[Peace-discuss] Lobbyist Documents Reveal Health Care Industry Battle Plan Against "Medicare for All"

Thu Jan 24 22:06:19 UTC 2019

Lobbyist Documents Reveal Health Care Industry Battle Plan Against "Medicare
for All"

 <https://theintercept.com/staff/leefang/>
https://theintercept.imgix.net/wp-uploads/sites/1/2018/03/Lee-Fang-headshot-
bw-crop-1521415569.jpg?auto=compress%2Cformat&q=90&h=60&w=60
<https://theintercept.com/staff/nick-surgey/>
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 <https://theintercept.com/staff/leefang/> Lee Fang,
<https://theintercept.com/staff/nick-surgey/> Nick Surgey

November 20 2018, 12:21 p.m.

 <http://documentedinvestigations.org/> 

 <http://documentedinvestigations.org/> In partnership with

 <http://documentedinvestigations.org/>  

Now that the midterms are finally over, the battle against "Medicare for
All" that has been quietly waged throughout the year is poised to take
center stage.

Internal strategy documents obtained by The Intercept and
<https://documented.net/> Documented reveal the strategy that private health
care interests plan to use to influence Democratic Party messaging and
stymie the momentum toward achieving universal health care coverage.

At least 48 incoming freshman lawmakers campaigned on enacting "Medicare for
All" or similar efforts to expand access to Medicare. And over the last
year, 123 incumbent House Democrats co-sponsored "Medicare for All"
legislation - double the number who supported the same bill during the
previous legislative session.

The growing popularity of "Medicare for All" in the House has made
progressives optimistic that the Democratic Party will embrace ideas to
expand government coverage options with minimal out-of-pocket costs for
patients going into the 2020 election. But industry groups have watched the
development with growing concern.

Over the summer, leading pharmaceutical, insurance, and hospital lobbyists
formed the Partnership for America's Health Care Future, an ad hoc alliance
of private health interests, to curb support for expanding Medicare.

The campaign, according to one planning document, is designed to "change the
conversation around Medicare for All," then "minimize the potential for this
option in health care from becoming part of a national political party's
platform in 2020."

https://theintercept.imgix.net/wp-uploads/sites/1/2018/11/objectives-1542237
655.jpg?auto=compress%2Cformat&q=90&w=1024&h=683

A slide from Partnership for America's Health Care Future presentation.

Behind the scenes, the group attempted to sway candidates during the
midterms, encouraging several of them to focus on shoring up the Affordable
Care Act instead of supporting single-payer health care.

The documents show that Partnership representatives spoke to the staffs of
Democratic Sens. Bill Nelson of Florida and Joe Donnelly of Indiana, and
received confirmation that both senators would maintain their "moderate
position." When the team met with Rep.-elect Lori Trahan, D-Mass., she said
that although she does not speak about the issue, she agreed that "language
around single payer should be tempered." (None of the three politicians'
offices provided responses to inquiries from The Intercept.)

In several competitive races, the Partnership pressed candidates to use
industry-crafted talking points when speaking about health care. In one
internal planning document circulated with health care lobbyists, the
Partnership touted its influence over Danny O'Connor, the Columbus,
Ohio-area Democrat who ran for the 12th Congressional District, claiming
that O'Connor used Partnership talking points "in national news interviews."
(O'Connor's campaign did not respond to a request for comment.)

Several of the candidates who agreed to embrace the Partnership's messaging
and policy ideas, including Donnelly and O'Connor, came up short on Election
Day. A recount ending on November 18 confirmed that Nelson received fewer
votes than Republican challenger Rick Scott. But soon after Election Day
results came in, the Partnership went on the offensive, informing reporters
that candidates who embraced "Medicare for All" had also lost, pointing to
the defeat of progressives such as Kara Eastman in Nebraska. The group also
relied on research from the business-friendly Democratic think tank Third
Way to argue that victorious pro-"Medicare for All" candidates couldn't
attribute their success to having supported "Medicare for All" because few
Democrats explicitly mentioned the policy in their campaign advertisements.

"'Medicare for All' didn't win," said Joel Kopperud, the vice president of
government affairs at the Council of Insurance Agents and Brokers, one of
the industry groups backing the Partnership. "I don't think that the Bernie
Sanders $32 trillion solution that's going to eviscerate the insurance for
156 million Americans is really something that's going to be helpful to the
party in critical states," he added in an interview with The Intercept.

Kopperud represents insurance brokers who sell employer-based health
insurance coverage. He noted that his organization has a vested interest in
backing the Partnership. "Medicare for All," as some envision the policy,
would eventually eliminate the need for most health insurance plans - a
death knell for companies represented by the CIAB.

Private health care lobbyists are confident that they can prevent any
federal expansion of Medicare in Congress, given Republican control of the
Senate and the White House. In the states, CIAB and other private health
groups have  <https://theintercept.com/2016/05/03/single-payer-dems-colo/>
easily defeated measures to develop single-payer proposals, such as the
ColoradoCare ballot question in 2016.

