For 28 years, the health care consumer group Families USA has been pushing for comprehensive health care legislation. With that mission accomplished, the group's executive director, Ron Pollack, is working on setting up a new nonprofit organization that will seek to get all people who qualify for government insurance subsidies or the expanded Medicaid program enrolled.

The group will be called Enroll America, Pollack said in an interview. "This effort I believe is going to be a huge collaboration not just among traditional allies, but strange bedfellows as well," he said, explaining that he hopes to enlist business groups, the insurance industry, various health care groups and consumer organizations in the effort.

Since everyone has a stake in getting as many people as possible signed up for the new benefits, "there is no real difference in terms of the interests among all the different stakeholders," he said. The group's already been chartered and will eventually have a board of directors and staff director, Pollack said. "We catalyzed it," Pollack said. "It will be a broad-based effort."

With the battle over health care reform legislation nearing the final stages, a powerful business coalition led by the U.S. Chamber of Commerce is launching a multi-million dollar television ad drive to kill the Democratic measures.  The ads will start on national cable tomorrow and are expected to focus on 20 to 25 key districts, say two sources familiar with the new ad blitz.

Employers for A Healthy Economy -- which includes the National Association of Manufacturers and the National Retail Federation--and another coalition that the chamber also underwrote, previously ran over $100 million in ads to kill or seriously weaken health care reform bills in the House and the Senate, both of which ultimately passed.

The new ads will run for 10 days and were developed by National Media, a firm co-founded by long-time Republican ad maven Alex Castellanos. One source described the ads as "the closing argument" by the chamber and its allies to kill the bill and try to convince Congress to "start over," a message that business and GOP leaders have been trying for months to hammer home to the public and members of Congress.

The White House and Democratic leaders are now focused on getting the House to adopt the less ambitious and less costly measure that the Senate passed. The chamber and several other business and conservative groups have targeted a few dozen Blue Dog Democrats who are deemed swing votes. The health care bill narrowly passed the House last fall by five votes and was opposed by a number of Blue Dogs who are now getting enormous pressure from lobbyist on both sides of the issue as well as the White house and political leaders in both parties.

In a related move, a grassroots coalition called Start Over that includes many of the same trade groups, has commissioned public opinion polls on the health care issue. The results expected later this week.

Among the myriad health care coalitions vying to influence the shape of reform, America's Agenda: Health Care for All has one of the more modest budgets and low profiles. But late last year, this union-inspired group hired one of its own board members, former House Majority Leader Dick Gephardt, to help get its priorities included in the reform measures in both houses.

The group's ambition: lowering health care costs by changing how medical care is delivered--chiefly by requiring more emphasis on preventive and chronic care management services, and greater use of primary care doctors to coordinate care.

When it was first formed, early in George Bush's second term, the organization was almost entirely comprised of unions, and focused on trying to advance health care reform at the state level, devising campaign strategies for passing legislation in states, such as Vermont and West Virginia. Later, it began courting business members -- which now include PhRMA, Johnson & Johnson, IBM, Textron--and shifting its focus to the federal level.

In 2008, the outfit launched an effort, underwritten by PhRMA, to help expand the State Children's Health Insurance Program. It now also boasts a bipartisan board, with the addition of former Bush Administration Secretary of Health and Human Services Tommy Thompson.

Continue reading Changing Healthcare Delivery

As lawmakers try to work out the final form a public option will take in health care reform legislation, interest groups are avoiding wading into the debates over the various versions of the public option until the dust has settled, staying more broadly on message as for or against a government-sponsored insurance plan.

"Our major objective is we would like to see the most robust public option we can achieve," said Chuck Loveless, legislative director at the American Federation of State, County and Municipal Employees. "As far as making compromises, we just have to wait and see as we get through the legislative process."

On the other side, Blue Cross Blue Shield Association's Senior Vice President for Policy and Representation Alissa Fox said her group is continuing its campaign against a public option generally because "any form" of a government-run insurance plan is "clearly going to lead to a single-payer system."

"We've made [the public option] a priority all year long," she said. "We have been to as many offices as we could physically go to multiple times."

Continue reading Groups Dodge Details As Public Option Forms

Over the summer, Under the Influence profiled the 25 top-spending health care players by total lobbying expenditures for the first half of the year. On the chart below, see how much those groups dished out from July through September. Lobbying numbers reflect total lobbying activities for a given organization, and several organizations are also involved in non-health care related issues.

