Health Care Lobbyists Are Trying to Block the Public Option at the State Level

By Julia Rock, Jacobin

21 May 21

Joe Biden said on the campaign trail he would fight for a public option for health care. He hasn't — leaving health insurance companies, hospitals, and pharmaceutical companies to work overtime to block states from passing their own public options.

hen President Joe Biden outlined his legislative priorities during his first address to Congress last month, notably absent was a major campaign promise: a public health insurance option. Instead, his current health reform proposal will funnel $200 billion more to private insurance companies to subsidize premiums, without any requirement that they cap out-of-pocket costs or eliminate them altogether.

As a result of Biden’s approach, states have been left to introduce public option legislation themselves, in the process taking on some of the nation’s largest and most politically organized businesses. From coast to coast, health insurance companies, hospitals, and pharmaceutical companies are using every tactic at their disposal to block states from passing public option legislation.

Such efforts show how determined the industry is to block any sort of reform that threatens its massive profits.

In particular, the Partnership for America’s Health Care Future Action (PAHCF Action), the state arm of the dark money group that has opposed Medicare for All and a public option at the federal level, has spent millions of dollars on TV ads and mailers in Colorado, Connecticut, and other states where public option bills are being considered. The group has spent more on lobbying in Colorado in 2021 than any other organization since 2011, and possibly ever.

As a result, the actual public option component of the Colorado legislation was removed in an agreement made with the hospital industry. What’s left of the bill is a requirement that private insurers offer so-called “standardized” health insurance plans and cut premiums on those plans by 18 percent over three years. Despite the overhaul, the industry has continued to oppose the plan.

“It’s a little intriguing to me that this is becoming such a big deal, because the bill is actually very narrow,” Rep. Dylan Roberts, the lead sponsor of the Colorado legislation, told the Daily Poster/Newsweek, before the bill was watered down. He added, “It’s not a total overhaul of the health care system in Colorado or in the United States by any means. So the opposition to me is a little intriguing on that front.”

Lobbyists Gut Colorado Option

In Colorado, PAHCF Action is smashing state lobbying records by spending millions of dollars to kill its public option proposal. The organization is running a full-scale advocacy campaign, blanketing the television airwaves and filling people’s mailboxes with propaganda.

While PAHCF Action’s donors are not public, its board includes top executives from lobbying groups for investor-owned hospital chains and health insurers.

The organization’s president is Chip Kahn, who leads the Federation of American Hospitals. His group lobbies for hospital chains like HCA Healthcare and Tenet Healthcare.

HCA reported $3.5 billion in profit last year, and its CEO made $83.6 million, according to Axios. The hospital chain owns seven hospitals in Colorado, including one that drew national headlines in 2019 for billing an emergency room patient more than $12,000 to treat a hangover after his bachelor party.

While HCA does not disclose its political contributions, Tenet has reported donating nearly $2.9 million to PAHCF between 2018 and 2020, according to company political spending disclosures. Tenet has a dozen surgery centers in Colorado, according to its website.

PAHCF Action’s secretary is David Merritt, a senior executive at America’s Health Insurance Plans (AHIP), which lobbies for big health insurers like Aetna.

CVS Health, which owns Aetna, donated $5 million last year to the national Partnership for America’s Health Care Future (PAHCF), according to reporting by the Intercept.

The dark money group isn’t alone: 149 individual lobbyists in the state are registered as opposing the legislation. These lobbyists represent AHIP, Anthem Blue Cross and Blue Shield, Cigna, UnitedHealth Group, and Kaiser Permanente, among other corporate interests. Americans for Prosperity, the Koch network’s political advocacy arm, has sixteen lobbyists alone registered in opposition of the bill.

These influence peddlers have already had significant success. Last year, lobbyists helped kill a public option proposal in the state. This year, legislators proposed a scaled-down version of the public option plan, one that would allow the state to set up a public option in two years if private insurers failed to set up standardized plans that meet certain cost criteria.