But the political calculus could be changing. Recent election gains by
Democrats in state government could create new opportunities for proponents
of expanded government-backed health care initiatives. Gov.-elect Gavin
Newsom of California campaigned on single payer and is expected to have one
of the largest Democratic supermajorities in recent memory in the
legislature, though California has a notoriously complex state constitution
that would likely require an amendment before any significant government
plan could be created.

The growing momentum for "Medicare for All" could raise expectations for the
next time Democrats are in full control of power in Washington, industry
groups worry. They are already pressuring conservative-leaning caucuses in
the House of Representatives, such as the Blue Dogs and New Democrats
Coalition, to push back against insurgent progressives' demands.

https://theintercept.imgix.net/wp-uploads/sites/1/2018/11/summer-1542238105.
jpg?auto=compress%2Cformat&q=90&w=1024&h=719

A slide from Partnership for America's Health Care Future presentation.

Reframing the Debate

For industry opponents of expanded government health insurance, there are
two main challenges. One is combatting growing public support for the idea.
The other is shaping elite opinion within the Beltway.

Over the last two years, several opinion surveys show
<http://nymag.com/intelligencer/2018/08/new-poll-majority-of-gop-voters-supp
ort-medicare-for-all.html> rising support for expanding Medicare. In March,
the Kaiser Health Tracking Poll found that 59 percent of Americans support
the idea, and by August, a poll conducted by Reuters-Ipsos found an
astounding 70 percent of Americans support "Medicare for All," including a
majority of self-identified Republicans.

But the Partnership is quick to zero in on research that shows support for
the idea drops precipitously when respondents are told that the plan would
require ending employer-based coverage, tax increases, and increased
government control.

The campaign has worked with advertising agencies to draw up a series of
messages to convince select audiences. Several of the messages, categorized
as "positive," are dedicated to educating the public on more minimal reforms
that do not include expanding Medicare. Other messages, categorized as
"persuasion" and "aggressive," are designed to instill fear about what could
happen if "Medicare for All" passes.

In the coming weeks, the Partnership plans to ramp up a campaign designed to
derail support for "Medicare for All." The group, working with leading
Democratic political consultants, will place issue advertisements to target
audiences, partner with Beltway think tanks to release studies to raise
concerns with the plan, and work to shape the public discourse through
targeted advocacy in key congressional districts.

The Partnership has tapped consulting firms with deep ties to Democratic
officials. Forbes-Tate, a lobbying firm founded by former officials in
President Bill Clinton's administration and conservative Democrats in
Congress, is managing part of the Partnership coalition. Blue Engine Message
& Media, a firm founded by former campaign aides to President Barack Obama,
has handled the Partnership's interactions with the media.

In one planning document circulated over the summer, the Partnership
suggested a series of messages to wean Americans away from supporting single
payer. The talking points emphasize that the current system provides
"world-class care," and that any move away from the Affordable Care Act
would be "ripping apart our current system."

The strategy exploits familiar themes that have long been used by business
groups against new government health care programs, calling for allies to
say lines such as "bureaucrats in DC have no understanding of a person's
medical situation and will be making decisions about your health care
instead of doctors."

The Partnership plans to form a speakers bureau of former Democratic elected
officials who can leverage the media to make the case that expanding
Medicare is bad politics and policy. The memo names former Democratic
Majority Leader Tom Daschle, now a health insurance lobbyist at the law firm
Baker Donelson, as one such potential surrogate.

The memo points to early success in shaping media coverage, citing several
"earned media" columns such as
<https://www.hoosiertimes.com/herald_times_online/opinion/fix-don-t-scrap-af
fordable-care-act-protections/article_4d35fa7d-d251-588f-847e-504107a582ac.h
tml> one published in August by former Rep. Jill Long Thompson, D-Ind.,
which argues that Democrats should only focus on small reforms to the
Affordable Care Act, and warns against wasting political capital on pursuing
a "government-controlled health insurance system." Thompson, now an
associate professor at Indiana University Bloomington, did not respond to a
request for comment.

Adam Gaffney, president-elect of Physicians for a National Health Program, a
national coalition that advocates in favor of "Medicare for All," said he is
not surprised by the messaging.

"What we're seeing is the wages of success: With single payer on the rise,
it was only a matter of time before the insurance companies, big pharma, and
other big-money groups came out swinging," said Gaffney, who also serves as
an instructor at Harvard Medical School.

"The smear of 'socialized medicine' has been used a thousand times and has
lost its bite," he added.

https://theintercept.imgix.net/wp-uploads/sites/1/2018/11/achieved-154223809
1.jpg?auto=compress%2Cformat&q=90&w=1024&h=682

A slide from Partnership for America's Health Care Future presentation.

Influencing the 2020 Democratic Field

"We're all focused on 2020," Lauren Crawford Shaver, a partner at
Forbes-Tate who is helping to manage the Partnership campaign, recently told
the National Association of Health Underwriters in a podcast produced by the
group.

Shaver, a former top staffer for the Hillary Clinton presidential campaign,
explained to the group that she is working to peel support away from the
"Medicare for All" bill sponsored by Sen. Bernie Sanders, I-Vt. The Sanders
bill is currently sponsored by several rumored 2020 Democratic presidential
candidates, including Sens. Elizabeth Warren, D-Mass.; Kamala Harris,
D-Calif.; and Kirsten Gillibrand, D-N.Y.