Several groups significantly increased lobbying spending in the third quarter over the second quarter: the Chamber of Commerce, America's Health Insurance Plans, American Cancer Society Cancer Action Network, American Academy of Family Physicians and the Alliance for Quality Nursing Home Care.

Lobbying spending often fluctuates from quarter to quarter, but this year's third quarter still topped previous years. The Chamber of Commerce, for example, spent $34.7 million in the third quarter of 2009, compared with $20.6 million in the third quarter of 2008.

Not all groups upped the ante, however: Business Roundtable, for example, spent $1.9 million in the third quarter of 2009, compared with $6.1 million in the second quarter of 2009 and $2.1 million in the third quarter of 2008.

Since August, Under the Influence has profiled the 25 top-spending groups involved in the health care debate, based on the amount of money devoted to all lobbying activities in the first half of 2009.

To find out which groups want a public option, how much money they've spent on TV advertising, where key players are going to voice concerns and much more, read all of the profiles here.

The "Health Care Players" for the first half of 2009 are:

Alliance For Quality Nursing Home Care
This coalition represents 16 long-term care providers, including HCR Manor Care Corp., Kindred Healthcare, Genesis HealthCare Corporation, Sun Healthcare Group and Extendicare, which all made the top 10 of Provider Magazine's 2009 ranking of the top nursing facility chains by number of beds.

What They Want
Since nursing homes receive payments from Medicare for health care services, the Alliance wants to see the Medicare reimbursement system changed to reflect patient need and services provided. Currently, the payment system is partially based on what kind of facility provides the care.

"Medicare funding policies should therefore encourage movement of patients into the lowest cost setting capable of providing high quality care and services to meet both patients' specific needs and choice," the Alliance's president, Alan Rosenbloom, said in an e-mail from his staff. He would not participate in an interview.

Deal Breakers
The Alliance insists that health care legislation provide for Medicare funding that will adequately support the long-term health care sector.

The group believes that the bill proposed by Senate Finance Chairman Max Baucus, D-Mont., addresses this issue more appropriately than legislation proposed in the House.

"Senator Baucus has moved the process forward in a positive manner, and demonstrates the necessary recognition that Medicare funding for our sector simply cannot be viewed in isolation from Medicaid," Rosenbloom said in a press release after Baucus released his proposed health care legislation last month.

Continue reading Alliance: Medicare Funding Affects Nursing Homes

American Federation of Labor and Congress of Industrial Organizations
This coalition of 57 national and international labor unions represents more than 11 million workers.

What They Want
The AFL-CIO has long wanted a single-payer health care system, said Gerald Shea, the AFL-CIO's assistant to the president for governmental affairs. But in the context of the current health care debate -- with single-payer long off the table -- the union federation's top priority is to ensure a "stabilized employer-based system by controlling cost," Shea said.

The best way to achieve that goal is through a public option, which will "inject competition into the private insurance market," Shea argued.

The AFL-CIO supports mandates that would require individuals to get coverage and employers to either provide coverage or pay into a government-run fund.

Deal Breakers
The AFL-CIO does not support "any form of taxation of existing health benefits," Shea said. Though changing or eliminating the tax exclusion on employer-based health benefits was discussed earlier in the summer, it is not currently in proposed legislation. But a tax on insurance companies for the most expensive health plans, which is included in the bill proposed by Senate Finance Chairman Max Baucus, D-Mont., would have the same effect because that tax would be passed on to the plan holders, Shea said.

"These aren't the Goldman Sachs executives who are going to get hit by this," Shea contended. Rather, workers "that have good, comprehensive benefits who might have other factors that drive up costs" will bear the burden of the tax, he said.

Continue reading AFL-CIO: Workers Need A Public Option

General Pharmaceutical Association
This association represents the manufacturers and distributors of generic drugs.

What They Want
GPhA's main priority for health care reform is to increase the use of generic pharmaceuticals as a way to drive down overall health care costs, president and CEO Kathleen Jaeger said.

Already, 72 percent of prescriptions dispensed in the U.S. are generics, and Jaeger estimates that by increasing that percentage even a couple of points, an additional $1 billion could be saved annually.

Deal Breakers
One type of pharmaceuticals has stirred more debate during the health care overhaul than any other: biologics. And GPhA isn't happy with how proposed measures related to biologics have panned out.

Biologics are complex drugs made from living organisms used to treat particularly serious or complex conditions, like cancer and HIV/AIDS, and manufacturers argue they need an extended exclusivity period to recoup their investment in development.

