People in the news

Chip Kahn

President, Federation of American Hospitals (since 2001)

(FAH)

Why He Matters

The driving force behind the ad campaign that undermined Bill Clinton's 1993 health-reform plan, Charles N. Kahn III is back in the ring for the debate over Barack Obama's health-care overhaul.

Kahn was an insurance lobbyist when he masterminded the famed "Harry and Louise" ads 16 years ago, Now he heads the Federation of American Hospitals (FHA), and he's still a crucial health-reform player. His name is a staple on both The Hill's annual list of top lobbyists and Modern Healthcare's annual "Most Powerful" list. He was part of influential coalitions -- including the late Senate Health, Education and Labor Committee Chairman Edward M. Kennedy's (D-Mass.) "Workhorse Group" -- the coalition of stakeholders met behind closed doors to hash out health reform before drafting legislation.

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Background

At a Glance

Career History: president, Health Insurance Association of America (1998 to 2001); staff director, House Ways and Means Health subcommittee (1995 to 1998); executive vice president, Health Insurance Association of America (1993 to 1995)
Birthday: January 4, 1952
Hometown: New Orleans, La.
Alma Mater: The Johns Hopkins University, B.A. (social and behavioral sciences), 1974; Tulane University School of tropical Medicine, M.P.H. (health systems management), 1980

Spouse: JoAnn Willis
Office: 801 Pennsylvania Ave., NW, Suite 245Washington, DC 20004202.624.1500
Web site

Path to Power

Kahn was born in New Orleans, La.

His exposure to the city's politics came at a young age from his mother, who was active in the League of Women Voters. "I could remember when I was 8 years old going to the state legislature with her," Kahn said.

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He worked on a campaign before he could vote, volunteering for Nelson Rockefeller's (R) 1968 presidential campaign in New Orleans at age 16.

That's when he first met Rockefeller's Louisiana campaign director, a young Republican named Newt Gingrich.

Gingrich, then in his mid-20s and getting a Ph.D. at Tulane, became a mentor to the teenage Kahn. ""I sort of felt like he was the big brother I never had," Kahn said.

Over the objections of his high-school football coach (Kahn was all-state as a senior), Kahn went to the Republican National Convention that summer as a public-relations page, and he continued volunteering for campaigns, including Democrat Maurice "Moon" Landrieu's successful 1969 New Orleans mayoral bid.

Gingrich Campaign Manager

Kahn left New Orleans to study history and political science at Johns Hopkins University in Baltimore, Md. But he kept up his relationship with Gingrich and returned South in the summers of 1971 and 1973 to do research for him.

Kahn completed college a semester early, and in December 1973 headed to Carrolton, Ga., to work as Gingrich's campaign manager on the Georgian's first run for Congress.

Kahn managed Gingrich's bids to represent Georgia's 6th district in both 1974 and 1976, working for the mayor's office in New Orleans in the intervening year. Both years were bad for Republicans, and Gingrich twice lost to incumbent Rep. Jack Flynt (D-Ga.).

Health Policy Focus

"I couldn't figure out what I was going to do, so I decided to go to graduate school," Kahn said.

Kahn knew he'd need a policy specialty if he wanted to continue working in politics, and he entered Tulane's health- policy program in the fall of 1970. "I sort of said, 'Well, I might like this,'" Kahn said."And then I really loved it."

Kahn spent his third year of graduate school doing a practicum at the Association of American Hospitals, a job that brought him from New Orleans to Washington, D.C.

After graduation in 1980, Kahn took a job directing the Office of Financial Management Education at the Association of University Programs in Health Administration (AUPHA) from 1980 until 1983. Kahn called the job a training ground for his future in health finance.

Capitol Hill Staffer

In 1983, Kahn finally became a health policy aide to Sen. Dan Quayle (R-Ind.), a member of the Senate Health, Education, Labor and Pensions Committee. In Quayle's office, Kahn worked on two successful bills, one modifying rural Medicare rules and another on health-care technology.

In the summer of 1984, Kahn became senior health-policy adviser to Sen. David Durenberger (R-Minn.), who chaired the health care subcommittee on Senate Finance. "Dave was a real leader in trying to look at health care in different ways," Kahn said of his old boss, who now leads the National Institute of Health Policy.

"We did a lot of legislation," Kahn said of his time with Durenberger.In addition to budget bills, Kahn worked on the Medicare Prospective Payment System, which offers financial incentives for hospitals to be cost-efficient, and on the 1986 COBRA bill, which allows workers to extend their health coverage after leaving a job.

Durenberger also proposed health-reform legislation that included a tax-cap on employee health benefits. It was part of a bill vetoed in 1986.

Despite Kahn's loyalty to Durenberger, he wanted to work on the staff of a committee, where, he said, "they got to call the shots."

At the end of 1986, Kahn took a job as minority health counsel for the House Ways and Means Health subcommittee under Rep. Willis Gradison (R-Ohio), where he remained until 1993.

In that job, Kahn helped develop the Stark-Gradison Medicare Catastrophic Coverage Act of 1988. But the next year, then-House Ways and Means ranking member Bill Archer (R-Texas) asked Kahn to draft a bill repealing the legislation.

"I worked both sides of the legislation because that was my role," Kahn said. "I have views, I have feelings about issues, but at the end of the day, you work for the members."

