Pharmaceutical manufacturers and health insurance companies don't agree on much these days. As Congress introduces bills to address rising drug prices, insurers and pharmacy benefit managers are engaged in a lobbying and public relations war with drugmakers over who is to blame.
But the giants of the healthcare industry agree on one thing: Medicare for All cannot become law.
Partnership for America's Health Care Future (PAHCF), a group comprised of major drugmakers, insurance companies and private hospitals, has spent the last several months lobbying members of Congress, running online ads and working with the media to drive down popularity of Medicare for All, a single-payer health platform that continues to gain popularity in the Democratic party.
The partnership includes some of the biggest names in the healthcare industry, including the American Medical Association (AMA), Pharmaceutical Research & Manufacturers of America (PhRMA), Federation of American Hospitals (FAH) and Blue Cross/Blue Shield.
All told, the members of the partnership have a lot of money and influence to spend on Capitol Hill. They spent a combined $143 million lobbying in 2018 alone, according to data from the Center for Responsive Politics.
As with every time a major U.S. health care reform bill is discussed, industry giants have a lot to lose and a major incentive to fight back.
The development of a broad anti-Medicare for All coalition isn't surprising. As with every time a major U.S. health care reform bill is discussed, industry giants have a lot to lose and a major incentive to fight back.
John McDonough, a Harvard health professor who helped craft the Affordable Care Act (ACA), would hear from industry lobbyists every day as he worked on the bill. He noted the final version of the bill -- with many concessions, including the removal of a public option -- passed with support from major industry players including PhRMA, AMA and FAH -- all of whom now oppose Medicare for All.
"I think, quite honestly, given how close we were to losing the whole thing, had the pharmaceutical industry been on the other side of the fence in 2010 there never would have been an ACA," McDonough said. "It would've been an afternoon's work for them to kill it."
Medicare for All is different, McDonough said, because there isn't as much room for lawmakers to make concessions. Depending on the version of the bill, it would likely create stricter regulation on drug prices, eliminate the need for some private insurers and cut the bottom line for hospitals that rely on private insurance reimbursement rates.
"When you point a gun at somebody and say 'we're gonna kill you,' don't be surprised when they fight like it's life or death," McDonough said. "The ACA was not life or death for the insurance industry. Medicare for All is a death notice for a large chunk of the U.S. healthcare industry and they know it."
An insurance industry insider told The Hill in 2018 that the group had originally planned to stop Medicare for All from becoming a litmus test for Democrats in 2020. The Intercept obtained an internal document noting its lobbyists and were successful in getting congressional Democratic candidates to adopt the partnership's "moderate" position on health care such as improving the Affordable Care Act.
That strategy didn't appear to work among Democratic presidential candidates though, as many major 2020 contenders, including Sens. Kamala Harris (D-Calif.), Bernie Sanders (I-Vt.), Elizabeth Warren (D-Mass.) and Cory Booker (D-N.J.), support the health care overhaul.
PAHCF recently launched efforts to get the public on their side. The group has spent at least $80,594 on Facebook ads since it released its first ads in late January and at least $13,000 on Twitter ads.
According to Twitter's ad transparency database, the partnership is using FP1 Strategies, an Arlington, Virginia consultant that took in $18 million from conservative groups in 2018, to place at least some of its ads.
Though it might be best known for producing ads that helped take down Democrat Randy Bryce in the 2018 Wisconsin 1st District race, FP1 has delved into the healthcare world before.
Among FP1's 2018 clients was New Yorkers for Excellent Health Care, a new super PAC funded by Greater New York Hospital Association management that spent $341,093 in support of former Rep. Dan Donovan (R-N.Y.). The firm also notes it helped the Consumer Healthcare Products Association defeat legislation to require prescriptions for certain medications.
PAHCF isn't the only group working to defeat Medicare for All -- its allies began their campaigns long ago and will continue to do so. America's Health Insurance Plans, for example, announced a six-figure ad campaign in June 2018 to spotlight millions of Americans covered by employer-provided health coverage. PAHCF has repeated similar numbers in its public relations push.
Medicare for All is up against serious challenges -- and it's unclear whether the measure has enough muscle, or money, behind it.
Though the bill has drawn praise from several major unions, including National Nurses United, National Union of Healthcare Workers, American Federation of Teachers and Service Employees International Union, few industry groups -- outside of those dedicated to backing single-payer health care -- publicly support the bill.
The Medicare for All bill (H.R.1384) introduced by Rep. Pramila Jayapal (D-Wash.) on Feb. 27 has 106 co-sponsors in the House, far fewer than it needs to pass, and does not have the support of House Democratic leaders.
Every attempt to completely overhaul the healthcare system has failed or become watered down due to opposition from the healthcare industry, from President Harry Truman's universal health care plan in 1949 to President Bill Clinton's universal health care plan in 1993. Supporters of Medicare for All are hoping this time will be different.