Continue reading GPhA: 12 Years Of Exclusivity Is Too Much

College of American Pathologists
This medical society represents 17,000 pathologists, who study and diagnose diseases.

What They Want
Not surprisingly, the group is concerned with the "emerging role for pathologists in this system that's going to be reformed," said John Scott, vice president of advocacy.

They support the coordinated care model, which encourages communication between health care providers instead of the current fragmentary system, and hope to develop a pilot program to test the impact of bringing pathologists more proactively into health care decisions.

"When you get more and more people covered, there will naturally be an increase in the volume of testing," Scott said. "In addition to that, the science behind the testing has become more and more complex." Pathologists, he went on, are vital to ensuring "patients get the right tests at the right time."

The group also wants to eliminate the loopholes in self-referral policies that allow physicians to refer a patient to imaging services such as an MRI in which they have a financial interest. And they want to ensure that the physician payment system moves away from the sustainable growth rate system, which ties Medicare payments to doctors to the growth of the economy rather than health care costs.

As physicians receive federal incentives to go into primary care, the pathologists don't want to see the government "just taking money out of the overall physician pie" to pay for the bonuses, Scott said.

Continue reading Coordination Is Key, Pathologists Say

Academy of Managed Care Pharmacy
This association represents 5,700 pharmacists and other health care professionals who design and administer drug benefit programs for health insurance plans and employers.

What They Want
AMCP's role in the health care debate has focused on medication therapy management and comparative effectiveness. Both measures are included in proposed legislation.

AMCP wants to ensure that the pharmaceutical benefits that are part of any mandated insurance policies include not only medication, but also the "therapy and counseling that goes along with those," said Judith Cahill, executive director of AMCP.

Encouraging those therapies through incentives like grant programs would "utilize the pharmacists for greater services beyond delivery of the product," said William Hermelin, AMCP's director of government relations.

The group supports comparative effectiveness because it wants to maximize the benefits of treatments. Comparative effectiveness measures seek to encourage and disseminate research into the cost-effectiveness of treatment options.

Continue reading Include Counseling In Drug Benefits, AMCP Says

National Association of Children's Hospitals
This organization, the public policy arm of the National Association of Children's Hospitals and Related Institutions, speaks for 141 hospitals, medical centers and health systems that treat children.

What They Want
NACH's main priority in the health care discussion is to ensure that children also feel the benefits of reform and have consistent access to quality care, but that task has been difficult because the challenges in children's health care are different from the overall system, said Jim Kaufman, the group's vice president of public policy.

"The one thing [Congress has] really missed and has been missing in the discussion overall is children's access to care," he said. In President Obama's speech to Congress last week, Kaufman said, "kids were mentioned as an afterthought."

For example, he said, the pediatric health care field is lacking in specialists, while the adult side of the system needs more primary care physicians. So measures in proposed health care legislation that provide incentives for doctors to go into primary care ignore the needs of children.

Because 1 in 4 children receives health care coverage through Medicaid, NACH has focused on reforming Medicaid's payment system to make it equal to that of Medicare. But Medicaid "has pretty much been left out of the discussion," Kaufman said.

Continue reading NACH: Kids Have Been 'An Afterthought'

Updated at 5:00 p.m. on Sept. 11.

American Association of Orthopaedic Surgeons
This association represents 36,000 musculoskeletal specialists.

What They Want
AAOS supports many of the basic measures most groups want out of reform -- affordable access to quality health care -- but with a couple slants from the perspective of specialist surgeons. "There should be freedom to choose doctors and directly access specialty doctors, like orthopaedic surgeons," said Peter Mandell, chair of AAOS' council on advocacy and a surgeon in California.

AAOS supports widely discussed insurance reforms like eliminating denials based on pre-existing conditions. But the surgeons group also emphasizes the need to focus on "streamlining the insurance claims process to reduce the extra paperwork and time," Mandell said.

The association would like to see medical malpractice reform addressed in health care legislation and was encouraged by President Obama's mention of the issue in his address to Congress this week, though it is currently not part of proposed legislation.

AAOS says that if a public option is included in health care reform, it should comply with free-market principles and not be mandatory for doctors or hospitals. A public option "should be part of the overall menu of insurances that some people are talking about through the exchange, but it should be on a level playing field," Mandell said.

Continue reading Don't Forget About The Specialists, AAOS Says

American Federation of State, County and Municipal Employees
This union speaks for 1.6 million local and state government employees including nurses, corrections offers and sanitation workers.

