Both BCBSMA and Partners want increases in coverage: any way you slice it, more people covered means more business for BCBSMA, the largest health-insurance provider in the state, and more money for Partners, the largest health-care provider.

The business representatives in the core group — the Chamber, Taxpayers Foundation, Roundtable, and AIM — are internally conflicted. Most businesses provide health-insurance plans to their employees, and are getting screwed by those companies that don’t: those uninsured employees use a lot of health care they can’t pay for, and those costs get picked up by a special uncompensated-care fund, paid for by the insurance and health-care providers and ultimately passed along as higher premiums for companies that do contribute to health-insurance plans.

Both types of companies belong to these associations. One likes the status quo; one doesn’t. The associations’ solution has been to oppose mandatory employee insurance coverage, calling it a “slippery slope” principle that would eventually lead to excessive mandates on all companies.

2) Labor and the left
Committee for Health Care for Massachusetts; SEIU United Healthcare Workers East, local 1199; Health Care for All; Greater Boston Interfaith Organization
2005 lobbying and PAC expenses: $702,051

Led by John McDonough, the SEIU, and GBIO leaders, this group pulled off a brilliant gambit early in the process. It successfully secured an initiative for this November’s ballot, which would require actual universal health-care coverage for all citizens of Massachusetts.

ADVERTISEMENT

It would almost certainly pass, if it comes to a vote. Universal coverage, shunned by business interests, is the most popular approach by far among the public.

The threat of that initiative, everyone agrees, has put tremendous pressure on everyone who doesn’t want universal health care to get a law passed that will convince the initiative’s sponsors — gathered under the banner Affordable Care Today (ACT) Coalition — to drop it.

McDonough and others have not yet given their blessing to the new Core Group plan. If they don’t, expect a big, ugly fight.

3) Business
National Federation of Independent Business; Massachusetts Restaurant Association; Retailers Association of Massachusetts; New England Convenience Stores Association; CVS; various Chambers of Commerce
2005 lobbying and PAC expenses: $771,173

Back in December, 30 groups representing Massachusetts businesses — 400,000 employers altogether — joined forces to launch Massachusetts Businesses for Real Healthcare Reform. They went to the public with a $200,000 ad campaign opposing the payroll tax included in the House’s version of the reform bill.

The problem for these groups is simple and obvious, and can be gleaned from a state list, updated last month, of 83 companies with 250 or more uninsured employees in Massachusetts.

Counting up by industry, we find more than 12,000 uninsured people working for supermarkets, convenience stores, and pharmacies; nearly 10,000 working for restaurant and fast-food chains; more than 9000 working for department and clothing stores; and nearly 5000 working for temp agencies and cleaning services.

Needless to say, these companies don’t want the massive expense of providing insurance to their employees. Nor do they want to pay a tax for not providing insurance. Their best bet is to derail any bill — and so far they are opposing the Core Group compromise.

4) Health-care providers
Massachusetts Hospital Association; Massachusetts Medical Society; BayState Health System; Children’s Hospital; Boston Medical Center; Lahey Clinic; Mass Assisted Living Facilities
2005 lobbying and PAC expenses: $1,710,213

They represent the biggest and fastest-growing industry in the state, so nobody wants to do anything that might hurt their growth. That gives them tremendous power on Beacon Hill, where they are led by MHA president Ronald Hollander.

However, Hollander and the hospitals have been distracted by their fight against a potentially very costly bill for them: it would mandate nurse-to-patient staffing ratios.

For the most part, they have let the powerful Partners lobbyists — part of the Core Group — fight this fight for them.

But Partners has financial interests on more than one side of the reform legislation. In addition to being a health-care provider, Partners employs more than 1000 people who lack health insurance. So, mandating employers to provide health insurance would cost Partners a fortune.

The new compromise of a $295 levy per uncovered employee could cost Partners a half-million dollars next year — but the company would gain $13 million in increased reimbursements. Whether it will play out as well for smaller providers is less certain.

5) Health-plan providers
Massachusetts Association of Health Plans; Harvard Pilgrim Health Care; Vanguard Health Systems; Tufts Associated Health Plans
2 005 lobbying and PAC expenses: $671,434

MAHP president Marylou Buyse — an actual practicing doctor — does not have the long relationships with politicians that Jack Conners and Peter Meade do, but she does represent the groups that actually provide most of the health plans to the state’s residents.

Broadly speaking, Buyse and other plan providers want the state government to offer incentives to push more companies and individuals to purchase health insurance from among the providers in the market. They don’t want the government to expand its own coverage of the uninsured through Medicaid, because any expansion of the government’s role cuts into their own business.

___

Email the author

David S. Bernstein: dbernstein@thephoenix.com