The Front Group Hall of Shame Gets a New Inductee

Insurance moneyToday will go down in the public relations history books as the day health insurers and their allies began a coordinated campaign to ensure that the health care reform law is implemented in ways that will benefit them way more than the rest of us. Today is the day they plan to launch their brand new front group -- drum roll, please -- the Choice and Competition Coalition (CCC). But first, a bit of context.

In a chapter of my book, Deadly Spin, entitled "The Playbook," I explain the remarkable track record that big corporations and their lobbyists have in getting the American public to buy the bill of goods they're selling. They bring out the Playbook, I note, for a single objective: to influence public policy by manipulating public opinion.

The Playbook comprises a set of activities that have long worked beautifully for industries fighting proposed new laws, regulations or taxes that are designed to make them behave in more socially responsible ways.

Among the first industries to use the Playbook was Big Tobacco. PR firms actually created the Playbook for tobacco companies almost half a century ago, after the U.S. Surgeon General declared that smoking was hazardous to our health. Consumer groups launched campaigns to discourage people from lighting up and pressured lawmakers to regulate the production and sale of cancer sticks.

According to the Playbook, these are the initial actions of industries under attack: (1) "Hire a big and well-connected PR firm," and (2) "Have your PR firm set up and operate a coalition or front group, which, if at all possible, should have words like 'American' or 'freedom' or 'choice' in its name."

So, as you see, the creation of the Choice and Competition Coalition is coming straight from the Playbook. And it undoubtedly will have some big money behind it.

Having helped birth similar front groups during the nearly two decades I spent inside the health insurance industry, I can hardly wait to see how the CCC will take shape, who will be its chief spokesperson, which big PR firm will be setting it up and how that firm will craft talking points. Those talking points, of course, will cause us to fear the loss of all we hold dear as freedom-loving Americans if the big, bad government restricts our choice of health plans and undermines the competition that adds so much value to the health insurance marketplace.

Speaking of competition, just imagine how much time and money the world's biggest PR firms devoted to landing this account. I would love to have been a fly on the wall during the presentations they made to my former colleagues about how successful they would be in helping the CCC achieve its objectives.

I can imagine Porter Novelli describing its success in the 1990s and early 2000s creating the front group called the Health Benefits Coalition (HBC), funded primarily by health insurers, to make sure Congress did not pass a Patient's Bill of Rights. The HBC allied with the conservative group FreedomWorks to demonize the legislation, which, among other things, would have expanded our rights to sue insurers or employers when we're denied coverage for doctor-ordered care. Using the HBC's messaging, FreedomWorks warned in a 1999 press release that the legislation "would only take money out of consumers' checkbooks and put it into the pockets of trial lawyers, making health insurance less affordable for all Americans." The campaign worked. No Patient's Bill of Rights was ever enacted.

I can also imagine APCO Worldwide describing how it helped the tobacco industry in the 1990s by recruiting allies to join The Advancement of Sound Science Coalition (TASSC). The mission of TASSC was to hang the label of "junk science" on any warning that second-hand smoke might cause health problems for nonsmokers.

Watch Out for the "Reframe the Debate" PR Tactic

Diversion signThe insurance industry took notice of that campaign, and hired APCO when thousands of doctors filed a class-action lawsuit against managed care companies in the late 1990s for cheating them out of payments they were due. Parroting a tactic employed by Porter Novelli and FreedomWorks, the coalition APCO created for its clients -- America's Health Insurers -- sought to "reframe the debate" by attacking the trial lawyers representing the doctors.

To give credit where credit is due, it was APCO, not Porter Novelli, that pioneered this particular tactic as part of its work for tobacco companies. To wage war in the court of public opinion against consumer advocates and people dying from smoking, APCO created a "grassroots" group called Citizens Against Lawsuit Abuse (CALA) and set up numerous chapters nationwide. According to, a website operated by the Center for Media and Democracy, the CALA chapters were created "to give the appearance of a groundswell of public desire to alter the legal system to make it harder to bring lawsuits for injuries and illness caused by hazardous products." APCO activates the CALAs whenever a client gets hit with a big class-action suit.

APCO was also the PR firm of choice when Michael Moore's documentary Sicko, which cast health insurers in an unfavorable light, was about to debut. APCO established the front group Health Care America for its insurance and drug company clients to discredit Moore and his movie and to begin the work of scaring Americans away from other countries' health care systems.

CCC Will Protect the Interests of Insurers, not Consumers

So what do the insurer's newest coalition hope to achieve? Well, according to a brief item on an industry website, the first priority is to assure that states set up their required health insurance "exchanges" in ways that protect the interests of insurers and the agents and brokers who sell their products. Of course, they won't describe it that way.

The reform law gives states wide latitude in how they operate their exchanges. Utah already has an exchange, and the insurance industry really likes it. That's because the exchange is little more than a website where insurers can post all their benefit plans, even the ones that all but guarantee the purchasers will be underinsured. Those plans, by the way, are very profitable for insurers because they rarely have to pay out much in claims. Utah officials do relatively little to assure state residents that they are getting any value for what they buy.

California, on the other hand, is taking an approach the insurance companies hate. When the California exchange is up and running in 2014, it will vet the insurers' benefit plans and only offer those it deems to be of value to consumers. According to a recent story in Politico, the CCC will include America's Health Insurance Plans (AHIP), the insurance industry's big lobbying group; AHIP's longtime ally, the U.S. Chamber of Commerce; PhRMA, the drug makers' lobbying group, and the National Association of Health Underwriters, which represents agents and brokers. The CCC will be advocating for exchanges that "promote competition and preserve consumer choice." The story said the group "is likely to advocate for exchanges that allow maximum participation, unlike the selective contracting model employed by California."

AHIP spokesman Robert Zirkelbach was quoted as saying, "Many stakeholders agree that exchanges must be true marketplaces that maximize choice and competition so that consumers and small businesses can purchase the plan that best meets their needs."

I am so grateful I no longer have to say stuff like that to the media. But I do agree with Zirkelbach that many stakeholders want the exchanges to be more like Utah's and less like California's. And those stakeholders are the 1,300 health plans AHIP says it represents, and the agents and brokers who worry that their services will no longer be needed if the states' exchanges do what Congress intended. And that is to provide us with the information we need to help us select the coverage that will protect us from financial ruin if we get sick or injured and help us avoid the junk insurance that far too many Americans are paying their hard earned money for in the "true marketplaces."


Thank you for the article, it was quite educating. The insurance companies are also quite upset in Vermont where the legislature is slowly getting bills passed that will pave the way for single-payer/universal healthcare. Universal healthcare started with one province in Canada and spread to the others. Here in the United States it can start with one small state and a big group of hard-working people, then spread to other states. Vermont has done it with civil unions, so chances are, we'll do it again. I am a member of the Healthcare is a Human Right Campaign of the Vermont Workers' Center that is part of these efforts. Through our struggles and determination, we'll start the ball rolling. It may prove to be a long and hard fight, but maybe that will lessen the burden for others in the future. We must do this so that future generations of Vermonters and Americans will never have to know the kinds of health struggles that we are facing right now at the hands of greedy corporations.