What They Want
AFSCME's priorities for health care reform are also some of the most fragile parts of proposed legislation: a public option, an employer mandate and federal funding for an expansion of Medicaid.

The public option "is a critical way to make the insurance companies honest and to help bring costs down," said Chuck Loveless, AFSCME's legislative director.

Congressional leadership and President Obama have come under pressure from some Republicans, moderate Democrats and interest groups to forgo a public option in favor of a co-op system or similar alternative. But Loveless said the public option and the employer mandate are necessary to achieve near universal coverage.

The union wants to see an expansion of Medicaid, but it worries that the cost will be pushed onto state governments. To avoid this problem, AFSCME wants reform legislation to provide for federal funding of a Medicaid expansion.

The states are under "severe fiscal distress at the moment," Loveless said. "This can not be laid on the backs of the states."

Continue reading AFSCME Fights For Public Option, Employer Mandate

Updated at 2:50 p.m. on Sept. 8.

American College of Emergency Physicians
This society of 25,000 members focuses on issues related to emergency health care.

What They Want
Since 2005, ACEP has pushed in vain for passage of the Access to Emergency Medical Services Act, and now it wants to see the measures from that bill included in health care legislation.

The group's priority is to reduce overcrowding in emergency departments, a problem it says is mostly caused by "boarding", the practice of keeping patients who have already been admitted to a hospital in the emergency department for prolonged periods of time. Those patients often wait 24 to 72 hours to move from the ER to the hospital, ACEP reports.

"That slows down life-saving medicine for everybody," said Angela Gardner, president-elect of ACEP and a medical professor at the University of Texas Medical Branch in Galveston.

Though it is commonly thought that overcrowding in ERs is caused by people who go in with non-emergency conditions, those individuals only account for 12 percent of patients, while "boarded" patients account for 30 percent, Gardner said, citing reports by the federal Centers for Disease Control and Prevention.

To reduce crowding, ACEP wants a federal commission to investigate emergency department practices and develop nationwide policies.  ACEP would also like to see the establishment of a working group under the Department of Health and Human Services made up of emergency medicine experts to address the same issues of crowding and boarding.

The group also wants a 10 percent increase in Medicare funding for subspecialists, like orthopedic surgeons and cardiologists, who are required to provide emergency care regardless of the patient's ability to pay.

Continue reading ACEP: Include ER Problems In Legislation

Service Employees International Union
This union represents 2.1 million workers in the health care, public services and property services industries.

What They Want
The SEIU has five priorities for health care reform legislation: affordability, inclusion of a public option, employer responsibility, investment in health care workforce training and investment in long-term patient care.

The union's demand for a public option puts it at odds with other influential groups involved in health care discussions, like the Chamber of Commerce, the National Federation of Independent Business and America's Health Insurance Plans, that are vehemently opposed to it.

A public option "is the only way we're going to have true competition," SEIU spokeswoman Lori Lodes said. "It's the only way we can drive down costs."

As the representative for workers, the SEIU is also on the other side of the table from business groups on the employer mandate. The union says employers should either have to provide coverage or pay into a fund, though small businesses should receive tax credits or be exempt.

Continue reading SEIU Calls For Public Option

American Academy of Family Physicians
This organization represents about 100,000 family physicians, family medicine residents and medical students.

What They Want
The AAFP has formally endorsed both the House bill and the Senate Health, Education, Labor and Pensions Committee bill, the two pieces of legislation that have so far left committee. The group supports these pieces of legislation because of they include provisions that will expand coverage, primary care access and the primary care work force.

The group reports that 70 percent of doctors in the U.S. are specialized, while internationally the breakdown is split 50-50 between primary care and specialized physicians. The group sees a need for a more even health care field, which it believes can happen through reform legislation.

To expand the primary care work force, the AAFP wants to see incentives put in place to draw more physicians into the primary care field, such as increasing payments for primary care services as well as scholarships and loan assistance for medical students.

"It's a terrible problem that's developing and that's already developed in terms of a work force imbalance," said Ted Epperly, AAFP's president and a family physician in Boise, Idaho. "If we don't have the right type of doctors for [people] to go to, then we won't be able to improve their health."

The group also supports a focus on prevention and insurance reforms that will eliminate coverage denials based on health status and variable rates based on gender and age. The AAFP would also like to see tort reform included in the discussion, though such measures aren't currently included in proposed legislation.

