People in the news

Karen Ignagni

President and Chief Executive, America's Health Insurance Plans (AHIP) (since 2003)

(AHIP)

Why She Matters

As president of America's Health Insurance Plans (AHIP), Ignagni is a powerful voice for the companies that offer health, dental, disability and long-term care coverage to millions of Americans. She turned from tentative ally in President Obama's health-care reform campaign to staunch foe.

Ignagni is, indisputably, very good at what she does. She's spent a career looking at benefits from a variety of angles; as a costs analyst, a Capitol Hill staffer, as a senior staffer at the AFL-CIO and, for more than a decade now, as the representative of the insurance industry in Washington.

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"In a city teeming with health-care lobbyists, Ms. Ignagni is widely considered one of the most effective. She blends a detailed knowledge of health policy with an intuitive feel for politics," the New York Times wrote in 1999.

As respected as Ignagni is in the insurance industry, she's been vilified by some outside of it, mostly by universal health-care advocates who say insurance companies put profits ahead of people.

As Obama's battle to reform health care wore on through 2009 into 2010, the insurance industry, which was largely credited with torpedoing the 1993-1994 Clinton health-reform effort, transformed from ally into outright foe. Ignagni's AHIP accused the Obama administration of turning them into the enemy and opposed many of the Democrat's reform plans, most notably the creation of a public health-insurance option to compete with private insurers.

After more than a year of legislative wrangling, the House passed the Senate version of health-care reform on March 21, 2010, clearing the way for the Senate to approve a package of amendments insisted on by the lower chamber with a simple majority (using a process known as reconciliation).

The $940 billion bill requires most Americans to carry health insurance and requires that insurance companies cover them, regardless of pre-existing conditions. It establishes a national insurance exchange allowing Americans to compare and purchase insurance plans. The bill will be paid for by increasing taxes on well-off Medicare recipients and by taxing premium insurance plans. By the end of the bill's 10-year roll-out, 32 million uninsured Americans will have health coverage and the deficit will be $138 billion lower, the Congressional Budget Office estimated.

But after the legislaiton passed, Ignagni warned that Congress "took a pass on" real cost control. "It's not nearly as aggressive as necessary to meet the scale and the scope of the cost problem we have nationwide."

More on: Karen Ignagni

At a Glance
Path to Power
The Issues
The Network
Additional Resources

Background

At a Glance

Career History: President, American Association of Health Plans (1993-2003); Director of the Department of Employee Benefits, AFL-CIO (1982-1993); Policy Aide to Sen. Claiborne Pell (D-R.I.), Senate Labor and Human Resources Committee (1979-1982)
Hometown: Providence, R.I.
Alma Mater: Providence College, B.A. (Political Science), 1975; Loyola University, Baltimore, Md., Executive M.B.A., 1985

Religion: Catholic
Office: America's Health Insurance Plans601 Pennsylvania Avenue, NW, South Building, Suite 500, Washington, DC 20004, 202.778.3200, 202.778.3200
Web site

Path to Power

Ignagni grew up in Providence, R.I., two miles from the Rhode Island state house. Her father was a fireman, and her mother worked at city hall.

With the help of a scholarship, which Ignagni said she will "forever appreciate," Ignagni joined the first class of women to attend Providence College in 1971. At college, her high school interest in student government turned into a major in political science.

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Social Security Administration

When it came time to look for a job, one of Ignagni's economics professors was doing research related to health policy and gave Ignagni the phone number of a contact in Washington, D.C. A few days after her 1975 graduation, Ignagni interviewed for and won a position analyzing health-related spending in the Social Security Administration. Her office would later be absorbed into the Department of Health and Human Services as the Health Care Financing Adminstration.

"It was a wonderful experience-I didn't realize it at the time," Ignagni said. "It was a wonderful way to get the building blocks down."

Committee for National Health Insurance

After two years analyzing health spending, she was recruited to the Committee for National Health Insurance in 1977. The policy group was founded by a former auto workers' union president after the creation of Medicare and Medicaid. Ignagni said she studied "Social-Security-like programs," which included looking into issues of employer responsibility and individual responsibility.

Capitol Hill Staffer

After two years in that role, Ignagni got a call from a friend saying that Sen. Claiborne Pell (D-R.I.) from her home state was hiring. She went to Capitol Hill in 1979 to work for Pell as a Democratic staffer on the Senate Labor and Human Resources Committee, which is now called the Senate Health, Education, Labor and Pension Committee.

Ignagni said she also worked with the office of that committee's former chair, Sen. Edward M. Kennedy (D-Mass.), who advocated reforming health-care coverage until his death in August 2009. That committee will have a crucial role in passing any health-care reform.

AFL-CIO

On the Hill, Ignagni had worked on health-care issues including Social Security and employee pension legislation. In 1982, she was recruited to work on similar issues for the AFL-CIO, the union umbrella organization that is still one of the most powerful voices for U.S. workers. They were looking for a health-policy expert, Ignagni said, and she became the director of the department of employee benefits.

Ignagni spent 11 years at the AFL-CIO, "helping unions save their benefits," she said. In many cases, she did so by negotiating newly-popular managed care plans, such as HMOs and PPOs, which focus on reducing health-care costs.

Ignagni received an executive M.B.A. from Loyola University in Baltimore, Md., in 1985.

