Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.
A week ago, the U.S. Chamber of Commerce was upset when The Yes Men, a group of pranksters and activists, held a fake press conference, claiming that the Chamber has reversed their opposition to climate change legislation. It’s true that the Chamber was misrepresented. But the real question should be, who does the Chamber represent--particularly when it comes to health care reform?
The Chamber of Commerce has traditionally fought health reform at the state and federal level. Health policy experts find this maddening: Employers, who are the conduit for providing coverage to more than half the population, should have as much interest as any stakeholder in reforming the health system and bringing down health care costs.
But the Chamber has clear conflicts of interest. It claims to speak for employers. But it also represents--and speaks for--health industry groups that have a distinct, frequently opposing, set of interests.
The U.S. Chamber of Commerce Board of Directors includes the heads of the Association of Chain Drug Stories, Pfizer, the American Medical Association, and others. The board of the California Chamber includes executives of Kaiser, Anthem Blue Cross, UnitedHealthcare, Anesthesia Service Medical Group, and others. And, at all levels, the Chamber’s policy committees are dominated by insurers, hospitals, brokers and other health industry players.
While employers would benefit from effective cost control--and, more generally, effective health care reform--the Chamber frequently opposes it. In California, for example, the Chamber has opposed calls to use government bargaining power to lower prescription drug costs. This stance isn't particularly good for employers. But it is good for the drug companies it represents.
Even excluding health industry players, the Chamber doesn’t seem to represent the employer community as a whole. The California Chamber of Commerce, for example, actively opposed an employer “pay or play” requirement, fighting the law’s (SB2) passage in 2003 and then helping to sponsor a repeal by referendum (Prop 72) in 2004. In that case, the Chamber seemed to be following the lead of fast food chains, who often don’t provide offer health benefits to their workers. But who represents the majority of large employers--the ones that do provide health coverage to their workers, and have to compete against those who don’t? Or those that want to provide coverage, but also want a level playing field, or the option of joining a bigger purchasing pool? It's worth noting that in more recent health reform debates--in California and now nationally--some business leaders have deviated from the Chamber talking points and are supporting some form of employers responsibility as part of overall health reform. Such supporters include local Chambers here in California, and even companies whose own health benefits have been under scrutiny, like Safeway and Wal-mart.
The Chamber claims to represent small businesses, in particular. And small businesses, like individuals, have little power in the present insurance market. They're at the mercy of insurers, who can adjust rates based on the risk profile of firms--and, depending on the state, play all sorts of games with benefits and/or premiums. These firms could really benefit from reform, since it'd mean getting access to the insurance exchanges--where more comprehensive an affordable coverage would be available. And while the bills in Congress would not require small businesses to provide workers with coverage--a mistake, in my view--they would offer significant subsidies for those firms that do.
So what do small business people think themselves? An upstart rival, the Small Business Majority, recently commissioned scientific polls in various states. Unlike the self-selecting surveys that some business groups take of their members, these surveys find that a majority of small business owners want health reform. The owners are wildly supportive of many elements, like cost containment efforts and guaranteed issue (which would allow entrepreneurs to self-employ and start up a company without fear of being rejected for coverage as an individual). They are even supportive of government regulation of insurers--and requirements that employers bear some responsibility for their workers’ health coverage.
In others words, small business people tend to have similar political beliefs and values as the population as a whole. The Chamber of Commerce, it appears, doesn't.