When lawmakers traveled their districts this month during Congress' summer recess, there was no drought of healthcare special-interest groups vying for their attention.
Groups representing hospitals, health plans and senior citizens blitzed their elected officials with postcards, faxes, personal meetings and advertisements covering a laundry list of healthcare issues.
For these special interests, Congress' vacation, which ends Sept. 8, is all business. It's one of the most crucial times for grass-roots lobbying.
"The important part of what's going on is to create the impression that this is not a Washington thing," said Peter Budetti, M.D., a professor and director at Northwestern University's Institute for Health Services Research and Policy Studies in Chicago. "You want to show that people are affected by this and (that those) people vote."
Budetti also has served as legal counsel to the House Ways and Means health subcommittee, which will consider many of these issues.
The goal of the healthcare lobbies, Budetti said, is to convince lawmakers that voters' concerns mirror lobbies' positions.
The stakes are high for healthcare special-interest groups this year because Congress is poised to tackle such key policy issues as Medicare reductions, managed-care reform and Medicare coverage for prescription drugs. All those issues could significantly affect healthcare delivery in this country.
One special-interest group-the hospital industry-is launching a massive postcard campaign to coincide with Congress' return to Washington.
The goal is to have hospital employees around the country send 1 million postcards to Congress and the president pleading for relief from Medicare reductions stemming from the Balanced Budget Act of 1997. The campaign, the latest effort of the hospital lobby, gets under way Sept. 6.
"We know we are beginning to get traction with members of Congress," said Richard Wade, the American Hospital Association's senior adviser for communications. "This is to keep the volume and the momentum going."
The postcard campaign is being coordinated with other national groups, including the Catholic Health Association, the Federation of American Health Systems, Premier and VHA.
According to the U.S. Department of Labor, more than 3.6 million people worked in the nation's acute-care hospitals in June. The budget law is expected to reduce Medicare's payments to hospitals for inpatient services by $25 billion between 1998 and 2002, according to Congressional Budget Office estimates.
The personal touch. Some hospitals, in coordination with national efforts, are going straight to the voters in their communities to whip up public support for their quest for more Medicare dollars.
Keith Heuser, chief executive officer of 59-bed Memorial Hospital in rural Carthage, Ill., is leading a letter-writing campaign.
The idea came from an employee, who suggested that Heuser compose letters asking for relief from the balanced-budget law, which employees could sign and send to Illinois' two senators and a local congressional representative. Heuser also composed letters that nonhospital employees in the community could send.
"I wanted (legislators) to hear from the people who are going to be impacted when we have to reduce services," Heuser said.
Other facilities are hoping to win sympathetic votes by rolling out the red carpet for lawmakers. House Speaker J. Dennis Hastert (R-Ill.) traveled to Seattle to meet with hospital officials at 208-bed Children's Hospital and Regional Medical Center. Joining them was Rep. Jennifer Dunn (R-Wash.), who represents suburban Seattle.
The hospital wants Congress to pass legislation that would create a capped, time-limited fund to cover graduate medical education costs for pediatricians. The hospital is working with the Alexandria, Va.-based National Association of Children's Hospitals, the lobbying affiliate of the National Association of Children's Hospitals and Related Institutions.
When lawmakers come to a hospital and mingle with children, it helps make the case for legislation.
"It's going to be hard for (Hastert) to shake when this issue gets addressed in any form in Washington," said Treuman Katz, Children's president and CEO.
Making rounds. State hospital associations are organizing events that allow hospital managers to share their sob stories with senators and representatives.
For example, the Minnesota Hospital and Healthcare Partnership is targeting the state's entire congressional delegation.
The group scheduled meetings for its members during the recess with at least three representatives and Sen. Rod Grams (R-Minn.).
"Our strategy is simply that we have this compelling situation and we want our representatives to see it for themselves," said Bruce Rueben, the association's president.
