The U.S. Chamber of Commerce, a nonprofit business federation, represents 3 million businesses nationwide.

What They Want
The Chamber has three main demands from health care reform: controlling costs, making it harder for insurance companies to deny coverage and streamlining a competitive insurance market.

The group wants to target costs because of the role businesses play in providing health insurance for Americans. About 160 million Americans receive health benefits from their employers, according to the Kaiser Family Foundation, and the Chamber reports that employers spend $500 billion annually on health benefits.

"We can't insure the uninsured unless we make it affordable to do so," said James Gelfand, senior manager of health policy. To achieve that goal, the Chamber supports many of the wide range of options that have been suggested for cost control, such as reforming and improving primary care services and tying physician pay to performance.

To reform the insurance system, they want legislation to stop insurance companies from denying coverage based on medical conditions and rating individuals based on factors like health and gender.

The competitive insurance market as envisioned by the Chamber would make it easy for individuals to find the best health coverage for them, not unlike a health exchange that is being considered by Congress.

"It should be like Orbitz, where you go on [to a Web site], type in what you're looking for it and it lists everything available with check boxes," Gelfand said.

Deal Breakers
The Chamber of Commerce will not support legislation that includes a government-run public option, a "job killing" employer mandate or an increase in taxes. All of those measures, Gelfand said, will hurt businesses by increasing health care costs. "We can't afford it in this economic climate," he said. "That's not going to help us get more people covered. That's going to cost us jobs."

He did add, however, that there may be ways to structure those measures so they do not negatively impact businesses. As they stand in the House's bill, however, the public option and employer mandate are "toxic," Gelfand said.

"There are probably ways to design a public plan that wouldn't screw up the system," he said. "There are probably ways to retain employers' role in financing and facilitating health insurance. But the House sure hasn't found one that works."

How Much They've Spent
According to lobbying disclosure forms, the Chamber has spent about $17.5 million on federal lobbying efforts for the first half of 2009. (Lobbying disclosure forms do not break down cost by issue.) The Chamber has spent money in relation to several bills this year, but Gelfand said that "health care is probably our number one issue right now."

In addition to official lobbying on Capitol Hill, the business group announced last month "a multimillion-dollar advertising, media and grassroots campaign to promote health care reform that protects employer-sponsored health care." The campaign is focused in Arkansas, Colorado, Maine, North Carolina, Arkansas and Louisiana, home to key Senate swing votes.

For the 2010 election cycle, the Chamber of Commerce has reported making $46,500 in contributions to political action committees and federal candidates, including Majority Committee PAC, the National Republican Senatorial Committee, New Democrat Coalition PAC and Blue Dog PAC, according to Federal Election Commission records. Ninety percent of its donations to individual federal candidates this cycle have gone to Republicans.

Key Players
In addition to Gelfand, Bruce Josten, the Chamber of Commerce's executive vice president for government affairs (pictured to the right), and Randel Johnson, the group's senior vice president of labor, immigration and employee benefits, have been involved in talks with lawmakers and congressional staff about health care reform legislation for the past 10 months, spokeswoman Blair Latoff said.

"We're working very closely with staff who are drafting legislation, providing a lot of technical assistance and trying to make these bills as good as we can," said Gelfand. Before becoming health policy senior manager at the Chamber of Commerce in 2007, Gelfand was health policy manager at the ERISA Industry Committee, an advocacy group for employee benefits.

Either Josten or Johnson have testified before four of the five committees working on health care reform: the House Ways and Means Committee and the Senate Health, Education, Labor and Pensions Committee in June, the Senate Finance Committee in May and the House Education and Labor Committee last year.

Both men have a background in health care issues. Prior to working for the Chamber of Commerce, Josten was co-chair of the Coalition to Save Medicare and Johnson worked on health care-related legislation as a legal counsel and coordinator for the House Committee on Education and the Workforce.

Links
Chamber of Commerce Health Care Page
Letter to Senate Finance Committee
Campaign for Responsible Health Reform
Testimony Before House Ways and Means Committee
Testimony Before Senate HELP Committee
Testimony Before Senate Finance Committee
Testimony Before House Education and Labor Committee
(Photo by Liz Lynch)