Coalition for Health Insurance Choices

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This article is part of the Center for Media & Democracy's spotlight on front groups and corporate spin.

The Coalition for Health Insurance Choices (CHIC) was a front group for the Health Insurance Association of America. It led the insurance industry's campaign to defeat the Clinton health plan in 1993.[1]


CHIC received major funding from the National Federation of Independent Business (NFIB) and the Health Insurance Association of America (HIAA), a trade group of insurance companies. According to Consumer Reports, "the HIAA doesn't just support the coalition; it created it from scratch."[2]


CHIC's mastermind was Blair G. Childs, who has been organizing astroturf, or fake grassroots support, for the insurance industry for more than a decade. From 1986-89 he orchestrated a media, grassroots and coalition-building campaign for the industry's American Tort Reform Association. Then he moved to Aetna Life and Casualty where he instituted one of the most sophisticated corporate astroturf systems in the nation. He wasn't the only PR genius behind the anti-health care campaign, but his coalition can honestly claim the kill. Childs was the person who advised industry health reform opponents on selecting names for their fake grassroots coalitions. He said they should use focus groups and surveys to find "words that resonate very positively." (Examples included the words “fairness, balance, choice, coalition and alliance.”)[3]


"Through a combination of skillfully-targeted media and grassroots lobbying, these groups were able to change more minds than the President could, despite the White House 'bully pulpit.' ... Never before have private interests spent so much money so publicly to defeat an initiative launched by a President," states Thomas Scarlett in an article titled "Killing Health Care Reform" in Campaigns & Elections magazine.

In 1993, Childs recalled, "The insurance industry was real nervous. Everybody was talking about health care reform. ... We felt like we were looking down the barrel of a gun." Forming coalitions, he explained, is a way to "provide cover for your interest. We needed cover because we were going to be painted as the bad guy. You [also] get strength in numbers. Some have lobby strength, some have grassroots strength, and some have good spokespersons. ... Start with the natural, strongest allies, sit around a table and build up ... to give your coalition a positive image." For the health care debate, his coalition drew in "everyone from the homeless Vietnam veterans ... to some very conservative groups. It was an amazing array, and they were all doing something."

Instead of forming a single coalition, health reform opponents used opinion polling to develop a point-by-point list of vulnerabilities in the Clinton administration proposal and organized over 20 separate coalitions to hammer away at each point. "In naming your coalition ... use words that you've identified in your research," Childs said. "There are certain words that ... have a general positive reaction. That's where focus group and survey work can be very beneficial. 'Fairness,' 'balance,' 'choice,' 'coalition,' and 'alliance' are all words that resonate very positively." The Coalition for Health Insurance Choices (CHIC), for example, focused on opposing the Clinton plan's proposed "mandatory health alliances."

The "Harry and Louise" ad campaign

To drive home the message, CHIC sponsored a now-legendary TV spot called "Harry and Louise," which featured a middle-class married couple lamenting the complexity of Clinton's plan and the menace of a new "billion-dollar bureaucracy." The ad was produced by Goddard Claussen/First Tuesday, a PR and election campaign management firm that has worked for liberal Democrats, including the presidential campaigns of Gary Hart, Bruce Babbitt and Jesse Jackson. According to Robin Toner, writing in the September 30, 1994, New York Times, "'Harry and Louise' symbolized everything that went wrong with the great health care struggle of 1994: A powerful advertising campaign, financed by the insurance industry, that played on people's fears and helped derail the process."

CHIC and the other coalitions also used direct mail and phoning, coordinated with daily doses of misinformation from radio blowtorch Rush Limbaugh, to spread fears that government health care would bankrupt the country, reduce the quality of care, and lead to jail terms for people who wanted to stick with their family doctor. Every day 20 million Americans tune in and turn on to the Limbaugh talk radio show, which is aired on 650 stations across the United States. However, few people realize the degree of technologically sophisticated orchestration behind Limbaugh's power.

