THE INFLUENCE GAME: Health care fight still rages

WASHINGTON — The fight over President Barack Obama's health care overhaul hasn't ended, it's simply shifted to a wider arena.

All sorts of special interests — business, labor, medical, consumer and ideological — are now focused on how the new law shaping the nation's health care system will be carried out. They're also turning lawmakers' votes into ammunition for this year's congressional campaigns and beyond.
It all shows how lobbying grinds on, well after Congress has spoken on an issue.
Supporters and opponents alike hope to influence the drafting of regulations to implement the 2,500-plus pages of health care legislation. Agencies such as the Department of Health and Human Services are in the early stages of writing those rules, a process that can take months or even years.
"If people don't like the outcome in Congress, they have another bite at it at the agency, to try to alter the rules so they're more favorable to their policy point of view," said Jim Burroughs, a public policy professor at George Mason University.
Among the anxious players:
_ Health insurers want to protect their bottom lines as the government creates new insurance pools this year for people with serious medical problems. Later, they'll focus on state exchanges where insurers will compete to sell policies to consumers beginning in 2014. Their concerns range from the legal documents insurers will need to provide customers to specific definitions of who will qualify for the programs.
_ AARP wants to make it easy for Medicare recipients to receive the drug discounts that pharmaceutical companies will be required to give them. They're also watching the rules for a new requirement that family policies cover children up to age 26 this year, of interest to the group's many members in their 50s.
_ Eager to limit the billions in costs they will incur, drug makers are monitoring that same Medicare discount program. They are also focused on the bigger Medicaid pharmaceutical rebates they will owe states, and new programs encouraging preventive care.
_ Businesses and unions alike are following requirements that many employers provide health coverage or face fines, and federal subsidies to help low-income people buy policies.
"We're keeping an eye on regulations to keep from driving this even further from what we can cope with," said E. Neil Trautwein, lobbyist for the National Retail Federation, which opposed the legislation.
Emerging regulations to implement policy on abortions also are under scrutiny.
While abortion foes hold little hope for tightening the law's restrictions, abortion rights groups will push for regulations "written in a way that maximizes access to abortion coverage," said Laurie Rubiner, a vice president of the Planned Parenthood Federation of America.
It is unclear how much leeway there is. The law allows health plans to cover abortion but requires people to pay for that option with their own money. It was accompanied by an executive order from Obama reaffirming the prohibition against federal aid for most abortions.
There's unusual agreement on one goal: getting eligible people signed up for the law's new programs. Business and labor groups like a proposal by Families USA, a consumer organization, for a multi-million-dollar campaign to promote enrollment. Ron Pollack, the group's executive director, said he believes such an effort could result in several million extra people registering.
The U.S. Chamber of Commerce and other business and conservative groups that opposed the legislation concede there is no chance of repealing the law this year, given Democratic control of the White House and Congress. Many foes say that their best opportunity for major changes lies with Republican victories in November's congressional elections and the 2012 presidential race.
"Realistically, most people are looking to the next two elections" for significant revisions, said David O'Steen, executive director of the National Right to Life Committee, which wants stricter limits on federal abortion aid.
Opponents of the overhaul say the new law will reinforce for voters the image of a big-spending, big-government Washington run amok. Supporters say they will use the GOP's lockstep opposition to argue that it favors the insurance industry over patients.
"Everybody's looking at November," said Jade West, lobbyist for the National Association of Wholesaler-Distributors. She predicted a fall advertising blitz by business, but said decisions must still be made about expected massive corporate campaign spending.
The giant Service Employees International Union and Health Care for America Now, a coalition of labor and liberal groups, have each run TV ads thanking House Democrats from tightly contested districts who voted "yes." The liberal MoveOn.org may seek challengers to run against some moderate Democrats who opposed the bill, and has already raised $1.5 million for a primary opponent to one Democrat they consider too centrist: Sen. Blanche Lincoln of Arkansas.
Right to Life has taken the unusual step of endorsing primary opponents to Reps. Alan Mollohan and Nick Rahall, two West Virginia Democrats the group backed until their "yes" votes for the health overhaul. Right to Life issued a broad warning that it will "remind pro-life voters how their congressmen voted on this critical issue as they head to the voting booth."
Conservative tea party leaders are also promising rallies and advertising against health overhaul supporters throughout the year.
Hoping for more direct action, conservatives in some states are pushing for ballot initiatives blocking the law's requirement that most people buy health insurance. Worried that such referendums could draw conservatives to the polls this November, progressives are considering seeking their own ballot questions that might attract liberal voters, perhaps by calling for something the new law lacks: government-run health insurance.
"Like it or not, the health care debate is not over," Chamber of Commerce President Tom Donohue said on the organization's Web site.