Foot soldiers square off in health-care battle

With a balmy fall breeze, blue skies overhead, and a nicely coalescing crowd of Center City lunchgoers, protesters, television camera crews, and reporters, it couldn't have been a nicer day to get locked up.

Well, maybe getting locked up Tuesday wasn't the best part, or even a great part.

But for Marc Stier, a 54-year-old activist from Mount Airy and a foot soldier - actually, let's call him a foot sergeant - in the war for changes in the health-care system, it was the part he had to play that day.

"There's a Kabuki element to political theater, like any other theater," said Stier, who, with five others, was arrested for blocking the entrance of Cigna Corp., one of the nation's largest health insurers.

"But this has a moral point," he said during an interview the night before he was arrested. "We're not fooling around."

Whether it is the rowdy "Tea Party" conservative activists who out-shouted politicians at town hall meetings this summer railing against President Obama's health-care proposals or the poster-carrying protesters organized by Stier's Health Care for America Now (HCAN) who accompanied him to Cigna's headquarters on Tuesday, the goal is the same - to affect what goes on in Washington.

The stakes are enormous - a recent Congressional Budget Office report estimated that health-care legislation before a U.S. Senate committee would cost $829 billion over 10 years.

In the nation's capital, there are 100 senators and 435 representatives who will vote, perhaps soon, on major changes to the way health care is delivered in the United States.

Behind each of their votes are activists, lobbyists, consulting firms, grassroots groups, lawyers, and trade associations, all willing to spend millions of dollars and hours to affect the votes of this relatively small group.

In this duel are G. William Hoagland and Stier. Hoagland is Cigna's chief government-relations executive and point man in Washington. Stier directs the Pennsylvania operation of HCAN, a national coalition of activist groups and labor unions based in Washington.

HCAN says it believes that insurance companies stand in the way of health-care change, putting profits and the avoidance of a government-run health insurance plan ahead of better care for people.

Not surprisingly, Hoagland, along with Cigna and other insurance companies, disagree.

"It is a little bit disheartening, at times, to be somewhat singled out as, industrywide, being 'the reason the health-care premiums have gone up over these years,' " Hoagland said.

"It's not just insurance companies, it's [doctors and hospitals], it's demographics. To be the whipping boy from time to time - it's unfortunate."

In Washington, Hoagland has a lobbying budget of $1.6 million, plus an additional $1.6 million to spend on memberships to trade associations, such as America's Health Insurance Plans, which has its own multimillion-dollar efforts.

Public Campaign Action Fund, a campaign-finance watchdog, found the insurance interests spent $126.4 million in the first six months of 2009.

About $25 million of HCAN's funding comes from Atlantic Philanthropies, a foundation created by Charles F. Feeney, the left-of-center entrepreneur who started Duty-Free Shoppers, the duty-free concessions in airports around the world. Labor unions, activist groups, and other foundations kick in the rest.

Some of that money ends up with Stier, a short, bearded former academic who directs protests against Cigna for reasons tactical as much as ideological:

It's a big company in a big city in a big media market.

But Cigna is not singled out. In every city where there is a big insurer, that company becomes the target. On the same day that Stier was arrested here, activists held a body pileup outside the headquarters of Anthem Blue Cross/Wellpoint in Los Angeles. There were similar actions elsewhere.

"When you think of a political movement, you think about getting 100,000 people on the street," Stier said. "But really, it's meetings of 20 to 40 people, night after night, in small rooms around the state, in which you build a membership, in which you have activists with a phone list.

"The focus from beginning to end is moving Congress," he said. "If you can develop a list of 30,000 who care and are willing to make calls, to write letters, to visit congressional offices, you can make a difference."

Rick Berman could not agree more. Berman operates a Washington-based consulting business that manages grassroots and advertising campaigns for a host of business interests - although nothing, he says, to do with insurance this time. In union circles, he is particularly well-known (and vilified) for his antilabor work.

"Money and lobbyists have checkmated each other" in Washington, bringing both sides to a draw, he said.

"Now it is a contest not for money, but for votes," he said. "If you can get [people] to write, urge the senator to take a position and promise to remember it when they vote, that's the new currency of lobbying."

Hoagland agrees. That currency can be counted simply by a junior congressional staffer opening the mail and making tally marks in a notebook - one column for pro, one column for con.

Before Hoagland joined Cigna in 2007, he served on Capitol Hill for two decades, working with Senate budget committees and serving as budget adviser for then-Senate Majority Leader Bill Frist for four years.

His take: Lobbyists can glad-hand in the corridors, associations can organize massive postcard mailings, "but at the end of the day, the most influential are those individuals who . . . sit down and take the time to thoughtfully address the issues."

If the goal is to move people to write, Stier knew from the start that Cigna posed a challenge.

In some ways, Independence Blue Cross would have been an easier target. The nonprofit insurer has a dominant market share in the Philadelphia metropolitan area, a major corporate presence, and its share of disgruntled local customers.

"But it's very hard politically to attack IBC in Philadelphia," Stier said. "It has every business, every labor union does business with it, and people are afraid of them.

"We wanted to focus on the for-profit insurers."

But Cigna maintains a low profile, even though it employs 2,000 in the area, including 1,200 at Two Liberty Place, where Stier was arrested.

"When they told me Cigna, I thought, 'Oh my God, how am I going to find a story?' "

Finding a story - a real person with a resonating experience - is key, Berman and Stier agreed. That is because stories help evoke the emotions of fear, sympathy, or anger that motivate letter writers. But emotions are tricky.

"People don't like to think about what danger they are in. It's scary. You have to dwell on all the horrible things that can happen when you get sick," Stier said. "We spent a lot of time honing our message so that people get concerned, but not fearful."

Unfortunately for HCAN, the best anti-Cigna story came before the HCAN campaign got rolling last July. That is when Cigna, perhaps unfairly, attracted a firestorm of negative publicity after it refused to fund a liver transplant for a 17-year-old California teenager who later died. Her court case lives on.

But then, HCAN got an unexpected boost: Wendell Potter, Cigna's former top corporate communicator, retired in 2008 and went, in a mild-mannered way, from being the company's staunchest public relations advocate to being an informed critic of the entire industry.

"It was a gift," Stier said. "Because of Wendell, we know their entire playbook."

Cigna officials say that rallies like the one at City Hall on Sept. 22 that drew more than 500, as well as staged events such as Stier's arrest Tuesday and an Oct. 1 visit to Cigna chief executive officer H. Edward Hanway's house in Rose Valley, are not constructive ways to engage in a meaningful debate over health care.

Maybe not, but that is not the point. Because the real talking takes place in Washington, motivating the letter writers matters. They will act, Stier said, only if they think it is worth their time.

"People need to see each other engaged in political activity, because that's what motivates them to do the hard work of calling their Congress-people or talking to their friends," he said.

So on Tuesday, Stier sat on 16th Street, blocking the entrance to Cigna's headquarters, playing his part. Cigna sent officials down to watch. And the police, who nearly outnumbered the protesters, played their role, between long stretches of watchful boredom.

"How much this really accomplishes, I don't know," said Capt. William V. Fisher, commanding officer of the civil affairs unit, after he gave the ritual warning:

Move or face arrest.

"This impacts a lot of people and, realistically," he said, after Stier and the others had been moved peacefully into waiting vans, "Cigna will still be in business tomorrow."

But what will happen in Washington - shaped by activists such as Stier and lobbyists such as Cigna's Hoagland - remains to be seen.