When Sen. Mike Enzi (R-Wyo.) met with his committee staff last fall, they were searching for a game plan to a politically impossible mission: moving a controversial healthcare bill less than a year before the elections.
Democrats were dug in against so-called association health plans (AHPs), partly because President Bush had been pushing them for years. But Enzi, chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, was facing two other obstacles: criticism in the insurance industry and from fellow Republicans.
Enzi himself had reservations about the House-passed AHP legislation, but he knew that the root reason the measure had died repeatedly in the upper chamber was because small businesses and insurers — two traditional GOP allies — were exchanging salvos about the merits of the bill.
Small-business groups praised the bill for allowing small businesses to pool their resources to buy cheaper insurance policies for their employees. Many insurers countered that the measure would allow small firms to self-insure without being regulated by the states. State regulators also expressed major reservations about the measure.
“We were facing years of calcified opposition,” a committee spokesman said.
Enzi and his staff decided the only way to revive the bill was to do something rarely done in Washington: get all the players in one room to hash out their differences.
In a statement to The Hill, Enzi said some people “called us crazy for trying, but we thought we could find a place of fair compromise between the major stakeholders.”
The proponents and critics of AHPs were invited last November to Room 835 in the Hart Senate Office Building. And over subs paid for by the committee, lobbyists who had attacked one another’s positions debated in a more cordial fashion.
At first, committee staffers said, it was awkward, but after a series of meetings both sides agreed to give a bit. A committee spokeswoman sad she knew progress was being made when a small-business representative and insurance official struck up a conversation about their kids playing high- school basketball.
“That would have never happened before,” the aide said.
The committee also had a lingering supply of Halloween candy that was a staple at most of the pre-Christmas meetings. Everyone was supposed to grab some when an issue was agreed to.
One of Enzi’s aides also passed out antacid tablets at one early meeting, according to a lobbyist who was there. “He was right,” the lobbyist said. The early going “gave everybody freaking heartburn.” In the first few months, the meetings could go on for four or five hours, one attendee said.
Enzi said, “After 10 years of deadlock on AHPs, I figured it was time for a change. If there was a blueprint for this kind of bridge building, I think it came from the work I did with Senator [Paul] Sarbanes [D-Md.] on the Banking Committee to report out Sarbanes-Oxley. In many ways, the two issues are politically similar in that the need for change has been as plain as the nose on your face for years.”
Lobbyists who participated in the negotiating sessions praised Enzi, and his aides, for impelling them to sit down and hash out their differences.
“The HELP Committee staff did an excellent job and had a lot of patience” as the different sides debated, said Joe Rossmann, vice president of fringe benefits for the Associated Builders and Contractors (ABC). ABC is part of a coalition of small-business groups that has long sought AHP legislation.
“That’s the only time we were really around the table” with AHP advocates, said Alissa Fox, vice president for legislative and regulatory affairs for the Blue Cross Blue Shield Association.
“It’s very different from my usual experience,” concurred the National Association of Realtors’ senior policy representative for government affairs, Marcia Salkin.
“There were a number of heated and passionate moments,” one lobbyist said, but the meetings were productive.
“You want to find a way you’re both singing ‘Kumbaya’ at the end of the day,” said Amanda Austin, the manager of legislative affairs for the National Federation of Independent Business (NFIB).
Not every participant in the talks walked away satisfied. While crediting Enzi with moving the issue forward, Fox said, “We still have concerns with the bill.” For now, Blue Cross Blue Shield is neither supporting nor opposing it.
Legislation to promote what Enzi now calls small-business health plans is scheduled to be marked up today by the committee. The breakthroughs achieved with the interest groups will not necessarily lead to a consensus on the panel, lobbyists acknowledged.
Senate Democrats are not interested in Enzi’s new approach.
Yesterday, the committee’s Democrats revealed that they would raise numerous amendments during the markup — including legislation to create a system for small businesses based on the federal employees’ health-benefits program.
Enzi offered harsh commentary: “I hope we can still have a constructive discussion during [today’s] markup, but some of my colleagues’ amendments suggest otherwise.”
Enzi tried to bring Sen. Edward Kennedy (D-Mass.), the committee’s ranking member, into the process, but they were too far apart from the beginning, according to Kennedy’s spokesperson.
When Enzi unveiled his compromise bill last week, Kennedy was quick to condemn it.
“For millions of Americans, this plan would do more harm than good. For far too many of our citizens, it will result in higher health costs and fewer benefits,” Kennedy said.
The senator noted that the bill would exempt the plans from some state insurance rules, though it would retain states’ regulatory authority over health insurance, unlike the House-passed bill.
“We’re going to need some Democrats to come on over,” Austin acknowledged.
A few Democrats have backed AHP legislation in the past, such as Sen. Robert Byrd (W.Va.). Sen. Ben Nelson (Neb.) is a co-sponsor of Enzi’s bill, and his staff participated in the lobbyist meetings. The House-passed bill garnered 36 Democratic votes.
In the last Congress, then-Sen. Don Nickles (R-Okla.) and Sen. Judd Gregg (R-N.H.) were outspoken critics of AHP legislation. Nickles is now a lobbyist, and Enzi is optimistic that he will get Gregg’s vote during the markup today.
Enzi also has to satisfy GOP senators who have pushed for AHP legislation for years but were not included in his recent efforts.
Sen. Olympia Snowe (R-Maine) has been the leading proponent of bills that parallel the House-passed measures and has held numerous hearings as chairwoman of the Small Business Committee. In addition, Sen. Jim Talent (R-Mo.) was a leader on the issue while in the House.
Enzi’s staff made sure that Snowe’s office was up to speed on where he was taking his bill, her spokesman said. Snowe is waiting to see the final product that emerges from the HELP Committee markup but is hopeful the Senate will take up some form of legislation this year, he said.
The lobbyists who helped craft Enzi’s bill hope so, too, and plan to continue their push.
The Realtors are directing a grassroots campaign targeting HELP Committee members this week, to go along with a Washington-area print and radio advertising campaign. Last week, Realtors from across the country staged a “fly-in” to Capitol Hill to lobby senators.
The NFIB also plans to employ its individual members to press senators to support Enzi’s bill. “I would expect that we would have a strong pull from all of NFIB’s members in every state,” Austin said.
If the Senate gets as far as passing the bill, significant compromises would have to be made by Enzi’s House counterparts to get legislation into conference committee. HELP Committee staff members have conferred with aides to House Energy and Commerce Committee Chairman Joe Barton (R-Texas), who is waiting for the Senate to act first. The bill also would fall under the jurisdiction of the new House Education and the Workforce Committee chairman, Rep. Buck McKeon (R-Calif.).
The White House, at this stage, is said to be monitoring the Senate legislation.