Who's Representing The Uninsured On Capitol Hill?

As the health care debate on Capitol Hill reaches its peak, many of the strongest opponents of an overhaul represent districts with the largest percentage of people who don't have health insurance, an NPR analysis shows.

Of the 100 congressional districts with the highest percentage rates of uninsured people, 53 are represented either by Republican lawmakers who are fighting the overhaul, or by conservative Blue Dog Democrats who have slowed down and diluted the overhaul proposals.

One leader of the Blue Dog effort is Rep. Mike Ross of Arkansas, the coalition's chief health care negotiator. His 4th Congressional District covers southern Arkansas, a rural area with a high poverty rate. In his district, more than one out of five residents under age 65 lacks health insurance. That's 30 percent higher than the national average.

Health care proposals from the White House and House Democratic leaders aim to help the uninsured in several ways. One possibility is a "public option" — that is, a government-run insurance plan that would compete with private insurers. It would be financially self-sustaining, while giving the uninsured a low-priced alternative to the private companies, and shaking up the near-monopoly that insurance companies enjoy in places like rural Arkansas.

But in June, Ross and the Blue Dog Coalition held up the House bill for two weeks. They wanted the measure to promote co-ops instead of a public option, an approach that more liberal lawmakers dismiss as unworkable.

Constituents' Voices

In his public appearances, Ross speaks passionately about the need for a health care overhaul. Last month, he told a town hall meeting in Arkadelphia, Ark., "I was negotiating 10 hours a day with everybody from the president to the speaker to the majority leader to the chairman of the committee. I wasn't negotiating to kill the bill. I was negotiating to give us the kind of common sense health care reform that we need and that reflects Arkansas values."

The meeting was a chance for Ross' constituents to be heard. It ran well over the two-hour time limit, but mostly, there was only the familiar bickering about illegal immigrants and the role of government. Just three people without insurance asked questions.

"Many of those individuals who would need a public health care option are those who are not likely to be able to take two hours out of their day to go to a public event like that town hall," says Kevin Motl, a history professor at Ouachita Baptist University who attended the meeting. "They were too busy earning hourly wages and trying to keep roofs above their children's heads. Those voices are not going to be present in that discourse."

Campaign Contributions

New data from the U.S. Census Bureau show that 17 percent of Americans under age 65 now go without health insurance. It's a basic truth of political analysis that low-income residents — that is, those most likely to be uninsured — are less likely than middle-class people to attend town meetings and less likely to vote. To state the obvious, the poor are also less likely to make campaign contributions.

Meanwhile, health care corporations and professional organizations have actively engaged the Blue Dogs. So far this year, the Blue Dogs' political action committee has received $301,500 from health care and health insurance PACs. Ross, the coalition's lead negotiator, has received $100,600 for his campaign committee and a PAC that he operates.

Ross got together with health care industry donors in June, around the same time the Blue Dogs were challenging the House bill. The event brought his campaign at least $20,000 from health care PACs.

NPR asked repeatedly to interview Ross over a two-week period. His office didn't respond.

But another Blue Dog, Rep. Jim Cooper of Tennessee, says the coalition believes the uninsured will benefit from other provisions in the bill, which would change the insurance system.

"The chief impetus of this whole effort is to help the uninsured," Cooper said in an interview at the Capitol. "It's unquestionably true in politics that powerful interests have probably a disproportionate voice, but we're doing double back flips to help the uninsured."

It would also be a mistake to assume that health care corporations are making contributions and lobbying in order to make the overhaul fail.

"I think the influence is there," says analyst Ethan Siegel, with The Washington Exchange, a firm that monitors Capitol Hill for institutional investors. "But it isn't necessarily on all parts to kill the bill. It's to make the bill more livable for the private sector."

An Eye On Re-Election

National Republicans have targeted many of the Blue Dogs for defeat. But it's not clear that so many of them are vulnerable. Fifteen of the 52 Blue Dogs, including Ross, haven't had a tough race since at least 2002.

But Julian Zelizer, a historian at Princeton University, says that in modern politics, even a lawmaker with a safe seat usually does not feel comfortable going against the interests of the most reliable voters at home, and the most reliable donors in Washington.

"Ideally, some people think incumbency should allow members of Congress to act more like independent leaders," says Zelizer. "But it doesn't actually work that way, very often."

Related Links

• How Health Overhaul Would Affect The Uninsured
• 46 Million Uninsured: A Look Behind The Number
• The Uninsured: Rates By State And Congressional District
• Gold-Plated Insurance Pays Nearly All Expenses