Five Republican senators returning to their states for the July 4 recess are in for a surprise welcome home next week: a barrage of television and radio ads aimed at rallying opposition to key provisions in "patients' rights" legislation due for floor debate when Congress reconvenes.

The week-long, $750,000 media blitz, paid for by a coalition of businesses and health insurers, takes aim at Democratic proposals that would let workers sue employers for grievances against company health plans. But while the ads will be widely aired, their precise targets are Republican senators up for reelection next year in Michigan, Ohio, Minnesota, Texas and Washington state. Viewers will hear a pitch from a worker, small businessman and mother and child, and then will be urged to call an 800 phone number or contact the senator to register their opposition.

The advertising campaign is just one foray into what is shaping up to be a health care summer for Washington lobbyists. Not since the big national debate over President Clinton's 1994 health care plan--when the health insurance industry deployed its "Harry and Louise" advertising campaign to sink the proposal--have the stakes been so high. The 1994 battle centered on one giant proposal. This year's debate will be more like a three-ring circus, with Congress considering not only patients' rights but also prescription drug benefits for seniors and broader reform of the Medicare system.

With so much on the line, interest groups plan to use what one strategist called "all the techniques of 21st century lobbying," including TV advertising, polling, voter education in key presidential primary states and political contributions. Much of the effort will be focused far from Washington and will not even deal directly with the legislation on Congress's agenda, but rather with polishing the "image" of vulnerable interest groups.

The health care battle pits some of Washington's most powerful and well-heeled lobbies against each other--the American Medical Association vs. the managed care industry on patients' rights, for example. It also has potentially huge implications for the 2000 elections, with both parties vying for the big dollars that the health care industry, businesses and organizations representing patients and retirees can muster.

This year's health care debate "will really increase the flow of money to Capitol Hill," said Holly Bailey of the Center for Responsive Politics. Both parties want to take positions that enable them to capitalize on that reality.

The first front will be the patients' rights bill, which the Senate is scheduled to take up July 12. The bill, which would regulate the managed care industry, has sweeping implications for HMOs, doctors and employers. Opponents are targeting an initiative by Sen. Edward M. Kennedy (D-Mass.), which would expand a patient's right to sue and gives doctors, not health plans, the final say in treatment decisions.

The Coalition for Affordable Quality Health Care, organized last year to represent HMOs, health insurance companies and trade associations, has collected $9 million to "change the image of the managed care industry," now under attack by doctors and some consumer groups, according to Roger Bolton, the coalition president. The group will kick off a multimillion-dollar television advertising campaign next week.

By the same token, the American Association of Health Plans, representing hundreds of managed care companies, has been quick off the mark in New Hampshire and Iowa this year, commissioning polls showing that voters were more concerned with Medicare's solvency than with the service provided by their HMOs, and running ads aimed at discouraging presidential candidates from "bashing" HMOs. Next week, the association will kick off a national ad campaign featuring a construction worker angry at politicians for increasing his health care costs.

"It's kind of a political campaign approach in both states," said the association's chief strategist, Mark Merritt, a veteran of Lamar Alexander's 1996 presidential campaign. "We decided more than a year ago if you're going to impact the political landscape, you have to have a plan to shape the debate in presidential campaigns."

In the patients' rights battle, the health insurance industry has made common cause with a powerful business front to fight the AMA and consumer groups favoring greater regulation of HMOs.

The Health Benefits Coalition, for example, is underwriting the July 4 advertising campaign with the Business Roundtable, which represents the biggest U.S. corporations. The coalition is made up of such lobbying heavyweights as the U.S. Chamber of Commerce, the Health Insurance Association of America, the National Association of Manufacturers and Aetna U.S. Healthcare. The coalition has spent $2 million this year trying to blunt support for the mandate allowing workers to sue employers.

Next week, it will target radio ads at Republican Sens. Kay Bailey Hutchison (Tex.) and Slade Gorton (Wash.). The spots warn that Kennedy's proposals would raise insurance premiums. Listeners are urged to tell their local senator that "you're counting on him to protect your health insurance from Ted Kennedy's Patients' Bill of Rights."

Meanwhile, the Business Roundtable's television ads will enlist voters' help in getting GOP Sens. Spencer Abraham (Mich.), Mike DeWine (Ohio) and Rod Grams (Minn.) to oppose Kennedy's initiative, which will be introduced as an amendment to a Republican patients' rights bill.

"We want to make sure they [the senators] do the right thing," said a business lobbyist. Though Republicans have generally opposed such mandates, employers fear they could waver under lobbying pressure from doctors and consumer groups.

But the managed care industry and its allies face a powerful opponent in the AMA, which has been actively pushing for tough new controls on managed care. The AMA is a difficult force for members of Congress to ignore. Two-thirds of the more than $2 million its political action committee gave to candidates in 1997 and 1998 went to Republicans. The AMA has branches in every state, and last year it spent more than $16 million on lobbying efforts.

Clinton's plan to reform Medicare and expand prescription drug benefits brings into play two other titans of the Washington lobbying world: the pharmaceutical industry and the elderly.

AARP has long put the prescription drug benefit near the top of its wish list. AARP spent $3.7 million lobbying in 1998, but its real influence comes from a battalion of grass-roots volunteers: retired seniors. Molly Daniels, who directs AARP's voter education drive, said the organization was setting up offices in Iowa and New Hampshire to "connect volunteers with candidates."

"We've done this before, but we're doing it more, and harder, and earlier this year than in the past," she said.

Clinton's plan, unveiled last week, would enable one-half to one-third of the 39 million Medicare beneficiaries not covered for prescription drugs to receive the benefit by paying a premium that would rise to $44 a month by 2008. The government would pay half the cost of the drugs, up to a set limit.

The Pharmaceutical Research and Manufacturers Association has signaled in full-page newspaper ads that it intends to be a player in the shaping of the final legislation. The ads support expanded prescription drug benefits, but caution that the choice of drugs must be left to doctors and patients, not to "government bureaucrats and their agents." The companies have made it clear that they will fight any attempt to impose price controls.

Many leading congressional Republicans support the expanded benefit because of its appeal to the elderly, a particularly active voting group. "It's the political jackpot . . . the pot of gold at the end of the rainbow," said Johanna Schneider, spokeswoman for the Business Roundtable.

But GOP fund-raisers may be reluctant to antagonize an industry that has been a major source of campaign cash. In 1997-98, the GOP reaped two-thirds of the pharmaceutical industry's $12 million in political contributions, according to the Center for Responsive Politics.

While the prescription drug benefit is the centerpiece of the Clinton proposal, representatives of hospitals, nursing homes, doctors and nurses and others hope to use the initiative as a vehicle to undo cuts in federal payments resulting from the 1997 balanced budget act.

To make its case that hospitals are hurting, the American Hospital Association has commissioned polling, hired an economic consulting firm to project the impact of the balanced budget act and spent more than $300,000 on newspaper advertising in the past few months.

Associations representing nursing home operators and teaching hospitals also hope to use Medicare reform to secure relief from the 1997 budget cuts, while doctors are focused on a drive in Congress to remove restrictions on their ability to organize labor unions.

CAPTION: Health Care Interests (This chart was not available)