and domestic violence.
At deadline, AMA officials had not responded to an interview request.
The American Hospital Association has been ahead of the game when it comes to the plight of the uninsured.
The AHA undertook a two-year initiative called "Campaign for Coverage," which helped enroll 2.5 million previously uninsured people in public insurance programs such as Medicaid and the Children's Health Insurance Program. No other provider group can claim such an effort.
The AHA said hospital groups aren't talking about the uninsured as a ploy to win sympathy for their alleged financial plight, but they do say the two issues are closely related.
"There is a really direct connection between the two," said Carmela Coyle, the AHA's senior vice president of policy. "As we look at how to cope financially, that's coupled with the increasing number of uninsured and the increase in the amount of uncompensated care."
In 1997, the nation's acute-care hospitals spent $18.5 billion on uncompensated care, or 6% of their total expenses, the latest AHA data show. That's down slightly from 6.1% in 1996 and the lowest since 1993, when hospitals also spent 6% of their expenses on uncompensated care.
"Against that backdrop, we have cuts in Medicare," Coyle said. "The ability to fund the Medicare shortfall from other sources just isn't there. We no longer have leeway on the private side, and we are also seeing a drop in Medicaid payments."
Judy Feder, dean of policy studies at Georgetown University in Washington, said that when healthcare groups lobby, they play off public concern about anything that will endanger people's access to quality care.
That's why "the more they can argue that a payment threat, a revenue threat, is a quality or access threat, the more support they muster," she said.
Feder said "it's not coincidental," that noble causes such as the plight of the uninsured are thrown into the public spotlight during money fights.
Peter Budetti, M.D., a professor and director at the Institute for Health Services Research and Policy Studies at Northwestern University in Evanston, Ill., agreed.
"That's what everybody does," said Budetti, a pediatrician and a lawyer who once served as legal counsel to the health subcommittee of the House Ways and Means Committee. "You always try to couch self-interested issues as somehow having a higher purpose, especially in healthcare."
But Pollack, of Families USA, is quick to point out that some groups, such as the CHA, have a history of working "steadfastly on the question of expanded coverage."
What helps hospital groups even more than a lofty goal is a common goal, said Fred Graefe, a lawyer with the Washington office of Baker & Hostetler. Graefe also does some lobbying for the Federation of American Health Systems, a for-profit hospital group.
For instance, the AHA, the CHA and the federation are all partners in an advertising-lobbying campaign called "Real Pain for Real People" (May 10, p. 6).
A focal point of the campaign has been short case studies about hospitals struggling with new Medicare spending limits. The case studies have been published in newspapers and newsletters widely read on Capitol Hill.
"It is definitely helping," said Thomas Scully, the federation's president.
But some, like Pollack and Budetti, said this tactic of touting altruism doesn't sway people on the Hill.
"What does fly on the Hill is the fact that each of these groups has enormous amounts of money that they are willing to throw into these fights," and each contributes to political campaigns, Pollack said. "That opens doors for you."