By Dan Eggen and Perry Bacon Jr.
Washington Post Staff Writers
Saturday, July 18, 2009

Months of relative cooperation among disparate interest groups in the heath-care reform debate appear to be coming to an end, as the major political parties and their surrogates unleash dueling television advertisements, e-mail campaigns and grass-roots protests.

Friendly alliances among medical and business groups have begun to splinter in reaction to concrete legislation from House Democrats, which cleared two important committee hurdles yesterday.

President Obama has left much of the wrangling over legislation to Congress. But he also waded into the fight, declaring during an impromptu White House appearance yesterday that "now is not the time to slow down."

"Those who are betting against this getting done this year are badly mistaken," he added.

The House bill aims to cover 97 percent of Americans by 2015, in part through a sliding surtax on household incomes exceeding $350,000. The proposal also includes a public insurance option, which is strongly opposed by Republicans and major insurers and faces difficult prospects in the Senate.

In one sign of the changing political climate, the Democratic National Committee this week began running cable television ads targeting many of the party's wavering senators, declaring that "it's time for health-care reform." The DNC, acting through its Organizing for America grass-roots project, has also ramped up a nationwide schedule of meetings and rallies drawing on Obama's 13 million-name campaign e-mail list.

Another leading liberal group, Health Care for America Now, announced an $800,000 ad campaign yesterday with the American Federation of State, Federal and Municipal Employees that is targeting centrist lawmakers in nine states, including Indiana, Ohio, Louisiana and North Dakota. The group is running a telephone campaign that has prompted as many as 16,000 calls a day from reform supporters to lawmakers on Capitol Hill.

Republicans, conservative groups and many business organizations have responded by accelerating efforts to derail the legislation, portraying Democratic proposals as costly and dangerous experiments that will put the country on a path to inefficient, "government-run" health care. Their main goal is to slow down the pace of the legislation in Congress in the hope of fomenting wider opposition.

"If we're able to stop Obama on this, it will be his Waterloo," Sen. Jim DeMint (R-S.C.) said yesterday during a conference call with conservative activists. "It will break him."

The Republican National Committee launched a Web site this week called BarackObamaExperiment.com, which urges supporters to write their representatives in opposition to Democratic proposals. The U.S. Chamber of Commerce and the National Federation of Independent Businesses also came out against the House legislation, which gained support from the American Medical Association and AARP.

Hundreds of conservatives gathered in congressional districts around the country yesterday for health-care protests organized by Tea Party Patriots, a fledgling group that got its start this year during protests over federal bailouts of Wall Street firms. The group is coordinating with Republican lawmakers and conservative groups that see Democratic reform proposals as a promising target for opposition.

Amy Menefee, spokeswoman for Americans for Prosperity, a conservative group that says it has 500,000 members in 50 states, said her organization is spending $2 million on television advertising this month and is planning more than 70 rallies against Democratic health-care plans over the next six weeks.

"Anywhere where we think people will really get engaged in the debate, we are contacting folks so that they can get the message across," Menefee said.

The political climate is notably different than it was in May, when Obama stood at the White House with half a dozen health-industry trade groups that had pledged to come up with $2 trillion in savings over the next decade. Keeping major insurers, hospitals and other health-care firms at the negotiating table has been the linchpin of the White House strategy, which takes lessons from the failed attempts at reform during the early years of the Clinton administration.

But with several pieces of legislation officially written, other interest groups have begun taking clear sides. Richard Kirsch, Health Care for America Now's national campaign manager, said that "things are heating up, because there are actual bills out there."

He added: "It's not just a concept anymore. From the point of view of the industry lobby, they now can see what this is going to mean for their industry, and for those of us in public advocacy, it shows us what it will mean for regular citizens. It gives you something to rally around."

Earlier this week, the Independent Insurance Agents and Brokers of America sponsored a "fly-in" that brought more than 1,000 insurance agents to Capitol Hill. The purpose: to "lobby their representatives in Congress about the important role" that they play in "providing health care to millions of Americans."

The National Federation of Independent Businesses sharply attacked the Clinton plan in 1994. On Wednesday, it sent a letter to House lawmakers saying it could not back a bill that includes an employer mandate or a public option. The U.S. Chamber of Commerce sent a similar letter, telling members of the House Ways and Means Committee that "this legislation will make a bad situation worse."

But many major trade groups continue to take a cautious approach, focusing criticism on a particular provision and balking at funding major ad campaigns or other costly opposition efforts. The powerful Pharmaceutical Research and Manufacturers of America is even teaming up with Families USA to fund ads featuring the original actors from the "Harry and Louise" ads, which helped derail President Bill Clinton's efforts to reshape health care. This time, the characters are in favor of general reform, though the ads do not endorse specific policies.

The strategy has complicated Republican efforts to cast the bill in starker terms as a job-killing intrusion into the private health sector. The evolving debate has also sparked conflicts within organizations such as the AMA, which faces a rebellion from some state chapters opposed to the group's endorsement of the Democratic House bill.

"These big Washington groups have their feet in both camps," said House Minority Leader John A. Boehner (R-Ohio). "A lot of their members are outraged by what their national associations are doing. The doctors are rising up."