Health cost issue divides former allies in Mass.

For business groups, stakes are higher as focus is on revenues

The state’s largest business groups, which came together to play a key role in passage of the 2006 law that expanded health insurance coverage, are now divided over how aggressively to slow the growth of health costs.

Associated Industries of Massachusetts, a business trade group, has called for tighter controls on spending than the House or Senate has proposed. Its regular allies - including the Massachusetts Taxpayers Foundation, a research organization for employers - warn against over-regulation.

The fracture highlights how the health care debate has changed in five years. There are no clearly defined camps. Controlling costs is a more nuanced issue than expanding coverage, some advocates said. And the stakes are higher.

“We’re talking about revenues in the health care system,’’ said Richard C. Lord, president of Associated Industries of Massachusetts, which represents about 6,000 businesses. “Every dollar in the system is somebody’s income stream. So, every dollar has an interest group that represents it.’’

Allegiances between consumer groups have shifted, too.

In 2006, Health Care for All and the Greater Boston Interfaith Organization led a diverse group lobbying for universal coverage. They also pushed an initiative to put the issue on the ballot. It was a public display that, along with threats from the federal government to withhold millions in Medicaid dollars, pressured lawmakers to act.

This time, though, there has been no similar effort.

Health Care for All has been quieter on the issues of controlling costs, focusing more on aspects of the bills that would put money toward public health initiatives, better integrate mental and physical health care, and monitor quality of care.

The Greater Boston Interfaith Organization, however, has been vocal in its calls for aggressive cost controls. It had joined Associated Industries of Massachusetts - not a traditional ally - in pushing for holding the growth in health care costs to two percentage points below the rate of growth in the overall state economy. The group now supports the House bill, which has a more moderate target but calls for stronger action than the Senate’s bill.

Asked why Health Care for All did not advocate a particular spending target, executive director Amy Whitcomb Slemmer said she did not know what the best target would be and did not want to be distracted by a number.

“We wanted to make sure there are no incentives to shortcut care,’’ she said.

Some, including Whitcomb Slemmer, said lawmakers will come out with a strong bill, despite the disparate views of business, hospital, and consumer groups.

John McDonough, who led Health Care for All during debate over the 2006 law and is now a professor at the Harvard School of Public Health, said, “the alliances are somewhat scrambled’’ this time around.

But, he said, “there’s a history in Massachusetts, even when people have intense disagreement, of dealing with those disagreements in a responsible way.’’

Perhaps in demonstration of that ideal, representatives of groups with widely varying interests, including the Massachusetts Association of Health Plans, Blue Cross Blue Shield of Massachusetts, the Massachusetts Hospital Association, the Massachusetts Medical Society, and others, began meeting nearly two years ago to discuss options for cost containment.

The governor had made clear that he wanted a bill that would rein in dramatic increases in costs to protect individuals and businesses.

The group wrote this month to lawmakers debating the Senate bill, urging them to set goals but to make many of the necessary steps voluntary. Even as they put forward their agreement, the groups individually met with lawmakers to advocate their own, often conflicting, positions.

The Massachusetts Association of Health Plans, for example, has lobbied the Legislature to address disparities in what hospitals charge for similar services through something like the “luxury tax’’ the House has proposed, a measure that hospitals and Senate leaders have opposed.

Business groups, including Lord’s Associated Industries of Massachusetts and the Massachusetts Taxpayers Foundation, originally were part of the broad coalition’s meetings, but left when they could not agree with the others - or each other.

Michael Widmer, president of the Massachusetts Taxpayers Foundation, which does policy research on behalf of several hundred employers, said he and Lord agree on much regarding how cost containment should happen, just not on how far to go.

“We need to be careful,’’ Widmer said, noting that health care companies are major employers and help drive the economy.

Unlike Lord’s group, the Taxpayers Foundation’s board includes hospitals and insurers, but Widmer said the board’s diverse membership protects against any one interest controlling the agenda.

Representative Steven Walsh, a Democrat from Lynn who has led the drafting of the House bill, said the fact that there are no clear coalitions among the many interest groups has “made the process somewhat exhausting.’’ But, he said, hundreds of meetings around the state “have helped to make it a better bill.’’

Nancy Turnbull, senior lecturer and associate dean at the Harvard School of Public Health, was less optimistic. Without a strong, unified consumer or business voice in the process, she said, “the provider voice ends up being the loudest.’’

The Globe reported last week that hospitals and medical organizations spent $9 million on lobbying last year, more than any other sector in the state.

“Organized money is hard to beat,’’ said Cheri Andes, lead organizer for the Greater Boston Interfaith Organization. “The only shot you have is organized people. If you don’t have that, organized money will win every time.

“That’s what we’re up against. And that’s what we’re suffering from. We don’t have the kind of organized people that we had last time.’’