Those eager to embrace the uninsured issue swear that the attraction is more than skin-deep.
The self-proclaimed "strange bedfellows" coalition that has sought to draw public attention to and solve the worsening problem of more than 39 million uninsured Americans recently swelled to 13 partners, nearly half of which are either healthcare or health insurance associations, and is using a new Covering the Uninsured advertising campaign to renew its goals.
As they dive into another lobbying year in which billions of dollars of their own reimbursement are at stake, the organizations signing the "Let's Get America Covered" proclamation during a well-produced media event earlier this month likely enjoyed the opportunity to look unselfish for a few moments.
The Robert Wood Johnson Foundation, sponsor of the coalition, has committed $10 million to the new campaign featuring television commercials and newspaper advertisements mostly targeting the Washington area. In addition to healthcare and insurance groups, the coalition includes large unions, business groups and consumer agencies.
A core of eight national organizations and the foundation formed the original strange bedfellows coalition in 2000 (Nov. 27, 2000, p. 3). The self-imposed nickname capitalized on a 1999 pairing between the left-leaning Families USA and the conservative Health Insurance Association of America to promote a proposal that featured expansion of public health insurance programs and the use of tax credits to help employers insure workers.
Is the renewed effort an attempt by the organizations to spit-shine their image so Congress will look favorably on their other requests?
"I would resist the sort of common inside-the-Beltway cynicism that this is a group of folks coming together to take on a white hat issue so they have some cover to do their dirty work," said the Rev. Michael Place, president and chief executive officer of the Catholic Health Association, a coalition member.
Not that there isn't plenty of selfish work to do this year. The American Medical Association, which joined the coalition when it was formed, is fighting to get at least some money back from a 5.4% cut in the 2002 Medicare physician fee schedule. The American Hospital Association and other coalition hospital groups hope to hold off a new round of reimbursement cuts now that those in the Balanced Budget Act of 1997 are about to expire, and the HIAA wants to block passage of a patients' bill of rights law.
But the appeal of joining to address the problem is high, as the plight of the uninsured appears to be worsening. Some 2.2 million people lost their health insurance in 2001, the largest one-year increase in nearly a decade, according to Families USA. Nearly 39 million Americans didn't have healthcare coverage in 2000, the most recent data available from the Census Bureau.
President Bush has proposed $89 billion over 10 years for tax credits to help uninsured people buy coverage. Last year, Congress approved $28 billion over three to 10 years for the uninsured, but the money was never used because lawmakers couldn't agree on how to spend it.
Hospital uncompensated care, as a percentage of total expenses, stayed relatively stable at 6% in 2000, the most recent year for which data was available from the AHA.
At least one industry expert believes that the politically broad coalition may initiate policy change for the uninsured. "If they have a proposal it possibly makes it easier for Congress to do something," said Robert Blendon, professor of health policy and management at the Harvard School of Public Health.
At this point, however, the only details on which members can publicly agree is that any proposal would likely be incremental, consisting of a series of measures to cover separate pockets of people, such as parents of children insured by public programs or people who have recently lost employer-sponsored coverage.
"Good intentions are not enough," said Ron Pollack, Families USA's executive director. "We need to find bipartisan approaches that can pass at a time when we have got a very divided government." He said he was optimistic that "something significant" would happen with regard to federal policy on the uninsured within the next two years.
Chip Kahn, president of the Federation of American Hospitals, which recently joined the coalition, called the partnering of so many diverse interest groups to try to solve the uninsured problem "a major breakthrough."
Kahn said the efforts to enact policy would follow a two-step plan-first, pushing Congress to set aside as much money as possible for the uninsured in a budget resolution this spring, then working with members of the Senate on specific policy.
Asked if he sees battling for the uninsured as a way to stave off Medicare cuts to hospitals, Kahn said, "We are in (the coalition) because it is the right thing to do."