Continue reading AAFP: Supporting All Reform Bills So Far

The ADA represents 157,000 dentist members and works to advance dentistry and advocates for issues related to oral health, especially access to dental care.

What They Want

The ADA's top priority for health care reform legislation is an increase in funding for dental Medicaid. "When it comes to access to dental care in this country, it's low income Americans that are facing the biggest struggle," said Bill Prentice, director of the ADA's Washington office. "We'd like to see the federal government step up more."

Currently, a provision related to dental Medicaid is not included in proposed legislation. "We're working to get that fixed," Prentice said.

The ADA would also like to ensure that insurance reforms apply to stand-alone dental plans, as well as the larger all-encompassing health insurance options.

Deal Breakers

The ADA is apprehensive about inclusion of a government-sponsored insurance option and an employer mandate in health care reform legislation.

"Like a lot of folks, we have some concerns bout the ramifications of the public plan option, depending on how it would be constructed," Prentice said, citing the possible impact on the private insurance market.

Because dental offices are often small businesses, Prentice said the ADA worries that an employer mandate would result in "unnecessary burdens on small employers."

The employer mandate included in the House bill would require businesses with payrolls above $250,000 a year to either provide satisfactory insurance for employees or pay a tax.

How Much They've Spent

The ADA spent $1.5 million on all lobbying activities in the first half of 2009, according to lobbying disclosure forms. Not all of the group's lobbying was directly related to health care reform legislation. In the first half of 2008, the ADA spent about $710,000 on all lobbying activities.

The ADA's PAC and individuals associated with the group have donated $530,800 to federal candidates and political parties during the 2010 election cycle and donated $2.1 million during the 2008 election cycle. This cycle, 60 percent of the donations have gone to Democrats and 40 percent to Republicans, while 54 percent of the donations went to Democrats and 46 percent to Republicans in the 2008 cycle, according to the Center for Responsive Politics. Recipients during the current election cycle include House Minority Whip Eric Cantor, R-Va., House Majority Leader Steny Hoyer, D-Md., House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev.

The ADA has not spent money on advertising related to health care reform legislation, but the group is considering running ads during the fall, Prentice said.

The group's total revenue for 2007 was $111.1 million, according to IRS forms.

Key Players

Prentice heads a staff of 20 in the ADA's Washington office, and says reform has been the "number one issue...over the past 6 months." He became director of the office in 2006, after working there for six years. Before joining the ADA, Prentice was director of government affairs for the New Jersey Dental Association.

The ADA's president, John Findley, has also been involved in health care reform discussions. Prentice is a registered lobbyist. Findley is not.

National Federation of Independent Business
This association speaks for the interests of small and independent business owners. The group has 350,000 members.

What They Want
The NFIB has four top goals for health care reform legislation: lowering costs while increasing access, reforming the individual and small group insurance markets, providing greater choice for insurance options and making insurance plans portable.

The group's focus is different from other business groups like the Business Roundtable, because small business owners are characteristically different from large corporations in their insurance-buying habits. NFIB reports that small businesses pay 18 percent more in premiums than large companies for the same health insurance benefits and premiums for small businesses have risen by 113 percent since 1999.

"We feel [the individual and small group] marketplaces are currently broken," said Amanda Austin, NFIB's director of federal public policy, citing the need to eliminate denials of coverage based on pre-existing conditions.

To increase choice in those markets, the NFIB would like to open up the system so insurance consumers can shop across state lines.

"We would like employers to be able to choose the plan that fits them," Austin said. Small business owners "need to be in the driver's seat and not the back seat."

The NFIB also feels health care reform should provide a way for people to keep their insurance plan if they leave a job that provided coverage. Because of the way the employer-based insurance system works now, individuals are often reluctant to become self-employed or move to a small business because they'll lose coverage, Austin contended.

"People are staying in jobs versus becoming the next big idea because of reasons like health care," she said.

The group's overall stance -- that reform needs to happen promptly -- is far different from the last time health care reform was on the table. In the 1990s, the NFIB actively worked against Clinton's reform plan.

"It is necessary we have reform," Austin said of this year's reform debate. "Status quo is unacceptable in our eyes."

Continue reading 'Status Quo Is Unacceptable' For NFIB

Federation of American Hospitals
This group represents the 1,100 investor-owned, or for-profit, hospitals that make up about 20 percent of the hospital industry.

What They Want
FAH's top priority for reform legislation is getting as close as possible to universal coverage -- about 95 percent coverage is the target, FAH President Charles Kahn said. "Our focus has been on assuring that all, or as many as possible, of Americans receive health care coverage," he said.