But even this legislation was derailed by special interest groups. In late April, lawmakers removed the public option component from the bill following negotiations with insurance industry lobbying groups and the Service Employees International Union (SEIU) of Colorado, which opposed the bill. The SEIU Local 105 argued that the premium-cutting measures in the legislation would lead to layoffs of health care workers at hospitals.

“Even as the bill has changed, they’ve had the same generic talking points about a government takeover of health care that doesn’t reflect what’s actually in the bill,” Roberts said.

The health care industry still opposes the bill, even in its weakened state.

On May 12, two days after the modified bill passed the Colorado House, the Taxpayers Protection Alliance (TPA), a Koch-affiliated political advocacy group, announced an “ad blitz” to oppose the legislation as it moves forward. Their so-called “No Big Handouts for Big Insurance” campaign will involve a statewide ad campaign targeting the rate-setting element of the legislation, according to a TPA press release.

The idea that big insurers would benefit from the legislation is more than a little dubious, given that health insurance lobbyists are helping lead the campaign to kill it.

Standoff in the Insurance Capital

Connecticut has long been a flash point in the battle over a public option. Hartford, the state capital, is known as the “Insurance Capital of the World,” because a number of the world’s largest insurance companies — Cigna, The Hartford, Chubb, and until recently Aetna — are headquartered there, and are also major employers.

The industry has used its presence in the state as leverage to kill public option efforts. In 2019, Cigna reportedly threatened to leave if the state passed public option legislation. Between that threat and a massive lobbying effort by the insurance industry against the legislation, the bill never passed.

Now the industry is doing it again. Last month, the CEOs of Anthem, Cigna, CVSHealth, Tufts Health Plan, Harvard Pilgrim Health Care, and UnitedHealth Group wrote a letter to Connecticut Gov. Ned Lamont, thanking him for opposing the legislature’s public option legislation and implicitly threatening to leave the state if it passes.

“The pandemic has demonstrated that employees can work virtually, making it easier for companies to choose where they are domiciled and grow,” the letter said. “As a result, it has never been more critical for the State to create a climate that retains and attracts businesses that will help stabilize the economy. All of us will have to decide where it will be best to deploy our resources long term. Private employers and taxpayers should not fund unsustainable public policy pursuits.” (When CVS acquired Aetna in 2018, it promised to keep Aetna headquartered in Hartford for at least a decade, and retain its staffing levels at least until 2022.)

UnitedHealth Group, whose CEO signed the letter to Lamont, held a webinar in February to train its employees to lobby against the legislation, the Daily Poster previously reported. According to the PAHCF Action’s first quarter lobbying report in Connecticut, the group has spent roughly $126,000 on lobbying so far this year, including about $95,000 on compensation and $31,000 on solicitations.

Beyond PAHCF Action, health insurance companies and businesses are also engaged in lobbying through other front groups or direct lobbying on the public option legislation.

The Connecticut Hospital Association, whose members include dozens of hospitals as well as insurance companies such as Anthem Blue Cross & Blue Shield and Harvard Pilgrim Health Care, has spent $296,000 on lobbying during the first quarter of this year, according to state filings.

Meanwhile, the Connecticut Association of Health Plans has spent $133,000 on lobbying and $1,200 on paid media during the first quarter of this year, according to state filings. The group’s president is Tim Meyers of Aetna, the insurance giant owned by CVS, and its treasurer and secretary work in government relations for ConnectiCare and Harvard Pilgrim Health Care, respectively.

The opposition’s talking points don’t reflect what the bill would actually do, says Tom Swan, the executive director of the Connecticut Citizen Action Group, a group advocating for the public option legislation. “A lot of their campaign is just railing against a bill that doesn’t exist,” Swan said.

“They’re saying, ‘don’t let them do a one-size-fits-all health insurance option,'” said Swan, who added that in truth, the bill includes multiple different public option plans and does not interfere with the private insurance industry’s capacity to operate.

Without action on health care at the federal level, more states may try to take on the health care industry and its national advocacy groups themselves.

