Key Players in Health Care Reform Debate

•Max Baucus
•Dan Danner
•Helen Darling
•Nancy-Ann DeParle
•Rahm Emanuel
•Chuck Grassley
•Karen Ignagni
•Gerald McEntee 
•George Miller
•Peter Orszag
•Nancy Pelosi
•A. Barry Rand
•Charles Rangel
•J. James Rohack
•Rick Scott
•Kathleen Sebelius
•John Seffrin
•Andy Stern
•Billy Tauzin
•Rich Umbdenstock
•Henry Waxman


Max Baucus, D-Mont., chairman, Senate Finance Committee

In his perch atop the Finance Committee, Max Baucus sits in the catbird seat for health care reform.

Good at counting votes, Baucus is in a unique position to gauge support for Obama’s health plan because his committee includes a representative cross-section of senators. If the plan passes his committee, it has a good shot at passing the full Senate and Congress as a whole. A pragmatic Democrat, Baucus gained the trust of Republicans by siding with them on Medicare changes. He favors a public health insurance option that supporters say would spur competition among private companies. This year, Baucus has brought together many of the groups that have a stake in the health care debate, seeking to establish the broadest possible coalition. Somewhat shy and quirky, Baucus nonetheless relishes his role in the health care arena. He was just reelected to a six-year term and is at the peak of his popularity and power.

Key quote: “The cost of inaction is too high. It’s too high for individuals, families, businesses, and state and federal governments.”

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Dan Danner, president and CEO, National Federation of Independent Business

Donald “Dan” Danner has championed the interests of small businesses in Washington since the mid-1990s. He has lobbied Congress and been a spokesman for the organization. Through his work, he’s become a key representative of what he likes to call the “biggest job creation machine in the country.” He only recently became president of NFIB, but the title means less than his reputation as the go-to guy for small businesses.

Although it’s historically a conservative group, the NFIB has become more moderate under Danner’s leadership. In 2007, the organization joined with AARP, the Service Employees International Union and the corporate alliance Business Roundtable to form the Divided We Fail coalition, which calls for bipartisan approaches to extend health care to more Americans. The partnership gives Danner even more clout in the current debate.

Key quote: “For [small businesses], cost is still the top issue. We very much look forward to looking for a solution together that works for America’s job creators.”

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Helen Darling, president, National Business Group on Health

Helen Darling has worked in the business community for years, and her background is in health care policy, so she’s the perfect point person in the health care debate for this influential group made up of large companies that provide employee health insurance to 50 million Americans. Darling looks at health care reform from their perspective; not surprisingly, they are leery of any proposals that would call for employer mandates—which could specify a minimum basket of benefits—unless accompanied by cost controls. Darling worked at a public relations firm concentrating on health issues and once was the director in charge of purchasing health benefits for Xerox Corporation’s 55,000 U.S. employees. Before that, she worked on Capitol Hill for former Sen. David Durenberger of Minnesota, the top Republican on a Senate health subcommittee.

Key quote: “The urgency for meaningful health reform grows by the hour and our nation can no longer afford to delay action as health reform is central to healing our economy.”

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Nancy-Ann DeParle, director of the White House Office of Health Reform
White House health care czar Nancy-Ann DeParle has spent nearly her entire professional life in the health policy field, starting in 1987 at age 29 when she headed the Tennessee Commission on Human Services. The daughter of Chinese immigrants, she was born in Cleveland but grew up in Rockwood, Tenn. She was the first female student body president at the University of Tennessee and became a Rhodes Scholar and Harvard Law School graduate. She practiced law briefly before taking on the state health job. In the 1990s, during the Clinton administration, she headed the Centers for Medicare and Medicaid Services. She has good contacts in both parties on Capitol Hill, where members respect her in-depth knowledge of health care issues and her political savvy. A nearly daily presence on Capitol Hill, she’ll need to help President Obama with those who offer only tepid support for his health care plan, as well as those who oppose it altogether.