"We understand, at the same time, that... costs need to be held under control and contained," he said.

To help reach that coverage goal, three groups representing hospitals -- FAH plus the American Hospital Association and the Catholic Health Association of the United States -- agreed in July to take $155 billion in government reimbursement cuts over the next 10 years, assuming legislation with near universal coverage passes.

Kahn suggested other ways to fund the overhaul that would lead to coverage expansion, like pay for performance.

Continue reading FAH: Reaching For 95 Percent Coverage

American Cancer Society Cancer Action Network
This organization, the advocacy wing of the American Cancer Society, works to find government solutions to issues affecting cancer patients and to reduce the disease's occurrence.

What They Want
ACS CAN has three priorities for reform legislation: guaranteed access to sufficient care, emphasis on preventative screenings and services, and improved quality of life for cancer patients. "We want to go from a sick care system to a true health care system," said President Dan Smith.

To help cancer patients gain access to affordable coverage, the group supports eliminating health insurance exclusions, ratings based on preexisting conditions and annual and lifetime caps. They'd also like to limit out-of-pocket costs for patients.

Ultimately, ACS CAN wants to drive down the incidence of cancer. The group says 60 percent of the country's 565,000 annual cancer deaths are preventable through measures like early screening, maintaining a healthy body weight and quitting smoking. So ACS CAN hopes to see provisions relating to those measures in health care legislation. "We're not properly incentivizing prevention in this country," Smith said. He added that such measures would lower overall costs while cutting down on cancer rates.

Continue reading ACS CAN Gives Voice To Cancer Patients

American College of Radiology
This association boasts 32,000 members in radiology-related professions, including radiologists, medical physicists and radiation oncologists.

What They Want
ACR would like to see three issues addressed in health care reform legislation: medical malpractice reform, physician self-referral and the implementation of computerized physician order entry (CPOE) technology.

As health care providers, who are affected by medical malpractice insurance rates, radiologists would like to see limits on the amount of money that can be paid out in malpractice cases.

"We hope and continue to hope [medical malpractice reforms] will be part of the health care reform discussion," said Ariel Gonzalez, ACR's director of congressional relations. "However, it looks like that isn't going to be the case this time."

The group also wants better regulation of physician self-referral for imaging services because the "financial conflict of interest" can hurt patients, Gonzalez said. Laws were passed in 1993 regulating imaging device referrals, but the self-referral loophole popped up because most doctors didn't own the machines at the time.

Another patient safety issue the ACR is pushing deals with how imaging services are ordered. Currently, radiology benefit management companies determine what tests a doctor can order for a patient, and if they say no, their word is final, Gonzalez said. But using CPOE technology instead would standardize the process, ACR contends, ensuring "the right test or the right scan is being ordered at the right time for the right person."

Doctors would input symptoms, and CPOE would give the doctor a rating of 0 to 10 on the appropriateness of the test. The technology would also track how many of each type of test doctors order, and it could be integrated into health information technology systems to avoid duplicating test orders. As a result, test orders would decrease, Gonzalez predicted, which would cut overall health care costs and protect patients from overexposure to radiation.

ACR also supports changing the sustainable growth rate, which ties Medicare payments to doctors to the growth of the economy, rather than health care costs.

Continue reading ACR Talks Radiology In Health Care Reform

Biotechnology Industry Organization
This organization advocates for 1,200 biotech companies, academic institutions and biotech centers. Its members include companies that develop health care technologies, like Pfizer, Johnson & Johnson, GlaxoSmithKline, Bayer and Merck.

What They Want
In the health care reform debate, BIO has concentrated on what it knows best: biologic drugs.

Biologics are drugs made from living organisms instead of chemical compounds. They are used to treat particularly serious or complex conditions like cancer, diabetes and HIV/AIDS.

Thus far, these drugs have not seen generic competition because the technology that creates them is cutting-edge. And true generic versions are unlikely because of the biologics' complexity. But Congress and the Food and Drug Administration are exploring how biosimilars -- drugs that would have small differences from the original -- can be manufactured and sold at a lower price. According to a June report from the Federal Trade Commission, treatment of breast cancer with a biologic drug can cost up to $48,000 per year. The report estimated that Americans spend a total of $40.3 billion per year on biologic drugs.