Childs explained how his coalition used paid ads on the Limbaugh show to generate thousands of citizen phone calls urging legislators to kill health reform. First, Rush would whip up his "dittohead" fans with a calculated rant against the Clinton health plan. Then during a commercial break listeners would hear an anti-health care ad and an 800 number to call for more information. Calling the number would connect them to a telemarketer, who would talk to them briefly and then "patch them through" directly to their congressperson's office. The congressional staffers fielding the calls typically had no idea that the constituents had been primed, loaded, aimed and fired at them by radio ads on the Limbaugh show, paid by the insurance industry, with the goal of orchestrating the appearance of overwhelming grassroots opposition to health reform. "That's a very effective thing on a national campaign and even in a local area if the issue is right," Childs said. He said this tactic is now widely used, although few will discuss the technique.

Childs also stepped in to provide corporate resources where members of the coalition were unable to do it themselves: "With one group we wrote a large portion of their direct mail package which went out to 4.5 million people and generated hundreds of thousands of contacts. We worked with a number of [business trade] associations to finance fly-ins to Washington, DC, where people lobbied their Representatives. ... In some case we funded them entirely, in some cases funded part of them, in others we didn't have to fund, we just provided the background and message. In other cases we actually wrote the stuff. ... With our coalition allies in some cases we were totally invisible. ... We actually ended up funding some advertising that our coalition partners ran under their names, mostly inside the Beltway to effect lawmakers' thinking."

By 1994, the barrage had substantially altered the political environment, and the Republicans became convinced that Clinton's plan - any plan - could be defeated. Their strategist, William Kristol, wrote a memo recommending a vote against any Administration health plan, "sight unseen." Republicans who previously had signed on to various components of the Clinton plan backed away. GOP Senator Robert Packwood, who had supported employer mandates for twenty years, announced that he opposed them in 1994, leading the National Journal to comment that Packwood "has assumed a prominent role in the campaign against a Democratic alternative that looks almost exactly like his own earlier policy prescriptions." In desperation George Mitchell, the Democratic Party's Senate majority leader, announced a scaled-back plan that was almost pure symbolism, with no employer mandates, and very little content except a long-term goal of universal coverage. Republicans dismissed it with fierce scorn.

In 1994, notes author James Fallows, the Wall Street Journal tested the reaction of a panel of citizens to various health plans, including the Clinton plan. First they tried describing each plan by its contents alone, and found that the panel preferred the Clinton plan to the main alternatives. "But when they explained that the preferred group of provisions was in fact 'the Clinton plan,'" writes Fallows, "most members of the panel changed their minds and opposed it. They knew, after all, that Clinton's plan could never work."

The Coalition for Health Insurance Choices disbanded following the political defeat of the Clinton plan, but its primary sponsor, HIAA, continues to lobby actively on health issues. The actors who played "Harry and Louise ads defeat health care reform" have reprised their roles in other TV commercials supporting HIAA objectives, and - in a development that dismayed the HIAA - hired themselves out separately to play "Harry and Louise" once again in a commercial that supports therapeutic human cloning.

Related SourceWatch Resources

External links

  • Ryan Chuttum, "Reuters is Excellent in Digging Up Insurer's Tactics," Columbia Journalism Review, March 17, 20010
  • Dena Bunis, "The Harry and Louise Show,", January 20, 2000.
  • Blair Childs speaking at "Shaping Public Opinion: If You Don't Do It, Somebody Else Will," in Chicago, Dec. 9, 1994. Tape recording of speech available from PR Watch.
  • James Fallows, "A Triumph of Misinformation," The Atlantic, Vol. 275, No. 1, p. 28.
  • "Public Interest Pretenders," Consumer Reports, May 1994.
  • Sheldon Rampton and John Stauber, 'Toxic Sludge Is Good For You: Lies, Damn Lies and the Public Relations Industry' (Monroe, ME: Common Courage Press, 1995), p. 96-98.
  • Thomas Scarlett, "Killing Health Care Reform," Campaigns & Elections, October/Nov. 1994, p. 34.