Health care debate: Minn. jumps into lobbying scrum

WASHINGTON - In an ideal world, Mayo Chief Executive Denis Cortese would leave it to the professionals to design a high-value, low-cost health care system. Congress, he told a National Press Club forum last week, would "step back, take a deep breath and ... close the door to lobbyists."

But in the real world of Washington politics, the Mayo Clinic has spent more than a half-million dollars on federal lobbying so far this year, more than its total for all of 2008. Still, that pales in comparison with Minnetonka-based UnitedHealth Group, America's largest insurer, which has spent more than $2.6 million so far this year to influence federal legislation.

Millions more have been spent by Medtronic Inc., St. Jude Medical and other Minnesota medical device companies with skin in the raging debate over President Obama's proposed health care overhaul.

Minnesota health care interests have joined an unprecedented scrum of influence seekers, from the AARP to the American Medical Association, who are aiming themselves at Congress in an attempt to ensure the landmark health care reform legislation addresses their issues. It's estimated that hundreds of former government officials are employed as lobbyists in the effort, and that more than $1 million is being spent each day on lobbying in the current fight.

"Once in 20 years something like this comes along," said Bruce Kelly, Mayo's director of government relations. "So if you work in health care, this is the big one."

From fending off a government-run health insurance plan to nixing a special tax on med-tech companies, there's ample evidence that Minnesota's health care lobby in Washington has made its presence felt.

The Mayo Clinic, by no means the largest lobby shop in Washington, has had a particularly outsized influence on the debate, cited by Obama as a model for the kind of cost-effective, patient-centered medicine that reformers would like to replicate across the nation.

'Doing wonderfully well'

The Mayo Clinic's "value index" agenda has unified the entire Minnesota congressional delegation and gained traction elsewhere in Congress as well.

This week, in what Sen. Amy Klobuchar, D-Minn., described as a "major breakthrough," Senate Democrats accepted a new provision changing the way Medicare reimburses doctors.

"It's the Mayo model," she said. "They worked with us on the bill."

But Mayo is hardly the most influential Minnesota player in the debate. UnitedHealth Group's $81.2 billion in revenues last year dwarfed Mayo's $9 billion in annual revenues. With 70 million customers, Minnetonka-based UnitedHealth is the largest entity in an insurance industry that has bristled at efforts to create a competing government-sponsored health plan. The industry has also battled Democratic efforts to chip away at elevated fees for Medicare Advantage, a privatized version of the government health insurance for the elderly.

While few of UnitedHealth's cost-cutting proposals have found their way into legislation, analysts say the company could be one of the biggest winners in the overall health reform effort.

"They're doing wonderfully well," said D.C.-area health care consultant Robert Laszewski, a former insurance company executive. "If you make the assumption the public option is off the table, the health insurance industry is going to get somewhere between $500 billion and $800 billion in federal subsidies for people to buy health insurance."

To be sure, that vast new market would come with some trade-offs. If there's bipartisan consensus on anything in Congress, it's that insurance companies should no longer be able to turn down people with pre-existing medical conditions, or set lifetime caps on benefits.

But beyond those broad regulatory proposals, Laszewiski said, "there is nothing in any of the bills that would change the way any of the health plans manage health care."

John Parker, a spokesman for UnitedHealth, said the company has advanced proposals to guarantee coverage for pre-existing conditions, discontinue the practice of adjusting premiums based on a person's health or gender, and ensure "everyone has insurance through an individual coverage requirement."

One of the Democrats' biggest headaches in the health care debate is finding the money for a massive expansion in coverage for millions of Americans who live without insurance today. One proposal has been a $4 billion tax on manufacturers of medical devices, a key industry in Minnesota.

A day after the proposal surfaced in the Senate, Fridley-based Medtronic Chief Executive Bill Hawkins was in touch with Minnesota Republican Erik Paulsen, who refers to his suburban Twin Cities congressional district as "medical alley."

Paulsen, chairman of the House Medical Technology Caucus, immediately joined forces with other members of the Minnesota delegation -- Democrats and Republicans -- in a letter asking the Senate to "reconsider" the fee.

"Only in Washington would someone claim you can lower health care costs by taxing it and making it more expensive," he said in an interview. "It's a major jobs issue in this state."

Paulsen and other Minnesota legislators say they've seen nothing insidious in the lobbying efforts of the state's major health care players.

Franken, like most others, says the most effective lobbying he's seen has come from the doctors, nurses and patient advocates he has met with over the past several months.

Among them was Robianne Schultz, a breast cancer survivor from Perham, Minn., who was on Capitol Hill this week as a volunteer for the American Cancer Society. Schultz, one of eight volunteers from Minnesota, talked with Franken as well as her own congressman, Collin Peterson, a "Blue Dog" Democrat who opposes the public option.

"We want to make sure they keep the health care debate moving," said Schultz, who lost her employer-sponsored health coverage when her cancer rendered her too weak to work. "We're looking for an end soon, hopefully this year."