- - Friday, May 31, 2019


Right now, American health care systems are facing a fundamental challenge in the growing lack of access for patients.

While there are obviously no simple solutions to addressing the many issues that go into this challenge, we can identify the problems and who is responsible for them.

One of the main barriers for patients is caused by the insurance companies that in theory are supposed to be helping to keep health care costs down. Instead, they’re forcing patients to jump through every possible hoop to keep their own costs down. Anytime a patient receives care, insurance companies lose.

These companies have a financial bottom line, and that line is in direct conflict with the interests of patients and the health care professionals who are trying to treat them.

Since 2010, the largest insurers in the country have seen exponential growth and have held a firm grip on the insurance marketplace. At the same time, premiums have skyrocketed, costs for providers have gone up, and hospitals have struggled to keep their doors open — all factors that directly limit patients’ access to care.

Health care providers are taking actions they believe necessary to survive the rising costs and demands for care, and reasonable people can argue over the individual actions that they take. For example, some hospitals are merging and consolidating in order to keep the lights on and to relieve the financial strain small hospitals face. In many of these cases, it is simply the only solution a hospital can find.

Insurance companies uniformly oppose mergers, as they would any action that would lead to a decrease in their profits.

The sad reality is that insurance companies find it more cost effective to spend millions of dollars to maintain the status quo, instead of taking the larger financial hit that would come with making care more affordable and easier to attain by their customers.

The lobbying playbook that insurers use isn’t particularly innovative, but it is effective. These companies, like Blue Cross Blue Shield, spread money around to nonprofits with positive sounding names, and as a result get a branded entity that doesn’t carry the stench of industry to advocate on their behalf.

In the instance of hospital mergers, the Physicians Advocacy Institute (PAI) is a leading voice for the insurance companies’ blanket opposition to the practice, no matter the circumstances.

And you may ask yourself why a group whose very name claims to be advocating for physicians, would be opposed to a step that may be the only way to maintain access to their patients.

But a peek behind the curtain of PAI’s financials and you’ll find chapter 1 of the Washington D.C. lobbying playbook, where corporate giants like Blue Cross Blue Shield and Aetna use their deep pocketbooks to exert their influence in order to protect their profits.

PAI is a nonprofit organization that was originally (and ironically) started with funds from class-action settlements against for-profit health insurers. The group’s board is comprised of executives from nine state medical associations, with a stated mission of advocating on behalf of physicians and compliance with the class-action settlement. Included among its advocacy is PAI’s opposition to consolidation in the health care system, including hospitals and health care providers.

Although PAI was started and is sustained on a $23.5 million infusion of legal settlement funds, the members that make up its board of directors run their own state medical associations which financially rely on donations from the very insurers who initially funded PAI through settlements, as well as other ties to anti-consolidation interests.

PAI’s leadership holds close financial ties to anti-consolidation interests, like insurers and drug manufacturers.

The North Carolina Medical Society, whose CEO Robert Seligson serves as PAI’s Board President, has received at least $8 million in funding from the Blue Cross & Blue Shield of North Carolina Foundation.

Blue Cross & Blue Shield of North Carolina has come out strongly against a proposed health care partnership that would make North Carolina home to one of the largest hospital networks in the country.

NCMS also received a grant totaling $150,000 from the Physicians Foundation, a nonprofit group that argues against mergers. NCMS has also received tens of thousands of dollars from massive managed health care and insurance companies, as well as the drug manufacturer Pfizer.

Another PAI board seat — which is occupied by California Medical Association CEO Dustin Corcoran — has ties to other advocates against consolidation and major health care players. Aside from the Physicians Foundation, which has provided at least $300,000 in funding, CMA’s funders include a nonprofit created and funded by Blue Cross of California which contributed nearly half a million dollars to CMA.

The Blue Shield of California Foundation, which was stripped of its tax-exempt status for failing to advocate for the public good, has also contributed over $300,000 to CMA. CMA also uses data from Blue Shield of California to argue against consolidation.

Additionally, CMA has received a quarter of a million dollars from the major insurers.

While it’s no surprise the health care system is a murky pit of individual and merging interests, groups like PAI that claim to advocate for patients, when they are so dependent on private insurers who are driving up health care costs, are a unique danger to the public debate surrounding high medical costs.

Of course, insurers don’t want to see pro-patient efforts enacted, as they would see a direct hit to their financial bottom line. For this reason, they formed an organization like PAI that can advocate for their interests without the obvious baggage insurance companies bring to the table.

Matt Mackowiak, president of Austin, Texas, and Washington, D.C.-based Potomac Strategy Group, is a Republican consultant, a Bush administration and Bush-Cheney reelection campaign veteran and former press secretary to two U.S. senators.


Sign up for Daily Opinion Newsletter

Manage Newsletters

Copyright © 2019 The Washington Times, LLC. Click here for reprint permission.

Please read our comment policy before commenting.


Click to Read More and View Comments

Click to Hide