Key quote: “As I go out in the country and talk to patients and clinicians about what they want to see changed, it’s quite clear that they want to see a better health care system where physicians can treat their patients in a smarter way, get them the care that they need.”

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Rahm Emanuel, White House chief of staff

Friends and foes alike describe Rahm Emanuel as a sharp-elbowed enforcer, while at the same time acknowledging his smart, savvy political skills. As a former congressional leader, he was instrumental in winning back the House for Democrats in 2006—and his White House experience with former President Clinton makes him a formidable member of President Obama’s health care team. A fellow Chicagoan, Emanuel also is a close friend of Obama’s. And, he’s not shy. Anyone who’s been on the receiving end of an unprintable Emanuel tirade can attest to that. But he wants the health care feather in his cap for Obama, and that will trump everything. Emanuel’s brother, Zeke, a distinguished doctor and medical ethicist, is advising the Obama team on health care reform. Zeke has advocated a value added tax (national sales tax) to help fund health care reform; brother Rahm keeps his own counsel on such controversial matters.

Key quote: “The goal (is) getting health care costs under control. So my recommendation is, we’ll work with people of all sides ... to get things done. The challenge will be—will the Republicans come to the table with constructive ideas?”

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Chuck Grassley, R-Iowa

Chuck Grassley is the highest-ranking Republican on the Senate Finance Committee. If there is going to be any bipartisanship in the health insurance reform debate, he’s the key. Grassley has been intimately involved in health care throughout his nearly 30-year career in the Senate.

A true legislator’s legislator, Grassley can put together deals and is always looking for compromise. He knows how to work the Senate chamber. A folksy, slow-talking farmer who takes phone calls in his barn when he’s home, Grassley possesses a keen intellect that he’s used effectively to root out government waste and protect whistleblowers.

The 75-year-old Grassley is wildly popular in Iowa and won his last election in 2004 with 70 percent of the vote.

Key quote: (on inclusion of a public plan in health care reform, noting Democrats are strongly for it and Republicans are strongly against): “I don’t see a compromise in that area,” he said. “But abortion is the only issue I know of that is not compromisable.”

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Karen Ignagni, president and CEO, America’s Health Insurance Plans

If Karen Ignagni is not the most powerful lobbyist in Washington, she’s part of a very select group at the top. As the head of AHIP, she is the voice of health insurance plans, representing insurance companies that provide benefits to more than 200 million Americans.

In the early 1990s, AHIP’s predecessor, the Health Insurance Association of America, nearly singlehandedly killed former President Clinton’s attempts to reform health care nationwide by commissioning the now-famous “Harry and Louise” TV ads, which claimed that Clinton’s plan would lead to a completely “government-run” health insurance system. The plan failed partly because the ads fueled the public perception that it would offer Americans few choices. Now, Ignagni is working on the inside, as part of a group that supports President Obama’s pledge to reform the health insurance system—up to a point. Her organization is still a private-sector group, after all, and it opposes a public insurance plan that would compete with private health insurance. Such a plan, AHIP maintains, would lead to the very same government-run system Harry and Louise warned Americans about.

Key quote: “It’s a very short step to a Medicare-like program for all Americans in a single-payer system.”

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Gerald McEntee, president, American Federation of State, County and Municipal Employees

Gerald McEntee, who leads the 1.6 million-member AFSCME union, has been a longtime fighter in the battle for health care reform. He is vice president of the umbrella labor group, the AFL-CIO, and heads its health care committee. McEntee also serves as a co-chair of Health Care for America NOW!, a coalition of groups, led by labor, that is backing, with a $40 million ad campaign, President Obama’s efforts to bring health care to all Americans. McEntee is a powerhouse in the field of health care reform; his labor connections mean he has instant access to thousands of workers who can campaign, write letters and organize political efforts. It should come as no surprise that the leader of the largest public employees union favors a public plan for health care.

Key quote: “America needs to guarantee quality, affordable health care for all. Americans recognize that real reform must include a public plan as an option for families looking for health care that meets their needs, so that they are not at the mercy of insurance companies.”