Legislation dealing with biosimilars was originally considered on its own, but it has since become part of health care reform legislation. BIO is supporting rules on biosimilars as a way to regulate the drugs to promote safety and further development.

"We took the position that we were going to be proactively in favor of biosimilars legislation," said Jim Greenwood, president and CEO of BIO.

Because the drugs are so complex, biosimilars need to be tested thoroughly to make sure they are as effective as biologics, BIO argues. And the group says the companies developing the biologics need to maintain exclusive rights for 12 years to get back their financial investment, since biologics take more time and resources to research and develop.

Health care reform bills passed by the Senate Health, Education, Labor and Pensions Committee and the House Energy and Commerce Committee included amendments mandating the 12-year exclusivity period. The amendments passed in both committees with bipartisan support, in the Senate HELP Committee by a vote of 16-7 and in the House Energy and Commerce Committee by a vote of 47-11.

The White House, AARP and others have called for a seven-year exclusivity period that would get the cheaper drugs to patients faster.

"Those legislative battles have been fairly ferocious with AARP and the administration," Greenwood said.

He added that with the Senate HELP and House Energy and Commerce amendments passed, BIO will still have to work to protect biologics language in conference committee and in floor debate, but "so far, so good."

BIO also supports comparative effectiveness initiatives.

"We think it's important [to have] good, well-designed studies that can compare one drug to another drug or a drug to a surgical procedure or one surgical procedure to another surgical procedure," Greenwood said.

Continue reading BIO Educates On Biologics

America's Health Insurance Plans
This association includes 1,300 health insurance companies that provide coverage for over 200 million Americans, according to company information. Members include America's largest insurers: Aetna, the Blue Cross Blue Shield chapters, Humana, UnitedHealth Group, WellPoint and others.

What They Want
As the representative of the health insurance industry, AHIP's focus is on one key aspect of the health care discussion: insurance reforms.

The group is on board with reforms that would eliminate the industry's practice of denying coverage based on pre-existing medical conditions and rating insurance based on health status or gender, AHIP spokesman Robert Zirkelbach said. But he added that those reforms can only happen if coverage is mandated.

"The only way it works is if everybody participates," Zirkelbach said. Without the personal requirement, individuals would wait to get insurance until health problems arose and overall premiums would increase, he said, citing data from states where insurance reforms have been implemented already.

To reach universal coverage, AHIP also proposes an expansion of Medicaid and tax credits for lower-income families.

Continue reading AHIP: All For Reforms, But Not Government Competition

American Hospital Association
About 5,000 hospitals and health care networks are members of the AHA, including a large majority of the 5,708 registered hospitals in the U.S.

What They Want
The AHA promotes a five-pronged approach to health care reform: coverage, prevention, quality, cost control and information.

"We'd like to see health reform be comprehensive, not just focus on a couple of small dimensions," said Robert Umbdenstock, president and CEO. "We don't think any one of them will solve the problem."

Because hospital emergency rooms are legally obligated to provide health service for everyone, whether or not they're insured or can pay out of pocket, hospitals have an interest in universal coverage. The AHA has taken to promoting "coverage for all, paid for by all," saying all stakeholders -- individuals, businesses, insurers and the government -- must help with the inevitable costs of expanding coverage.

To do its part, the AHA, along with two other hospital associations, announced in July an agreement to take $155 billion in cuts in Medicare reimbursements and other payments over the next 10 years. The relinquished funds will instead be used for the health care overhaul.

To control overall health costs, the AHA proposes a focus on preventive measures, a reduction in administrative costs and improvement in chronic disease management; to improve quality of care, the group wants to see payment incentives and care coordination.

Finally, the AHA is calling for greater access to information, both on the provider side and on the patient side.

"We do want to see greater movement and sharing of information across the health system," Umbdenstock said, citing health information technology and "informed decision-making by patients and providing them with alternatives."

Continue reading AHA's Vision For Health Care Reform

Blue Cross Blue Shield Association
This federation represents the interests of the 39 "independent, community-based and locally operated" Blue Cross Blue Shield insurance companies, which collectively cover more than 100 million Americans.

What They Want
The Blue Cross Blue Shield Association's basic requirements for health reform are in line with most everyone talking reform. The group wants to "expand coverage to everyone and rein in costs while improving quality," Senior Vice President for Policy and Representation Alissa Fox said.

To expand coverage, BCBSA wants to get rid of the current blockages such as ratings based on age or gender and denials based on pre-existing coverage. As a representative for insurance companies, BCBSA's support of those reforms is significant, but the group says its push for those changes is nothing new.

