U.S. Chamber of Commerce Swings Into Action to Protect Health Insurers’ Profits at the Expense of Its Members

Defending the indefensible and hoping we’re all suckers

Unless you hang out on the U.S. Chamber of Commerce's website (I do so you don’t have to), you likely would have missed the Chamber’s recent and seemingly random defense of employer-sponsored health insurance (or ESI, which is what corporate types call it). 

Under the headline, “Employer-sponsored Insurance Delivers $1.5 Trillion in Value for Employees, U.S. Economy,” the Chamber’s VP of health policy, Katie Mahoney, wrote that those of us who are not big fans of ESI are refusing to acknowledge just how wonderful and reliable that world is. 

You can be certain Mahoney’s piece was not a random, out-of-the-blue commentary. In the world of corporate propaganda, nothing happens by chance. I’d be willing to bet good money--drawing on history--that Mahoney’s post is part of a carefully planned, generously resourced insurance industry strategy to protect ESI, which for years has been most big insurers’s major source of revenue and profits. Mahoney’s full-throated defense of ESI served as a volley, a shot across the bow, a preview of what to expect if Congress gets serious about a public option or even lowering the age of eligibility for Medicare, both of which the insurance industry views as a serious threat to the profitable status quo.

For the big insurers like the ones I used to work for, employer-sponsored insurance is essential for life (and profits). It is, frankly, their lifeblood. Most of them care next to nothing about the individual “Obamacare” marketplace because it is such small potatoes compared to ESI. When I was at Cigna, way more than 80% of the company’s health plan revenues came from the huge fees big employers paid Cigna to administer health benefits for the employer customers’ workers and their dependents. Cigna wouldn’t even sell coverage to individuals unless a state law required it to do so.

It would be unseemly and not nearly as effective or credible if Cigna or another big insurer said what Mahoney wrote--but I would be shocked if my former colleagues didn't have a hand in writing or editing it. 

Here’s how Mahoney led off her piece: 

“Throughout the COVID-19 pandemic, employer-sponsored insurance (ESI) provided much-needed peace of mind and support for the more than 160 million Americans that benefit from its robust, flexible, and affordable coverage.”

That entire first sentence is laughable (for starters, the average premium for employer-sponsored family coverage hit $21,342 this year), but you can be certain that the Chamber and the large corporations that fund it believe we’re so gullible, and that our collective memory is so short, we’ll all buy what they’re selling--and even write letters to members of Congress about how sacred and untouchable ESI is.

Chamber of Commerce national headquarters on H Street, NW in Washington, D.C. – 25 May 2008

Never mind that tens of millions of Americans either lost their ESI when they lost their jobs along with their health insurance during the pandemic or were worried sick that they would lose it. Peace of mind? It was harrowing for those folks--and it undoubtedly still is for those who remain unemployed and uninsured. And never mind that over the past 20 years the percentage of employers offering comprehensive health insurance to their workers fell from almost half to less than one-third. That’s according to the Robert Wood Johnson Foundation and the Urban Institute.

Even large employers that still offer coverage have had enough. A recent survey of the CEOs of America’s biggest companies, conducted by the Kaiser Family Foundation and the Purchaser Business Group on Health, found that the overwhelming majority of them said that the cost of providing coverage to their workers will become unsustainable within the coming five to ten years.

Mahoney grudgingly acknowledged that millions of people lost both their jobs and their health insurance during the pandemic, but she suggested it was hardly consequential, saying that “the number of people with employer-sponsored insurance only incrementally fell by only 1% or 2%”.

Using percentages like that is a handy gimmick propagandists use to obscure an awful reality or diminish the importance of that reality. For one thing, it deflects attention from the fact that we are talking about real human beings, people we all know. If you take the time to do the math, you will see that “only” 1% or 2% comes out to 1,600,000 to 3,200,000 women, men and children who were dumped into the ranks of the uninsured simply because they had ESI that vanished when they needed it most. 

What Mahoney is attempting to do is rewrite history and convince us that ESI is always there--and will always be there--when we need it. That, of course, is anything but the truth.

Mahoney’s post came just weeks after two states, Colorado and Nevada, passed bills to create state-based public options. The insurance industry and its allies spent heavily in both states to kill the legislation, but their well-funded efforts were not successful. (Full disclosure: my team and I at the Center for Health and Democracy joined reform advocates in both states in supporting the legislation.)

The passage of those bills undoubtedly spooked insurance industry executives. For one thing, it makes it more likely perhaps that Congress will eventually give serious consideration to a federally run public option--although probably not this year. What is more of an immediate threat to insurers’s profits is the growing support among members of Congress to lower the age of eligibility for Medicare to 60, which is something President Biden supports and which very possibly could be included in a reconciliation bill later this year. You can expect a huge campaign from my former employers and their allies, including the Chamber, to keep that from happening.

There is no doubt in my mind that Mahoney’s post is the first evidence that insurers are going to be relying on the Chamber’s huge influence in Washington to try to keep anything from happening that might result in more Americans having an alternative to ESI.

The industry's big PR and lobbying outfit, AHIP, clearly has been anticipating an assault on ESI, which is why it launched a campaign it calls Coverage@Work several months ago. 

In a news release when it launched the campaign, AHIP quoted Cigna CEO David Cordani as saying that “Employer-provided insurance is the cornerstone of the United States healthcare system, covering over 150 million Americans and spurring innovation that helps improve the overall healthcare marketplace.” I used to work with Cordani. Of course he would say that. 

AHIP’s release went on to quote another former Cigna colleague, G. William Hoagland, now SVP at the Bipartisan Policy Center (a reliable ally of the insurance industry), as saying that, “Together, we can find bipartisan solutions to ensure it (ESI) remains a strong and viable option for years to come.”

That’s an example of how the insurance industry gets its messaging out in the world, and especially in the Washington world of public policy. It uses outfits like the Bipartisan Policy Center, the American Benefits Council (another consistent ally of the industry) and the Chamber of Commerce to wield influence on Capitol Hill. 

It’s important to remember that AHIP quietly funnelled more than $100 million to the Chamber of Commerce in 2009-2010 in an effort to try to kill the bill that would become the Affordable Care Act. When it became clear that the bill would pass, AHIP and the Chamber shifted gears to shape the bill to their liking. It was worth their time and trouble (and our money): for-profit insurers have amassed enormous profits since the ACA became law. Last year, the first year of the pandemic, was the most profitable year in history for big health insurers.

I’ll be keeping an eye on the Chamber and the industry’s other allies over the coming months and keeping you informed on the various ways they’ll be carrying water for big insurers--and how they are influencing policymakers in Washington to protect the status quo and keep the ESI tap flowing.