Insurance Industry

In 1993, after being recruited by an executive search firm, Ignagni became president of the American Association of Health Plans. In that job, she lobbied politicians on behalf of many of the companies that offer Americans insurance coverage for health and dental problems, disability, long-term care and more.

Some called it switching sides. "She has become part of the enemy, as far as I'm concerned," Dr. Sidney M. Wolfe, director of Ralph Nader's Health Research Group, told the New York Times in 1999.

But Ignagni doesn't see it that way. Rather, she views her work on the insurance side of the equation as a natural step in her career.

In 2003, the American Association of Health Plans merged with the Health Insurance Association of America to become America's Health Insurance Plans (AHIP), with Ignagni installed in the powerful slot as president and CEO.

The Issues

Unlike its fight against the early '90s Clinton health-reform plan, Ignagni and AHIP at first tried to collaborate with the White House in its drive for reform.

"You have our commitment to play, to contribute and to help pass health-care reform this year," Ignagni told Obama at his White House Health Care Summit in March 2009.

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In 1993 "we were commenting on other individual's proposals," Ignagni said, describing the insurance industry's role during the Clinton attempts as passive. But in 2009, AHIP's board made a conscious decision to do research, identify areas ripe for change and propose plans for reform, Ignagni said.

"It's very different positioning than 14 years ago," she said in 2009.

In September 2009, Ignagni and AHIP chose sides when they publicly opposed the Senate health-reform bill released by Senate Finance Committee Chairman Max Baucus (D-Mont.), saying it did not effectively cut costs. In a letter to Baucus, Ignagni cited a study by PricewaterhouseCoopers that showed the average family's premiums would actually increase under the plan.

After the health-care reform bill passed in March 2010, Ignagni predicted the higher cost of premiums would drive people away from the insurance markets. "The question," she told the National Journal, "is whether or not individuals themselves -- because we still have a voluntary market in 2011 and 2012 and 2013 -- whether they decide they want to pay those additional costs. If they decide they don't want to pay those additional costs, then you have more people uninsured. That's the ultimate unintended consequence."

Individual Mandates

Ignagni and the health-insurance lobby favored mandating that every individual carry coverage. This requirement, similar to the law that all drivers buy car insurance, made it into the final legislation, but offered a few exceptions.

For health insurers, a mandate means millions more customers. Health reforms off small businesses and those who can't afford insurance government subsidies to help them purchase it.

But there's another side to the mandate coin. Since everyone is covered, insurers are required to cover those with pre-existing illnesses. They may ask for government subsidies to defray the high-cost of covering already-ill people and keep others' premiums from spiking.

In March 2009, Ignagni's AHIP joined the Blue Cross Blue Shield Association in pledging to end charging higher premiums to people who are already sick. "When you have everyone in the system, and you can bring (financial) assistance to working families, then you can move away from health status rating," Ignagni told the Associated Press.

Pay for Performance

The insurance industry is not alone in supporting an overhaul in the way doctors are paid. Many interest groups want to pay doctors based on the outcome of the treatment rather than paying them for every procedure prescribed .

"We either in this country are going to make a commitment to a modern health system that relies on best practices, or we are going to be in 19th century program where we pay for whatever is done," Ignagni said.

Obama has dedicated money in his 2009 economic stimulus package to studying what treatments work best.

Still, the idea has been criticized for inhibiting experimentation and innovation. Ignagni said there needs to be, "more transparency about what they tradeoffs are."

The Public Option

Ignagni fought a plan to offer a government-funded health insurance option alongside private plans, a proposal she believed would spell disaster for private insurers. Though the House bill, passed in November 2009, included a public option, the final legislation did not.

The insurance industry argued the government would be an unfair competitor, paying doctors at lower rates, similar to the way government-funded Medicare already does, Ignagni said. Independent research showed that 100 million people would quickly migrate to a public plan, if one had been offered.

"If that happens there won't be any kind of opportunity to have the bests of both worlds," she said. "There wouldn't be a private system, potentially."

Taxing Insurers

Ignagni and AHIP oppose the taxing of high-end or "Cadillac" insurance plans as a means of defraying the costs of health-care reform. The idea was advanced in the Senate by Finance Committee Chairman Max Baucus (D-Mont.) and ultimately became part of the Senate bill. The House bill paid for reform by raising taxes on wealthy individuals.

In a September 2009 letter to Baucus, Ignagni worried that, taxing Cadillac plans could make coverage less affordable. "Without system-wide cost containment provisions, the proposed new taxes on high cost plans and the proposed new taxes on key components of health expenditures would cause many Americans to spend more on coverage," Ignagni wrote.

The Network

Early in her career, Ignagni worked for Sen. Claiborne Pell (D-R.I.) as a staffer on the Senate Labor and Human Resources Committee (now the Senate Health, Education, Labor and Pensions Committee). She worked with staff for Sen. Edward M. Kennedy (D-Mass.), who chaired the committee until his death in August 2009.

Some of the lawmakers who will be key players in an overhaul of the nation's health care system include Senate Finance Committee Chairman Max Baucus (D-Mont.) and Republican ranking member Charles E. Grassley (R-Iowa), as well as Sen. Tom Harkin (D-Iowa).

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Additional Resources