Harry and Louise

In 1993, Gradison left Congress to become president of the Health Insurance Association of America (HIAA), an insurance lobby. He took Kahn with him and the two became a pivotal pair in helping to defeat Hillary and Bill Clinton's health-care reform efforts, creating the killer Harry and Louise ads in the process.

Back to the Hill

Partly as a backlash to the Clintons health reform efforts, the GOP, led by Kahn's old mentor Newt Gingrich, captured the Congressional majority in 1995 for the first time in 40 years, and Kahn returned to the Hill, to take his dream job: staff director for the House Ways and Means Health subcommittee.

Between 1995 and 1998, Kahn worked closely with Health subcommittee Chairman Bill Thomas (R-Calif.) on the Balanced Budget Acts of 1995 and 1997, as well as the Health Insurance Portability and Accountability Act of 1997 (HIPAA).

"That probably was the high point of my life in some ways, being able to play that kind of role in the legislation," he said.

Back to K Street

In early 1998, Gradison was ready to retire as HIAA president, and Kahn replaced him.

Back on the lobbyists' side, Kahn worked on a Consumer Bill of Rights and joined Ron Pollock's consumer advocacy group FamiliesUSA in what he called "the first kind of strange bedfellows' coalition" that foreshadowed the health-care coalitions today that often contain competing interests.

Federation of American Hospitals

In 2001, Kahn moved to the Federation of American Hospitals (FAH), a lobbying group that represents investor-owned hospitals around the country. He said representing private hospitals after representing the insurance industry wasn't as huge a jump as some might suspect. "I'm a private sector kind of guy, I believe in the free enterprise system and in the market."

The Issues

The early 1990s was a pivotal time in health-care policy. Bill Clinton took office promising sweeping reforms. Kahn said the Health Insurance Association of America (HIAA) supported reforming the broken health-coverage system, but not with all of the Clinton administration's proposals. "We decided we needed to be a real squeaky wheel," he said.

Kahn was in charge of preparing an HIAA advertising campaign that could get the attention of Americans in their homes. The common refrain at the HIAA was that health-care reform would be decided around the kitchen tables of America.

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"That gave me the idea to suggest to Ben [Goddard, a public relations consultant] that we should test two people sitting around a table," Kahn said.

The idea tested off the charts, and Harry and Louise were born.

The ads, which featured a middle-class husband and wife at the kitchen table discussing their concerns about the Clinton health plan, are considered a major factor in the defeat of the Clinton reform plan.

Kahn recently expressed ambivalence about his role in that debate. "I wasn't enthusiastic about it I felt like it was something we had to do because they just didn't want to pay attention to us," he told Newsweek.

"It became an icon partly because the administration decided to make it an icon, by attacking us," Kahn said.

But Harry and Louise won't be making a return. Kahn calls the campaign an animal of 1993, when television advertising had not yet been extensively exploited in political issues campaigns. "I think it had its day," he said.

In 2007, Kahn's Federation of American Hospitals (FAH) developed a health-reform proposal with the goal of "building on what works in the current system."

The group proposes insuring all Americans by expanding government programs such as Medicaid and the state children's health insurance program (SCHIP) and offering subsides to help those who don't qualify for them afford health coverage. "What we'd like to see is a maximum level of coverage," Kahn said.

But Kahn said the major players in the health-reform debate have moved beyond arguing for any one plan, and are focused on working out issues such as financing a new system and regulating private insurance companies.

Universal Health Coverage and Mandates

The FAH's private hospitals are legally required to treat the ill, whether or not the patient can pay for treatment. As a result, the hospitals write billions of dollars in unpaid health costs off each year. Thus, the FAH wants to require all Americans to carry health insurance, and argues the government should offer subsidies to help people buy it.

"We really want to have coverage expansion, and we want to find the best ways to do it," Kahn said. "Our orientation is to do it through existing programs."

The group's plan would preserve much of the existing system, expanding on government programs like SCHIP and Medicaid to cover more people. FAH also proposes what it calls Health Coverage Passports. These "HCPs" are government subsidies offered on a sliding scale based on income that would help those not eligible for Medicaid afford health insurance.

"We assume the dollars will be there," Kahn said of the subsidies.

"Everybody has to play to make the thing work."

Improving Quality

Another priority for the FAH is improving the quality of care in hospitals, which means putting more money into studying what works.

In the long-term, quality controls could be a cost-cutting tool. "Hopefully over time you'd get more cost-effective efficient service if it's focused on doing the right thing at the right point," Kahn said.

Critics argue that effectiveness studies could limit what treatments doctors are allowed to use, inhibiting medical innovation and breakthroughs.

The Network

Kahn's early political mentor was one-time Speaker of the House Newt Gingrich (R-Ga.). The two met in 1968 when a 16-year-old Kahn volunteered for Nelson Rockefeller's (R) presidential campaign. Their friendship became rocky in the 1980s, but Kahn said they have since mended it and are still in touch.

Kahn worked as a Hill staffer for Sen. Dan Quayle (R-Ind.) and Sen. David Durenberger (R-Minn.). On the House Ways and Means Committee, Kahn worked closely with ranking member Rep. Bill Archer (R-Tex.) and Rep. Willis Gradison (R-Ohio), the ranking member on the tax-writing panel's Health subcommittee. He also worked with the Health subcommittee chairman, Rep. Pete Stark (D-Calif.), who still holds that position.

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