Hospitals in central Georgia found a willing listener in Rep. Charlie Norwood (R-Ga.), who spent Aug. 18 dining with healthcare executives in Augusta and chatting with rural hospital officials in Louisville.
Some asked about the controversial managed-care reform bill Norwood is co-sponsoring with Reps. John Dingell (D-Mich.) and Greg Ganske (R-Iowa). But Norwood got an earful about the Medicare reductions prescribed by the budget law.
"We're all suffering," said Rita Culvern, administrator of 37-bed Jefferson Hospital in Louisville, about 60 miles south of Augusta.
Norwood said he feels more comfortable with small groups such as the Georgia Hospital Association than with bigger groups like the AHA. That opinion shows why grass-roots campaigns can be so effective.
"I'm not reacting to the AHA at all," Norwood said, referring to the "Real Pain for Real People" campaign the AHA launched earlier this year (May 10, p. 6). "I'm reacting to what I hear from home."
But Norwood also told the hospitals that without the budget law, Medicare might not have had a future.
"The Medicare trust fund would be gone, and there's no provision in federal law to keep it going. We had to take the steps we did to balance the budget," Norwood said.
"It isn't that hospitals aren't important," he continued. "It's that there's a big, large picture out there."
Another lawmaker, Rep. David Hobson (R-Ohio), met with hospital executives in Dayton, Ohio, last week. He predicted that Congress would pass some kind of patient-protection bill and some relief from the budget law.
Hobson told the hospital leaders there are "anomalies" in the budget law. "I think HCFA has taken advantage of some things that were unintended consequences," he said.
Although the post-recess period in a nonelection year is usually a good time to get things done in Washington, this year is different, Hobson warned hospital officials.
"The (2000) election environment is taking over much faster than it normally does," he said.
But hospital executives gave Hobson a hint of what they face at home. "We've thrown overboard a lot of the nice things," said Roy Chew, president of Dayton's 278-bed Grandview Hospital and Medical Center.
Doug Deck, president and CEO of 428-bed Good Samaritan Hospital and Health Center in Dayton, said some physicians are beginning to consider limiting the number of Medicare patients they treat because of reimbursement issues.
"That's new talk, and I just thought you needed to know that," Deck told Hobson.
And prescriptions for all. The big political picture includes Medicare coverage of prescription drugs, which the American Association of Retired Persons has chosen as its priority issue. The AARP spent August busily setting up individual and group meetings between seniors and their representatives in Congress.
"We're trying to work with every member of Congress so that they will have some personal contact on this issue over the recess," said John Rother, the AARP's legislative director. "I imagine the vast majority of Congress will have some contact with AARP constituents."
Rep. Jim Davis (D-Fla.) got some of that personal contact in Tampa, Fla., when he met with about 250 concerned seniors Aug. 18 to discuss Medicare reform and prescription drug coverage.
Davis said seniors want a drug benefit but are also worried about the solvency of Medicare. The program is expected to last until 2015, according to the latest estimates.
"I'm on the House Budget Committee, so I tend to look at the fiscal implications (of Medicare)," Davis said. "We have a range of choices (about how to spend the federal budget surplus), and they all have merit."
Davis said he tried to be "open and honest" with seniors about other healthcare issues facing Congress, such as rolling back some scheduled Medicare reductions for hospitals, nursing homes and home health agencies.
"I wanted them to look at the big picture," Davis said, echoing Norwood. "I tried to put everything on the table in a very full context, and I left there feeling like people were thinking the same things I'm thinking: We're in the early stages of a very great debate."
Managed-care flare-up. Health plans and payers also are jockeying for attention. They want to discourage Congress and voters from supporting managed-care reform bills like the one sponsored by Dingell, Ganske and Norwood, which would allow patients to sue their plans for punitive damages. Plans and payers also are denouncing a Republican draft bill released last week (See story, p. 12).
Their national associations have made killing such legislation a top priority.
