This has become an especially rough-and-tumble time for Karen Ignagni, the health industry’s chief lobbyist. House Speaker Nancy Pelosi, D-Calif., has denounced insurers as “villains,” and President Obama has criticized the industry for its “windfall profits.” Earlier this year, Ignagni pledged to work with Obama and Congress to pass major health care legislation this year, but relations have cooled as the White House and congressional Democrats have begun citing the industry’s practices as a top reason to pass an overhaul of the nation’s health care system.

Ignagni, 55, the President and CEO of America’s Health Insurance Plans sat down Wednesday with KHN’s Laurie McGinley, Julie Appleby and Eric Pianin at her office on Pennsylvania Avenue, overlooking the U.S. Capitol. She discussed her take on the Democratic political assault, her industry’s end-game strategy and her unflagging opposition to the Democrats’ efforts to create a public insurance plan to compete with private insurers. Here are edited excerpts:

Q: You seem a little bit surprised by the insurance industry’s being portrayed as a villain by some of the Democrats.

A: I wasn’t particularly surprised because we had heard from various sources that it was coming. Now, before I heard that it was coming, I was surprised that – given the focus that people have had on trying to encourage stakeholders to participate at the table, to commit to a real contribution and to stick with it and be productive agents in achieving health care reform – I was surprised to hear that the course was changed. But it’s clearly I think consultant-driven, poll-driven, and it’s a strategy that probably is going to backfire from a number of perspectives.

Number one, this is an industry that has advanced the very market reforms that people are now talking about. Two, I think the concept that people should be judged on whether they’re for reform or not based on whether they accept a government-run program or not is something folks will regret because they’re setting up a litmus test

And three, everything we proposed as part of the $2 trillion coalition, we have followed through on, and you will shortly seethe administrative simplification promises and commitment we made will be part of the Senate Finance Committee package.

Q. Clearly we’re going into a long, hot August and not surprisingly the Democrats will be striking back even more in response to Republican attacks on their plan, and this could mean more attacks on the insurance industry. At what point do you walk away from the table?

A. Well, you have to consider what is your endgame strategy, and our members meant it what they said three years ago when they made a commitment to contribute to reformSo the first job for us, given the heightened rhetoric, is to make sure the American people understand that we meant what we said in terms of being committed to health care reform.

Two, that we’re working very hard with members of Congress, even where we disagree, which has never been a secret, about the public program, to try to encourage support for insurance market reform, for subsidies, for Medicaid expansion, and getting everyone in. And if you do that, you’re 80 percent of the way there to health care reform. So we think now we have to make sure people outside the Beltway know what people inside the Beltway know, which is not only our commitment but our contribution to health-care reform. At the same time we are going to work very, very actively to fact-check what people are saying, to set the record straight

We’re going to be going to town hall meetings and making sure the people who have been villainized– the people who have been villainized are pillars of their communities, they are regular people. It’s not the CEOs, but it’s nurses, it’s doctors, it’s folks who are helping to build personal health records.

Q. The Senate Finance Committee has been having trouble coming up with the money for the health care bill, which is the reason they’re talking now about windfall profits taxes on insurers and taxes on companies that sell high-cost policies. Since you’re opposed to both of those, what would you propose as an alternative?

A. I think the country has to get serious about bending the cost curveWe think there needs to be incentives for things to happen over the next few years that can reduce the rate of increase in health care costs, but there should be a commission, a broad commission not simply looking at Medicare, but a broad commission to monitor the progress and to make recommendations if goals are not achieved.

Q. Should there be some kind of mechanism for an across-the-board cut [in health spending]?


A. I think we have to look at those sorts of things. It doesn’t have to happen right away, but having a commission, having a mechanism, would give every stakeholder group an incentive to create more productivity, to reduce unit costs and to create more efficiency. And those are the kinds of incentives that I think the system needs.

Q: Is there any version of a public plan or co-op that you would find less objectionable?

A: It’s hard to envision any kind of publicly sponsored option, no matter the nomenclature, that wouldn’t rely on administered pricing, which is the government’s only strategy right now to contain costs. The reason we’re concerned about that is if you go out and ask leading hospitals and physicians if they can live on Medicare rates, they will give you a resounding ‘No.’ We are kidding ourselves if we think underpaying providers means cost-containment. What we have is a significant amount of cost shifting because the government underpays. Our [premium] rates are higher as a result of that. If you set up a public structure, whatever you call it, and it has the benefit of government rates, we are still disadvantaged because of the cost-shifting.

Q: Are you concerned there won’t be significant subsidies and that at some point lawmakers may say we can’t require individuals to have insurance?

A: It’s very important that the subsidies be adequate for individuals to be able to afford coverage. Members of Congress should not miss the opportunity to address the cost-containment problem. Subsidies should be one of the last decisions made. One of the first decisions needs to be how to structure everything possible to make sure the system is as affordable as possible. That’s the first order of conversation.

Q: Will the industry step forward and say we’re going to cut our premiums by X amount as part of the negotiating process?

A: It would be irresponsible to do that unless we knew that cost would be cut by X amount because premiums are driven by cost. You’ve just put your finger on the Gordian Knot for members of Congress. It’s much easier in the political dialog to talk about premiums. No congressperson gets re-elected by talking about underlying costs.

Q: Can Congress do insurance reform without an individual mandate?

A: We asked [consulting firm] Milliman to do a study on what happens in states that did that. The markets essentially blew up in all those states. [There was premium] rate shock for people who stayed in. All the states had to walk back from it.

Q: Will the protests now being made by opponents at town hall meetings around the country backfire?

A: Members of Congress are hearing vehemently from both the left and the right. It’s very important for members to hear from the center. [Without that], we’ll miss an important opportunity in August for members of Congress to hear about how to create the consensus we believe can be created. Members of Congress got off on wrong foot on health care in past few months in confusing support for a public option with health care reform. Reform is about access, quality and cost. Whether we have a public option or a government option is one aspect, but, unfortunately, it has distracted a great deal of attention from all the consensus that does exist around some of the essential building blocks of reform.