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George Miller, D-Calif., chairman, House Education and Labor Committee

In addition to the title above, George Miller has another, unofficial role that is far more important to the health care debate—he is House Speaker Nancy Pelosi’s aide-de-camp. His committee has jurisdiction over a few items related to health care reform—most connected to employment issues—but he would never have appeared in recent White House press photos with Pelosi, President Barack Obama and other House leaders meeting on health care reform, were it not for his special relationship with Pelosi. A fellow liberal and a fellow Californian from the San Francisco Bay area, Miller is Pelosi’s staunchest defender and protector. He knows how to work the caucuses, both Democratic and Republican, as evidenced by his work with Republicans on the No Child Left Behind Act. Miller’s voice is critical to health care reform.

Key quote: “I believe we can finally deliver on groundbreaking health care reform that will help solve our long-term fiscal challenges and get Americans the coverage they deserve.”

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Peter Orszag, director, Office of Management and Budget

A budget geek who enjoys country music and is quick with a quote? That’s Peter Orszag. Brainy (degrees in economics from Princeton University and the London School of Economics), politically savvy and an expert on health issues, Orszag is in the top tier of Obama aides leading the charge on health reform. He’s just as comfortable bantering with Jon Stewart on Comedy Central’s Daily Show as he is briefing testy members of Congress about budget cuts. Orszag’s job is to crunch and explain the numbers when questions arise about the costs of health care reform. He’s the man who can tell whether a tax change here or a budget cut there would save money in the long run.

Key quote: “The single most important thing we could do to address our long term fiscal problem is to address the growth rate of health care costs.”

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Nancy Pelosi, D-Calif., speaker of the House

House Speaker Nancy Pelosi has made no secret of her desire to enact health care reform this year, to add to her list of major accomplishments since becoming the first woman speaker of the House in January 2007. Pelosi has pushed through ethics reform, an energy bill, an increase in the minimum wage, and the equal pay act. But nothing will test her leadership skills more than health care reform.

A master of parliamentary dealmaking, Pelosi championed a parliamentary rule (called reconciliation) that will make it easier to pass health care changes through the House. She personally favors a public health insurance option and used her clout to make sure the House considers it. The daughter of the former mayor of Baltimore, Pelosi grew up with old-fashioned politics and can be tough in closed-door meetings or in open debates.

Key quote: “This is a big [health care] agenda, and I believe it should have a public option in it for it to be really substantial.”

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A. Barry Rand, AARP CEO

A former top executive with Xerox Corporation—he started work there as a sales rep and rose to become vice president of worldwide operations—A. Barry Rand has spent his life working for social change and relishes his role as a champion of health care reform. Rand grew up in a racially segregated America, and his values were shaped by the 1960s civil rights struggles. AARP’s new CEO took over in April and is leading the group’s push to guarantee access to affordable health coverage for Americans ages 50 to 64 and to narrow the Medicare doughnut hole. AARP also would like to see a new transition benefit to help Medicare patients discharged from hospitals get the care they need to avoid costly readmissions—and more money for home and community care to help older Americans age in place and avoid costly nursing facilities.

Key quote: “Americans want health care reform now. We need more affordable coverage, lower drug costs and real access to long-term care. Let’s make it happen.”

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Charles Rangel, D-N.Y., chairman, House Ways and Means Committee

“Charlie” Rangel is a gregarious, raspy-voiced glad-hander from Harlem whose friendly demeanor masks a steely interior. After waiting decades to chair the most powerful committee in the House (it writes tax law), Rangel is now in a position to put his liberal stamp on all kinds of legislation, including health care reform. He is opposed to taxing employer-provided health benefits, an idea that has been floated as a way to help pay for reforms. His opposition is not surprising considering he has often acted to protect state and local income tax deductions. Rangel’s liberalism is tempered by a pragmatism that allows him to cut deals in his committee. Lately, his star has been tarnished by tax scandals, including alleged misuse of rent-controlled apartments in New York and unreported income on a Dominican Republic home. The House ethics committee is investigating.