"The No. 1 thing we need to focus on is that there are a lot of likely
candidates that currently support the Senate bill," said Shaver. "We need to
make sure we educate the public, we educate both parties, and we educate all
the campaigns about both the policy and political challenges."

Shaver encouraged health care companies concerned about the growing
popularity of "Medicare for All" to mobilize opposition among clients,
customers, and employees. Industry groups will likely have workers or
customers residing in key districts who can be tapped to influence wavering
lawmakers on Capitol Hill.

The Partnership plans to "take stories of how these proposals would directly
impact your clients and the constituents of the policymakers who are voting
for or against these proposals," Shaver said.

The Partnership strategy
<https://thinkprogress.org/leaked-memos-reveal-ahip-is-recycling-playbook-ag
ainst-michael-moore-to-derail-health-reform-f5d0b35e9cff/> echoes the health
insurance industry's campaign to shape the 2008 presidential primary. At
that time, the health insurance lobby group known as America's Health
Insurance Plans, or AHIP, tapped the consulting firm APCO to develop an
effort to label any government-run insurance option as an existential threat
to Democratic political goals. The initiative emerged from a plan to
minimize the impact of Michael Moore's documentary "Sicko," which was deeply
critical of the American health care system.

The campaign involved planting studies with think tanks, mobilizing pundits
on television, and sponsoring YouTube videos on "the horrors of
government-run systems," among other publicity tactics. The APCO-crafted
blitz leaned on right-wing voices such as Fox News pundit John Stossel,
conservative think tanks like the American Enterprise Institute, and
centrist Democratic groups such as the Democratic Leadership Council, a
now-defunct group associated with the Third Way. The 2008 campaign adopted a
two-pronged strategy: position private health insurance as the only positive
solution to America's health care woes and "disqualify government-run health
care as a politically viable solution."

Now, the same lobby groups are involved in a similar effort. AHIP, the
insurance trade group behind the 2008 plan, is also a sponsor of the
Partnership's 2020 campaign, along with the Federation of American
Hospitals, Pharmaceutical Research and Manufacturers of America, the Blue
Cross Blue Shield Association, the Biotechnology Innovation Organization,
and the American Medical Association.

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Not only are the same health insurance groups financing a renewed campaign
against "Medicare for All," but many of the same players who worked to
undermine the public option during the ACA debate are now fighting for
influence within the party. The public option was the government-run
insurance plan that advocates intended to use to compete with private
insurance and bring down consumer costs. In one version of the plan, the
public option would pay doctors and other providers the same reimbursement
rates as Medicare.

Despite a pledge by many Democratic candidates to eschew corporate PAC
donations, health care lobbyists have
<https://www.fec.gov/data/receipts/?two_year_transaction_period=2018&cycle=2
018&data_type=processed&committee_id=C00409730&min_date=01%2F01%2F2017&max_d
ate=11%2F14%2F2018&line_number=F3X-11C> funneled cash to many incoming
lawmakers through the New Democrats PAC, the Blue Dog PAC, and other
centrist committees. Unsurprisingly, the centrist New Democrats Coalition,
the caucus of business-friendly centrist Democrats, has worked to depress
momentum for "Medicare for All," reprising the role centrist Democrats
played in killing the public option during the Obama administration. In
2009, then-Sen. Joe Lieberman, I-Conn., a founding member of the New
Democrats caucus,
<https://slate.com/news-and-politics/2009/10/did-sen-joe-lieberman-just-kill
-the-public-option.html> threatened to join the Republican filibuster
against health reform unless the public option was dropped from the bill.

Immediately following the midterm elections this month, the Washington Post
<https://www.washingtonpost.com/opinions/dont-let-progressives-fool-you-mode
rate-democrats-can-win/2018/11/07/37648218-e2b1-11e8-ab2c-b31dcd53ca6b_story
.html?utm_term=.db81c2ba7d41> published a column by Third Way warning that
"Medicare for All" "failed the Hippocratic Oath" because opposition to the
plan helped Republican candidates, thus causing "harm" to the long-term
health interests of voters.

But advocates for "Medicare for All" are feeling optimistic.

"In terms of tactics, it sounds like they will just be updating the same
lines they used in the 1990s to sideline reform efforts and in the ACA fight
to keep single-payer health care off the table," said Eagan Kemp, a health
care policy advocate with Public Citizen. "The Partnership for America's
Health Care Future would be more accurately titled the 'Partnership for
Profiting Off America's Health Care.'"

Private health care interests will certainly have much more money, media
attention, and political resources with which to campaign. Advocates,
however, are hoping Americans see past the public relations smokescreen and
support health care as a human right.

"There is no brand loyalty to insurance companies, which are rightly seen as
parasitic," Gaffney, the PNHP leader, said.

"Once single payer is widely understood as a program that covers everyone,
that doesn't impose copays and deductibles, that has more comprehensive
benefits than existing plans, and that doesn't employ restrictive insurance
'networks,' support will only grow," he added.

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