Nevada, a state with one of the highest uninsured rates in the nation, recently introduced its own public option bill — and PAHCF Action immediately launched an operation to kill it.

How Pramila Jayapal Views the Biden Administration

By Peter Slevin, The New Yorker

21 May 21

The leader of the Congressional Progressive Caucus has been surprised by how much she agrees with the President.

s Joe Biden laid out a grand vision for his Presidency, in a speech before Congress late last month, cameras caught Representative Pramila Jayapal standing and applauding. Behind her face mask, she later told an aide, she was smiling. This was not the Joe Biden whom progressives like Jayapal expected to see when he meandered out of the Democratic pack and vanquished their champions, Bernie Sanders and Elizabeth Warren, in last year’s primaries. That was the avuncular centrist who persuaded enough voters that he was the safe choice to beat Donald Trump in November. But this Joe Biden is going much, much bigger. As Jayapal said, “President Biden has risen to the moment, and I really do give him an ‘A’ in what he’s done so far. It’s been bold, it’s been progressive, it’s been what the country needs.”

Jayapal is the leader of the Congressional Progressive Caucus, whose ninety-five members have found themselves, to their surprise, pushing on an open door in the early months of the Biden Presidency. After years of frustration with the incrementalist approaches of the Party’s most powerful Democrats, they are backing a White House occupant who is pursuing progressive priorities more strongly than any President since Lyndon Johnson or Franklin Roosevelt. Biden’s agenda has only grown more ambitious, evident in his endorsement of federal legislation on voting rights and police reform; his $2.25 trillion jobs, infrastructure, and climate plan; and, now, his $1.8 trillion American Families Plan. “It feels like we’re actually doing what we came to Congress to do,” Jayapal said, when we spoke recently.

Jayapal was working from home, in Seattle, in early February, with the chatter of cable news in the background, when Biden stepped to a White House lectern to tout his American Rescue Plan and its $1.9 trillion in spending. He laid out the benefits, including relief checks, rental assistance, money for child care, and family leave—plus billions to cities, states, and small businesses. Though the principal motivation was the continuing fallout from COVID-19, this was a wholehearted White House endorsement of spending priorities that Jayapal and her colleagues on the left of the Democratic Party had long advocated. But she really perked up when she heard Biden say, “The biggest risk is not going too big. . . . It’s if we go too small.” Jayapal called across the room to her husband, “That’s our line! He used our line!”

Embarking on Democratic control of the White House and Congress for the first time in a decade, Jayapal had been urging Party leaders to use the phrase and ditch the cautious solutions that had defined the Presidencies of Barack Obama and Bill Clinton. With slim majorities in the House and the Senate, the Senate filibuster stands in the way. Jayapal favors invoking procedural maneuvers—such as the budget-reconciliation process, if possible—or reforming or eliminating the filibuster, if necessary. Jayapal told me, “We can’t go back to voters and say, ‘You know what, I’m really sorry, but there are these racist, arcane Senate procedures that stopped us from doing what we said we would do if you gave us the House, the Senate, and the White House.’ ” In other words, go big, even if it means that Republicans may benefit when they next take charge of the upper chamber. “For anybody who says, ‘Well, then what happens if the Republicans are in power and then we don’t have any backstops?,’ I’d say, ‘If we don’t do this, they will be in power.’ ”

On April 21st, she and Sanders introduced the College for All Act, which would eliminate tuition and fees at public colleges and universities, and also at nonprofit historically Black colleges and universities, for families earning less than a hundred and twenty-five thousand dollars a year. It would also double the size of Pell Grant awards, to nearly thirteen thousand dollars per year, and make community colleges and public trade schools free. This is significantly more ambitious than Biden’s American Families Plan. According to details released last month by the White House, Biden’s proposal would deliver two years of free community college, an increase of fourteen hundred dollars in Pell Grant awards, and thirty-nine billion dollars in income-based tuition support for students attending H.B.C.U.s and other colleges that serve tribal and certain other minority communities. “It’s a progressive moment,” she told me. “It’s a populist moment. It’s an urgent moment.”