Key quote: “Health reform cannot wait any longer. President Obama made a significant investment in health reform in his budget, and this committee is eager to continue working with the administration to ensure success in our shared goal of improving the health system.”

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J. James Rohack, president-elect, American Medical Association

J. James Rohack, M.D., is a Texan through and through. When he’s not working as a senior staff cardiologist at Scott & White Clinic in Temple, Texas, he can be found on his ranch near Bryan, Texas, which also serves as a wildlife rescue, rehabilitation and release facility directed by his wife, Charli. Rohack, who assumes the presidency of the American Medical Association on June 13, is known as a straight shooter when it comes to policy—a man who wants to balance quality medical care from doctors with reductions in health care spending. Rohack and the AMA, along with officials from other health care groups, won praise from the White House when they voluntarily pledged to cut the growth of health care spending by 1.5 percent a year for the next 10 years. The new leader of the AMA says health care reform has to respect doctors or it will go the way of President Clinton’s failed attempt at reform in the 1990s.

Key quote: “Health system reform that doesn’t have the physicians as part of the solution is doomed to fail.”

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Rick Scott, former hospital mogul, Conservatives for Patients’ Rights

You’ve probably seen Rick Scott on television: He’s the man on TV with the ads saying that if President Obama and Congress try to reform health care, the United States will end up with a government-run system like Britain’s or Canada’s. The ads are produced by Conservatives for Patients’ Rights, an organization Scott founded and helped bankroll. Opponents say he’s engaging in misleading hyperbole. But there is no question he’s getting plenty of attention—no surprise, given his history. A mergers and acquisitions lawyer, Scott took the hospital industry by storm in the go-go 1990s, when he successfully helped turn Columbia/HCA into the largest for-profit hospital conglomerate in the United States by buying up other hospitals. The company’s board of directors ousted him as CEO in 1997 in the midst of a growing scandal involving charges the company bilked Medicare and Medicaid out of millions and paid kickbacks to doctors who sent patients to its hospitals. The company paid a record $1.7 billion to settle the case. Scott was never charged. He took his golden parachute and jumped into the urgent-care-center business. Still mega-wealthy, he’s poured at least $5 million into his own ads on health care reform.

Key quote: “Tell Congress you won’t trade your doctor for a national board of bureaucrats. Let’s put patients first.”

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Kathleen Sebelius, secretary of Health and Human Services

Kathleen Sebelius is expected to play a high-profile role in the administration’s health care reform effort.

The former governor of Kansas was not President Obama’s first choice to head HHS (that would have been Tom Daschle, whose nomination collapsed under questions about taxes and perks), but many observers believe she may turn out to be exactly what the country needs in these turbulent times.

A Democrat, she appealed to a broad cross-section of moderate voters in both parties to win the governorship of her conservative state in 2002—a coalition-building skill that should be useful in current debates. Sebelius pushed for health care reform in Kansas, but a conservative legislature often blocked her efforts. As a state lawmaker and insurance commissioner before becoming governor, her knowledge of the insurance industry should prove especially helpful in shaping health care reform.

Key quote: “This is not political and it is not optional. Inaction threatens our health and our economic security.”

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John Seffrin, CEO, American Cancer Society

John Seffrin is credited with transforming the American Cancer Society from a volunteer single-issue group into an advocacy organization that seeks to inform lawmakers about larger health issues affecting cancer patients. Seffrin, who was a volunteer with the society for 20 years, took the reins of the organization in 1992. Before becoming the society’s top staff executive, he served as Indiana University’s chairman of the department of applied health science and was president of a group that worked for international controls on tobacco. Seffrin served as chairman of the board of Independent Sector, a coalition of charities, foundations, corporations and individuals, from 2002 to 2005.

Earlier this year, the advocacy arm of the ACS joined with five other health organizations in an advertising campaign urging President Obama and Congress to enact health care reform, with the goal of insuring more Americans. The group did not take a position on specifics.

Key quote: “Cancer patients across the country—including those with insurance—often must dig deep into their savings and risk financial ruin to pay for cancer treatment and care.”

