Depending on which numbers you believe, somewhere between 500,000 and 750,000 Massachusetts residents have no health insurance. Some — call them the young pups (this writer was once among them) — are in their 20s, generally healthy, and scraping by on part-time and contract jobs at which they don’t qualify for benefits. Others — call them the working screwed — toil for employers such as Wal-mart or stop and shop that don’t offer them a company health plan. Members of both groups are often unable or unwilling to pay the high premiums for individual coverage.
Neither group is well represented on Beacon Hill. What happens to them — to you, if you fall into either group — is being decided by well-connected folks with very real financial interests of their own. The final result — a comprehensive bill reforming the state’s health-care system — could be released by the time you read this, and it could become law soon after.
So who are these people who hold your fate in their hands? Health insurers, for one. They want to force the Young Pups to buy insurance. Why? Because that group pays far more in premiums than they take out in health-care costs. But many large companies have a different agenda. So do hospitals and other health-care providers. In fact, almost every interest group in the state has some stake in how this shakes out.
In fact, more than five dozen organizations, ranging from the First Church of Christ Scientist to the New England Convenience Stores Association, lobbied on the bill last year.
“This is the World Series for lobbying,” says John McDonough, executive director of Health Care for All, which lobbies for universal health care.
Instead of two teams, however, a multitude of competing interests are in play, and that has helped stall the legislation — which legislative leaders promised to complete by last November, then by the new year, and then by more deadlines that have come and gone.
In a nutshell, the House version of the bill would cover almost everybody in the state, and it would pay for the bill by taxing companies that don’t fully cover their own employees. The Senate wants a more modest plan, without any tax on business.
The logjam appears finally to be broken — not by consensus, and not by legislative initiative, but by a core group of power lobbyists. At the start of this month, they came up with a compromise: instead of a tax, businesses would pay an assessment, or levy, of $295 per uninsured employee. That money would fund incentives and financial assistance so that most of the uninsured could afford insurance.
The question is, do those core supporters have enough clout to get it passed, or will others block it once they see the final version?
The answers lie in the rosters of lobby groups and PACs that spent more than $5 million on the legislation last year, and continue to spend. So, who are they, and what are their real interests? We’ve put them into five groups, in order of their power.