Within health care advocacy group, disagreement on details

Monday, February 16, 2009 | 7:49 p.m. CST; updated 11:29 a.m. CDT, Thursday, September 3, 2009

WASHINGTON — Labor unions and business groups have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation's health care system. But as they get down to the specifics, their strange-bedfellows alliance is quietly at odds.

After spending two years and more than $20 million to promote the idea, collaborators in the Divided We Fail coalition — a project of the seniors lobby AARP, the service workers' union and groups representing small business and the Fortune 500 — are indeed divided over key elements of how to fix health care.

Its members agree that something should be done to revamp health care in the United States, and there's consensus on a vague set of general principles that include making coverage more accessible, affordable and efficient. But they differ over important details, including what roles the government and private businesses should play.

The emerging rifts highlight how difficult it will be for Obama and the Democratic-run Congress to deliver what they say they are committed to: a health care overhaul that would guarantee everyone affordable coverage.

They also illustrate the limits of one of lobbyists' favorite tactics: banding together with partners to try to build support for a top priority. Such alliances are born and die all the time in Washington, often falling victim to internal disputes over policy. Even the ones that fizzle, however, can give those in charge a seat at the negotiating table.

If nothing else, "it's fantastic public relations," said Bob Laszewski, a health care policy consultant. "What you're doing is you're putting some political credibility, some political capital in the bank for (when) the tough days come."

Obama campaigned on, among other things, the promise that he would bring Democrats and Republicans together on health care and cut special interests out of the debate. Reform will stall as it has in the past, he said in one TV ad last year, "unless we end the bickering and the lobbyists."

The Divided We Fail group launched in 2007 with a similar message, stressing its bipartisan nature with a logo, a creature named Champ, which is an amalgam of the Democratic donkey and the Republican elephant. Its purple hue is meant to signify a melding of the two parties' primary colors.

The coalition is led by a handful of Washington's most influential lobbyists — Bill Novelli of AARP, John J. Castellani of the Business Roundtable and Dan Danner of the National Federation of Independent Business — as well as Andy Stern of the Service Employees International Union, among the most politically active groups in organized labor. Together, their organizations spent more than $45 million lobbying Congress in 2008 — more than half of that by AARP alone.

The group aired TV ads calling on the presidential candidates to embrace affordable, accessible health coverage, collected pledges from more than two-thirds of Congress backing it and held events in states across the country to rally support. It recently launched its "drive for solutions," including a new TV spot saying Obama is "ready to lead," and, "we're ready to help."

Because of their clout and their organizations' disparate memberships, its leaders argue, the coalition is uniquely positioned to make a public case for health care reform, privately lobby Congress on the plan and ultimately sell it to voters.

"It's an inside-outside game," Novelli said.

They acknowledge, however, that keeping the coalition together is getting more difficult as Obama and Congress prepare to delve into specifics.

"We're moving down from 30,000 feet ... to 1,000," SEIU's Stern said. "The next thousand is bumpy."

For instance, labor unions and liberal groups are pressing for a universal health coverage system in which the government provides insurance that competes with private plans. SEIU wants to give everyone health benefits similar to those enjoyed by federal employees. It backs Obama's "pay or play" idea of forcing employers to either offer health insurance to their workers or pay a fee so they can get it elsewhere.

The Business Roundtable and National Federation of Independent Business, on the other hand, want a system based mostly on private health insurance and are against new requirements for employers. The Business Roundtable's members include health-insurance giants CIGNA, Aetna and Humana, all of which would have to compete with the government if labor got its way.

There's also a fight brewing between private insurers and consumer groups over how to ensure that everyone is covered. Insurers say they'll agree to accept any patient regardless of pre-existing health conditions — but only if everyone is required to buy coverage. Consumer groups say that would turn the government into a collection agency for private insurance companies.

While the disparate groups trumpet their alliance in public, negotiations on such issues are brewing behind closed doors, said Joseph Antos, a health analyst at the conservative American Enterprise Institute. "You start off by being congenial and agreeable," he said, "so you can get into those meetings where you say, 'This is the way we need to have it work — or else.' "

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