Jayapal, who is fifty-five, is serving her third term in Congress. Born in Madras, now Chennai, she grew up in India, Singapore, and Indonesia; arrived in the United States, at age sixteen, to attend Georgetown University; and eventually became a naturalized U.S. citizen. After earning an M.B.A. and working in the private sector, she spent nearly a decade working on health-equity issues for PATH, a global nonprofit. The backlash against immigrants of color, including Muslims, Arab Americans, and South Asians, following the September 11th attacks, prompted her to establish Hate Free Zone, now known as OneAmerica, a Seattle-based immigrant-rights organization that she ran for a dozen years. She won a seat in the Washington State Senate, in 2014, and in the U.S. Congress two years later. A backer of Medicare for All, during the Trump Administration she prodded Democrats to move beyond what she called “murky moderation.”

In 2020, Jayapal supported universal health insurance and chaired Sanders’s health-policy team, but her hopes for a progressive turn were muted after Biden won the nomination. She became more hopeful last summer, after leading the Biden-Sanders health-care-policy committee, when Biden unexpectedly pledged support for an array of progressive ideas. To apply pressure, Jayapal and her colleagues in the Congressional Progressive Caucus announced, in December, a sweeping set of priorities that stretched from cancelling student debt and restructuring tax policy to ending the war in Afghanistan. Yet, even after Jon Ossoff and Raphael Warnock won their Georgia runoffs, shifting Senate control to the Democrats, she wondered whether a party pinned to the middle ground for decades would budge. “Would we actually deliver?” she asked herself.

By every indication, Biden aims to deliver, guided by what is fast becoming the animating principle of his Presidency: an expanded, activist role for the federal government as funder, incubator, regulator, agenda setter, and service provider. “Government must be a powerful force for good in the lives of Americans,” Brian Deese, the director of the National Economic Council, told the Wall Street Journal. He also said that the Administration would be “unapologetic” about a particular point, and there was that phrase again: “The risk of doing too little outweighs the risk of doing too much.”

Biden himself has generally avoided press conferences and interviews, but he is defending his policies in controlled settings. His speech to Congress, lasting slightly longer than an hour and delivered in muted tones, was the fullest description of his vision he has yet offered. (He ended by saying, “Thank you for your patience.”) He spoke of the need to demonstrate the resilience of American democracy, after the transgressions of the Trump Administration and the former President’s followers, but one could substitute the word “government.” “In our first one hundred days together,” he said, “we have acted to restore the people’s faith in our democracy to deliver. We’re vaccinating the nation, creating hundreds of thousands of jobs. We’re delivering real results—people, they can see it, feel in their own lives.”

One sign of the challenges that Biden will face in gathering support for his agenda—and maintaining Democratic control of Congress next year—is clear in the findings of a Washington Post-ABC News poll, conducted in mid-April. Fifty-three per cent of all respondents said that they are worried that he will “do too much to increase the size and role of government.” As Biden addressed Congress, a fund-raising e-mail from the Republican National Committee popped into my in-box, with the subject line, “Are you watching Biden’s speech?” I was. It read, in a style that typified the R.N.C. during the Trump era, “You don’t have to sit through Joe Biden’s speech to know he’s a member of the Radical Left and wants to force his BIG GOVERNMENT SOCIALIST agenda on the entire Country.” The e-mail asked for a donation as evidence that “the American people see through his LIES.” Similar house-on-fire messaging, echoed by like-minded pundits and media outlets, boosted Republicans last year in large swaths of the country.

When I asked Jayapal about this line of attack and its potential impact on the 2022 midterm elections, when—history suggests—the party in power will lose lustre, and seats, she was blunt. “They’re going to do that, no matter what,” she said. “Every President that passed a major program that is enormously successful, whether it’s Medicare or Social Security, or pushed for those things, was called a socialist.” The surest way to counter the invective and the labels, she said, is to deliver results that improve voters’ lives. “The only thing that’s going to work for us as Democrats is to actually push ideas that are populist,” she said. “What would’ve happened if we had passed a fifteen-dollar minimum wage five or six years ago? Would we have lost all these voters to Donald Trump?”