Leading the opposition is the Health Benefits Coalition, a group made up of employers, insurers and the Premier hospital alliance.
The coalition is paying for radio and television ads to be broadcast in 10 to 12 congressional districts this month (See chart, p. 3).
In addition to participating in the coalition's efforts, some member organizations are campaigning on their own against managed-care reform.
"Our top two priorities are healthcare and tax relief," said Neil Trautwein, director of employment policy for the Washington office of the National Association of Manufacturers, which has 14,000 member companies and is part of the coalition.
"Ninety-eight percent of our members provide health benefits, but when additional costs like (those related to the ability to sue health plans) are put on us, we face the prospect of being forced to drop coverage," he said.
NAM is urging its members and their employees to campaign against the bipartisan patient-protection bill. In addition to inviting lawmakers for the usual plant tours and district meetings, NAM is sending targeted mailings and faxes to lawmakers and local media in districts where a member of Congress co-sponsored the bipartisan bill or will likely support it.
Trautwein declined to name the number of districts targeted but said NAM's grass-roots campaign enlisted only volunteers.
"We don't believe in paid (grass-roots) campaigns," he said. "Very often, our member companies are the single largest employer in a district, and we hope that members of Congress will think about that when we talk to them."
Norwood has already noticed NAM's activities. "(NAM) represents almost every major corporation in America," he told the rural hospital executives on his Aug. 18 visit.
Another coalition member, the American Association of Health Plans, is planning an aggressive, three-pronged attack on the bipartisan managed-care reform bill and its supporters.
The AAHP, which represents 1,000 health plans, is sending its president, Karen Ignagni, and other officials to appear on radio talk shows around the country.
AAHP member plans also are organizing town hall-style meetings with voters "to educate them about the negative implications" of the various managed-care bills, AAHP spokesman John Murray said.
Finally, the AAHP has launched a television ad campaign that portrays plaintiff lawyers as profiteers who will take advantage of patients if managed-care reform bills become law.
The ads, which claim that 2 million Americans would lose coverage if the bills were passed, will be broadcast in 60 congressional districts held by both Democrats and Republicans. The AAHP did not have a total cost estimate for the campaign.
Last week, the Health Insurance Association of America, which represents 269 companies, began airing radio ads that also attacked plaintiff lawyers as the force behind the bipartisan bill.
The HIAA's ads will be broadcast through Sept. 3 in 72 congressional districts across the country. This initial effort will cost $250,000.
HIAA President Chip Kahn said that while his group heavily supports the Health Benefits Coalition's efforts, his members thought it was time to send their own message to consumers.
"We will supplement the efforts of the coalition," Kahn said. "We're working toward a cacophony of employers and insurers' getting the message to the public."
Will it work? It's unclear how all of this home-front lobbying will affect congressional votes on managed-care reform, budget law fixes and Medicare restructuring.
In talking with their constituents, lawmakers seemed hopeful that some money would be put back into provider payments.
While Norwood is not a member of the House Ways and Means Committee, which will decide who gets relief from the scheduled Medicare reductions, he said he would do what he could to get the hospitals' message to key decisionmakers.
"I don't think Congress has any lack of understanding for the needs of rural hospitals," Norwood said. "We have had some serious, unintended consequences here. The cavalry is on the way, but I don't know how many horses they're bringing."
More than 20 North Dakota hospital executives met Aug. 17 in Bismarck with Sen. Kent Conrad (D-N.D.) to talk about the budget law and other inequities in Medicare reimbursement.
Richard Tschider, the administrator and CEO of St. Alexius Medical Center in Bismarck, said the hospitals' efforts will affect Conrad's action when he returns to Washington.
"He will go back and make every attempt to get something done," Tschider said.
But Katz, of Children's in Seattle, said he knows that when you want something from Capitol Hill, there are no guarantees.
"There are no assurances in the public policy arena," Katz said. "You just keep working at it."