"We've been supporting insurance reforms for years. Blue Cross Blue Shield plans had the exact same position in 1993 and 1994," Fox said. "No other industry is coming to the table offering reforms of their own industry in such a significant way."

To control costs while improving outcomes, the group supports comparative effectiveness research and more preventative care, according to the group's reform plan, "The Pathway to Covering America."

"We agree with the vast majority of what's in the bills that we've seen," Fox said.

Continue reading BCBSA Likes The 'Vast Majority' Of What It Sees

American Medical Association
This 162-year-old national organization advocates for physicians and medical students.

What They Want
The AMA endorsed the House bill for its inclusion of near-universal coverage, a health insurance exchange, Medicare reform, and prevention and wellness initiatives.

In a July letter to House Ways and Means Chairman Charles Rangel, D-N.Y., the AMA also praised the bill for funding chronic disease management and care coordination, stopping denials of insurance based on preexisting conditions, mandating insurance coverage, improving the Physician Quality Reporting Initiative and addressing "growing physician workforce concerns."

Under the House bill, those workforce concerns will be addressed through an increase in funding for the National Health Service Corps -- a program within the Department of Health and Human Services that assists doctors in underserved communities -- and greater promotion of primary care services and community health centers.

The House bill, however, does not include any provisions relating to tort reform or defensive medical practices, issues the AMA has advocated for in the past. For years, the AMA has said that tort reform, which would cap pain and suffering awards in medical malpractice cases, could lower insurers' payouts and limit the rising costs of insurance.

Continue reading AMA: On Board With The House Bill

Business Roundtable
This association includes about 160 chief executive officers of the country's top companies.

What They Want
As the providers of employer-sponsored coverage for about 35 million employees and dependents, the CEOs that make up the Business Roundtable are primarily concerned with controlling health care costs. "The CEOs have said their companies will continue to provide coverage, but what they want out of this is a better system," said Maria Ghazal, the policy director heading the Business Roundtable's Consumer Health and Retirement Initiative.

To those ends, the group would like to see more competition in the health insurance marketplace, perhaps through a regional system of insurance markets, and an increase in insurance options so individuals can keep coverage no matter their employment status.

But until a system overhaul becomes reality, the business leaders want to make sure their coverage of employees continues without interruption. "We need to make sure that we don't do anything that dismantles" the current coverage system, Ghazal said.

Continue reading Business Roundtable: Top CEOs Weigh In

Pharmaceutical Research and Manufacturers of America
This trade group speaks for the pharmaceutical and biotechnology companies that provide and develop drugs.

What They Want
Drugmakers don't sell their products in a vacuum, so when the health care discussion began, PhRMA made sure it was part of the conversation early on. "When the president called on leaders in the health care industry to work on health care reform, we were one of the first ones to do it," said Ken Johnson, senior vice president at PhRMA.

According to its "Platform for a Healthy America," PhRMA wants reform to emphasize patient care by focusing on disease prevention, management of chronic disease and expansion of insurance coverage. The group also wants to increase use of health information technology, coordination of care and comparative effectiveness research.

"The problem is that we have a sick care system and not a health care system," Johnson said. "We've got it backwards."

Continue reading PhRMA: Involved In Health Care 'Since Day One'

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.

Continue reading What The Chamber Wants From Reform

This nonprofit organization of 40 million members represents Americans aged 50 and over, a segment of the population that's particularly tuned in to the health care debate.

What They Want
AARP's No. 1 goal from reform legislation is to make health care affordable, said John Rother, executive vice president of policy and strategy at AARP. The group suggests reaching that goal by limiting insurance companies' ability to rate costumers based on age or preexisting conditions.

Additionally, AARP wants to improve Medicare, specifically by closing the "doughnut hole." Currently, Medicare Part D -- the prescription drug program -- covers 75 percent of prescription drug costs up to a certain level, then covers no part of prescription costs in a coverage gap, then covers 95 percent at the highest levels of prescription costs. The cost limits change annually; for 2009 the coverage gap where seniors must pay 100 percent of their prescription costs is between $2,700 and $6,154.

In 2007, 26 percent of seniors who were enrolled in Medicare Part D and did not receive low-income subsidies reached the level where they had to pay 100 percent of their prescription costs out of pocket, according to a Kaiser Family Foundation report. Of that 26 percent, 15 percent eventually reached the level of catastrophic costs.

Continue reading Meet The Health Care Players: AARP