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Andy Stern, president, Service Employees International Union

Fast-talking Andy Stern is a man in a hurry who uses the strength of his growing union like a tactical weapon—2 million members who vote, organize and lobby. After college, Stern took a job with the Pennsylvania welfare department and joined the SEIU. Eventually, he went to work full time for the union and came to Washington in 1984 to run its national organizing drive. After a fractious election in 1996, Stern became, at age 45, the youngest leader in the history of the nearly 90-year-old union. Stern and the SEIU maintain that putting a public health insurance plan in place alongside private plans will give people more choices and force the private companies to provide better, cheaper service.

Key quote: “Availability of a public plan is a necessary part of a comprehensive cost-containment strategy. A public plan will have lower administrative costs and offer less red tape through standardized forms and simpler policies for consumers and providers.”

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Billy Tauzin, president and CEO, PhRMA

Billy Tauzin knows the health care system “up close and personal” and is a powerful spokesman for the drug companies.

After 24 years on Capitol Hill as a representative from his native Louisiana, Tauzin joined the Pharmaceutical Research and Manufacturers of America in 2005 and took up the cause of the big drug companies it represents. A conservative Democrat turned Republican, Tauzin has friends on both sides of the aisle. He has championed drug research and development and defended drug companies’ pricing policies as necessary to fund research for cutting-edge drugs. His support for R&D is personal as well as professional. In 2004 he was diagnosed with abdominal cancer. The prognosis was grim. But Tauzin tried a new drug, Avastan, and it worked. According to Tauzin’s firsthand account, if he had been diagnosed a year earlier, the drug would not have been available and he would not have survived. PhRMA has broadly supported President Obama’s health care plans, but the devil will be in the details. PhRMA hopes that giving more Americans health care coverage will mean more people will be able to purchase prescription drugs.

Key quote: “PhRMA echoes the sentiment shared by President Obama and members of Congress that it is critical for all Americans to have access to high-quality, affordable health care coverage and services.”

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Rich Umbdenstock, president and CEO, American Hospital Association

While health care reform, especially budget cuts, might be a problem for Rich Umbdenstock’s hospital group, he’s signed on to the cause, preferring to be in the circle rather than outside looking in. Umbdenstock says that uninsured patients are a hospital’s biggest financial problem, but he balks at cutting other hospital payments in order to raise money to help extend health insurance to more people. Umbdenstock traces his interest in hospitals to his boyhood, when he used to hear his parents—who volunteered at two local community hospitals in New York—discussing the many health care issues that arose there. He has years of  experience consulting with hospitals and writing books, reports and surveys aimed at hospital boards and administrations. Umbdenstock’s most current report discusses the impact of the recession on hospitals. It includes the finding that people put off care when they lose their jobs and often end up in emergency rooms—putting more financial stress on hospitals.

Key quote: “We commend President Obama for making health reform a top priority in his budget blueprint. However, we are concerned about any cuts that would affect the work hospitals do for their communities during this economic downturn.”

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Henry Waxman, D-Calif., chairman, House Energy and Commerce Committee

Henry Waxman has a flair for the dramatic and a lust for the jugular—just ask baseball players and tobacco company executives—that will play an important role in health care reform. In his former post as chairman of the House Oversight and Government Reform Committee, Waxman hauled in baseball players and made them testify about steroid use under oath. Tobacco company executives, who once swore that cigarettes were not addictive, then had to take it back four years later, both times before Waxman. Now, as Energy and Commerce chairman, Waxman brings the same intensity and studied interest in health issues to the debate on health care reform. He favors setting up a public insurance plan alongside private insurance plans. But he wants to make sure that those who have private insurance that they like get to keep it. Waxman also favors a proposal by President Obama for independent studies of the comparative effectiveness of drugs and other medical treatments. These studies, supporters say, would give doctors unbiased scientific information to use when making treatment decisions.

Key quote: “Many ask, given the failures to adequately address these issues in the past, whether this is truly achievable in this Congress. I believe it most certainly is—and that we cannot afford to fail.”

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Elaine S. Povich writes about politics and health care.