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Keenly aware of the potential impacts of various patient protection bills being debated in Congress, health care insurers, employer groups and trade organizations are mounting major lobbying campaigns to voice their perspectives on the issue.

"This has been a very active year for us," said Bill Pierce, director of public affairs for the Blue Cross & Blue Shield Assn. in Washington.

"Obviously, we are fully engaged in the debate in Washington," Mr. Pierce said. BC/BS has mounted a vigorous lobbying campaign on Capitol Hill, meeting with members of Congress in both houses and on both sides of the aisle.

"As the debate has gone from being very focused to very broad, that changes who the audience is somewhat," Mr. Pierce said.

Early on, the effort focused on congressional task forces and key committee members looking at modifying managed care. As votes began to occur on specific bills, "we then kind of broadened it to include more members than that," Mr. Pierce said.

The Blues also have been running "inside the Beltway" advocacy advertising aimed directly at the staff and members of Congress to reinforce the message sent through direct lobbying. "Hearing it and seeing it is what we want to create," Mr. Pierce said.

BC/BS also has done a "fair amount" of public opinion research, which the organization uses both in its own dealings with policyholders and to bolster the points in its advocacy advertising.

Another piece of the equation is a media strategy involving talking to reporters. "We must have done a half-dozen briefings this year on various issues that were before Congress," Mr. Pierce said.

While he wasn't sure how much his organization has spent so far on lobbying in connection with the patient protection legislation, Mr. Pierce said, "Obviously, this is a very big issue for the Blue Cross & Blue Shield system, and we commit what we consider the necessary and available resources to it."

As have other insurance and employer organizations, Blue Cross & Blue Shield has been actively involved in the Health Benefits Coalition, a group that has been carrying much of the weight of representing employer and insurer interests in the debate over patient protection legislation.

The coalition includes 31 insurance and employer organizations. In addition to BC/BS, participants include Aetna U.S. Healthcare, the American Assn. of Health Plans, the American Insurance Assn., CIGNA Corp., the Health Insurance Assn. of America, Humana Inc. and Prudential HealthCare.

Also participating in the coalition are the Business Roundtable, the National Assn. of Manufacturers, the ERISA Industry Committee and the National Federation of Independent Business.

Industry efforts have involved "kind of coordinating the lobbying and communication so the left hand knows what the right hand is doing," said Alan Mertz, vp-government relations at the Washington-based Health Care Leadership Council.

"You've got to do something on your own for your membership and to address your own individual concerns," said Julie Goon, vp-government affairs for the American Assn. of Health Plans. But, she said, joining with other groups in the coalition's activities has "a multiplier effect."

"We're definitely all interrelated," Ms. Goon said.

Through June, the coalition had spent about $2 million on its campaign to influence the patient protection legislation debate, with considerably more expected to be spent during the August congressional recess. The recess is seen as a key period for bringing pressure to bear in congressional members' home districts.

As do many groups participating in the Health Benefits Coalition, the Washington-based HIAA continues with its own efforts to make sure congressional representatives and staff "understand how the insurance industry works," as well as the potential impact of legislation on employers and the public, according to Richard Coorsh, a spokesman for the association.

But, he noted, "We've been working through the coalition to get across our concerns."

The Health Care Leadership Council has taken a similar approach. "Educating members of Congress is part of what we do," Mr. Mertz said.

"We do some grass-roots (efforts), too, where we will communicate with members back in their districts," Mr. Mertz said. "We have companies that are based all over the country, so we communicate with the members of Congress back there."

The coalition began its efforts to sway congressional and public opinion on the patient protection issue in January with a strategy that combined lobbying, media relations, advertising and grass-roots efforts.

The initial advertising was intended to "slow the train down," particularly in connection with efforts to amend the Employee Retirement Income Security Act to allow malpractice suits against employer-sponsored health plans.

Part of the basis for that effort

was the notion that many in Congress who had signed onto a measure introduced by Rep. Charles Norwood, R-Ga., to amend ERISA did not fully understand the implications of such a move.

One of the advertisements the coalition ran at that time featured an image of Frankenstein's monster warning Congress to "be careful when you play doctor, because you might create a monster."

As this year's congressional session continued, during each recess the coalition took its message outside the Beltway, targeting its campaign through June at key legislators in the patient protection bill process. The effort then was fine-tuned further to focus on legislators who might be pivotal in the patient protection debate.

While the coalition sees shortcomings in all the various measures now before Congress, the top priority at this point is to defeat the Patients' Bill of Rights legislation promoted by Sen. Edward Kennedy, D-Mass., and Rep. John Dingell, D-Mich.

A particular focus of the coalition's lobbying effort is fighting the "right to sue" issue in that bill; the group also has tried to drive that message home to the public through its advertising campaign.

During House debate on that chamber's version of the Kennedy-Dingell bill, the coalition's campaign was particularly intense in about 15 media markets across the country, targeting the efforts to critical legislators. A toll-free phone number soliciting telegrams to callers' congressional representatives generated about 12,000 such telegrams during a 10-day period.

A similar campaign was to be mounted during the August recess, probably in 10 to 12 states of key senators or where labor unions are pushing patient protection legislation.

According to Mr. Mertz, the defeat of Rep. Dingell's proposal in the House last month shows the value of the sort of lobbying effort insurers, employers and others have put forth to make their views heard during the patient protection debate.

"I think it was important to shape the debate and, ultimately, the debate that the bill fostered to expand the liability," he said. "I think we won that issue."