Any number of Republicans would like to lay claim to voters who turned out for Trump and helped elect down-ballot G.O.P. candidates. Increasingly, they are appealing to populism. Marco Rubio, the Florida senator, has lambasted mostly unidentified corporate big shots as hypocrites who are “waging a merciless war against traditional values.” Ted Cruz, his Texas counterpart, has called himself a populist with “deep libertarian principles.” He told the Washington Examiner, last year, “Republicans have become the party of the working class.”

At the head of the purportedly populist class is Josh Hawley, of Missouri. He led the Senate opposition to certifying Biden’s clear victory, and he raised objections even after rioters invaded the Capitol. Almost two years ago, at the National Conservatism Conference, he attacked “cosmopolitan priorities,” “cosmopolitan elite,” and the “globalizing and liberationist policies of the cosmopolitan agenda.” At this year’s Conservative Political Action Conference, he lumped together “corporate America and the radical left.” On May 4th, he released a book, blurbed by Tucker Carlson and J. D. Vance, called “The Tyranny of Big Tech,” building on the thinking that led him to introduce an antitrust bill attacking large technology firms. (Adding a culture-wars edge, he called them, in a press release, “Woke Big Tech companies like Google and Amazon.”)

Jayapal recalled, with approval, Hawley’s support of government pay for workers early in the COVID-19 outbreak, and his partnership with Sanders on a new round of stimulus checks. But, she added, “It’s a selective populism,” noting that Hawley joined every other Republican in Congress in opposing Biden’s rescue package, and that he supports policies, including the Trump-approved tax cuts, that “transfer wealth to the wealthiest, even more than the economy already does.” Representative Marie Newman, of Illinois, a progressive Democrat, was more succinct. She would tell Hawley, “You’re against fifteen dollars an hour. You’re anti-union. Please let me know how you are pro-worker, and then I’ll have a discussion with you.” (Hawley has introduced a bill that would require companies with revenues of a billion dollars or more to pay a fifteen-dollar minimum wage.)

Ro Khanna, a co-chair of Sanders’s 2020 campaign and a deputy whip of the Congressional Progressive Caucus, represents Silicon Valley and calls himself a “progressive capitalist.” He considers Biden’s endorsement of government-driven solutions and public-sector investments a welcome corrective to neoliberalism and Clinton’s declaration, in 1996, that “the era of big government is over.” But he says that the Democratic leadership “has not found the best way to push back on the Republican messaging about the economy.” When we spoke, he launched into a nuanced argument that “free-market absolutism” has led to brick-and-mortar bankruptcies, the decline of small towns, and policies that privilege speculation over productive investment. Lost somewhere in the neoliberal model, he said, is a commitment to the common good. And, lost somewhere in his description, he later conceded, is a tight message. “Now, I’m sure that’s a little bit too convoluted,” he said, “and we have to narrow it further. We have to be the Party that says, ‘We’re about rebuilding America, we’re about growth, we’re about opportunity.’ ” (Or, as Newman put it to me, “How about we just deliver and we keep our message super-simple: ‘Shots in arms. Jobs for people. Money in pockets.’ ”)

Khanna credits Biden with moving to the left and recognizing the staying power of “the ascendant progressive movement” and the fact that many Americans are upset with “fundamental inequality.” But he sees a tension between the power moves required by Biden to transform the economy and the President’s conviction that he was elected to find common ground and heal the country. “We’ve got a long way to go,” he said, “before we can proclaim this the next progressive era.”

Jayapal does see something “transformative” in the way Biden perceives the role of government as an equalizer of opportunity. Even the starting points, she said, represent a “huge shift.” “Part of the reason we lost people is because we didn’t deliver for them,” Jayapal told me. “If we can really deliver on a big infrastructure package, if we can really deliver on things like paid leave and child care,” she said, voters will “wake up and feel different about what opportunity the world offers them.”