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Mixed Agendas Divide Health Coalition Effort

In 2007, four groups representing small and big business, labor and senior citizens joined forces to promote the need to revamp the health care system.

The creation of Divided We Fail was an indication that powerful competing interests that had in the past contributed to thwarting health care reform were ready for a truce. But with the Senate and the House now on the verge of bringing historic legislation to a vote, this diverse coalition is not exactly unified.

Instead, each of the four members — the Business Roundtable, the National Federation of Independent Business, AARP and the Service Employees International Union — has been actively pursuing its own agenda on health care.

The statements issued by the organizations following Speaker Nancy Pelosi’s (D-Calif.) unveiling of the House health care bill last week underscored the gulf between them.

“Today the House brings us one step closer to a decades-long goal of repairing America’s broken health care system,— AARP Executive Vice President Nancy LeaMond said after the release of the plan.

But Brad Close, vice president of the NFIB, responded, “H.R. 3962 is the ‘how to’ on how NOT to do health care reform.—

The Business Roundtable also reacted negatively to the House plan as well as Senate Majority Leader Harry Reid’s (D-Nev.) earlier announcement that he was including a public insurance option in the Senate plan.

In contrast, the SEIU, along with other unions, has been among the most ardent supporters of the public plan.

Representatives from these groups say they always assumed that once health care legislation was drafted, their organizations might end up parting ways.

Nevertheless, they argue that they still are promoting the general notion of health care reform. And they still hold weekly staff phone conferences to discuss health care and other issues such as economic security.

“It has not fallen apart,— said Maria Ghazal, director of public policy for the Business Roundtable, of the coalition efforts. “We meet weekly.—

It is also not clear how much of a role the group has played in the past few crucial months in crafting legislation that has been the target of intense lobbying by everyone from drug companies to medical device firms and doctors.

But Ghazal points to President Barack Obama’s making health care a signature issue during his 2008 campaign and pushing legislation to dramatically overhaul the medical system during his first months in office.

“We can say we have been pretty successful at getting health care at the top of the list,— she said.

Ghazal added that Divided We Fail still agrees on some aspects of reform including cost containment, moves toward more information technology in the health sector, and wellness and prevention programs.

Other Divided We Fail members echoed her message.

“We all understood there would come a time we would have disagreements,— said Lori Lodes, a spokeswoman for SEIU. “We’re shifting to a different part of the debate where everyone is pushing for their specific priorities.—

“We each have our own piece of the pie,— said Stephanie Cathcart, spokeswoman for NFIB. “We knew that going in.—

Jim Dau, a spokesman for AARP, added: “None of this has been a surprise. We’re from groups that represent far different constituencies.—

Dau acknowledged the coalition was more visible in 2007 and 2008 when it underwrote media campaigns promoting the need for health care reform. Business Roundtable officials have estimated the ads cost in excess of $20 million.

However, the coalition has not run any advertising recently.

Dau said that, despite their differences, the groups are not giving up on seeking consensus.

“We’re still at the table,— he said.

AARP, which has spent more than $15 million on lobbying in the first three quarters of this year, has been among the most visible players promoting health care reform both on Capitol Hill and at town hall meetings around the country. While the group has been generally supportive of Democratic health care initiatives, it has been more vague about specific provisions. Dau said that the seniors’ group could accept a public option but has not embraced any one proposal yet.

AARP has lobbied on Medicare-related issues — such as filling gaps in prescription drug coverage — that are contained in both bills.

Up until recently, the Business Roundtable, whose membership includes the chief executives of major corporations, has stayed more in the background compared with some other health care stakeholders. The Business Roundtable spent $9.2 million on lobbying in the first three quarters of this year compared with $52.1 million by the U.S. Chamber of Commerce and $19.8 million by the Pharmaceutical Research and Manufacturers of America.

But as it became clear recently that the public option would be included in both the House and Senate versions, the Business Roundtable has become more public in its criticism.

In a phone conference call with reporters last week, Business Roundtable officials said they feared the government option would shift costs to employer-based private insurance plans.

“Our employees are happy with the system they have,— said Antonio M. Perez, the chairman of Eastman Kodak Co. and head of Business Roundtable’s consumer health and retirement initiative. Business Roundtable officials said they were more comfortable with the version approved by the Senate Finance Committee, which omitted the public option.

A high priority for the NFIB, which has spent $2.2 million on federal lobbying so far this year, has been to ensure that small businesses have access to small-group insurance markets that are currently prohibitively expensive, Cathcart said. The group also has opposed the mandate in the House bill that would require employers to provide health insurance. The NFIB is internally divided on a mandate that individuals buy insurance, a provision that is included in the Senate and House measures.

The SEIU, which has spent $2.1 million on lobbying so far in 2009, has enthusiastically supported many of the reform efforts but opposed provisions in the Senate bill that would tax expensive health plans.

Despite the differences, Ron Pollack, president of the liberal health care organization Families USA, said the significance of these “strange bedfellows— having come together at all, should not be underestimated.

“That is a sea change,— said Pollack, who was active in the unsuccessful fight for health care reform in 1994.