THE INFLUENCE GAME: Little-known lobbyist scores money for birth centers in health overhaul

THE INFLUENCE GAME: Birth centers fight for fees

WASHINGTON — Karen Fennell is not your typical high-rolling lobbyist with a fat expense account and clients paying six-figure fees.

But this former nurse is doing something that Gucci-clad lobbyists would envy: she’s won her clients some coveted federal money in the battle over health care.

How she did it is a case study in how Washington’s influence game can work, even for those without bottomless checkbooks. She cultivated key allies in Congress, crafted an argument that aligns with the prevailing political winds, and represents a constituency no lawmaker could shun: mothers-to-be.

Fennell’s clients are birth centers around the country that mainly serve pregnant women who are too poor or too far away from a hospital to have any other option for prenatal care or delivering their babies. Fennell is happy to show lawmakers a letter signed by thousands of their female constituents pleading to keep birth centers open.

And while she lacks the money to make hefty campaign donations, she’s got another financial pitch: an official opinion from congressional budgeteers that says her proposal will actually save the government cash. That kind of blessing is increasingly valuable in a health care debate obsessed with cost savings and lowering the deficit. It’s another of her arguments for why Medicaid, the federal health program for the poor, should bother reimbursing places many lawmakers and aides have never heard of.

“This fits now because it saves money,” Fennell says.

Old-fashioned connections and years of experience haven’t hurt either. Fennell, a seasoned community activist on women’s health issues, was friendly with the late wife of House Majority Leader Steny Hoyer, D-Md., who happens to be her congressman. She used to represent the American College of Nurse-Midwives and has worked closely with influential health care aides and lobbyists who are helping to shape the health overhaul.

She prowled the hallways of a House office building on a recent morning, checking in with supporters of her initiative to make sure they were still on board. Clad in a hot-pink jacket and practical black pumps, the self-described “grandmother with blonde highlights” sounded more like a seasoned pro as she reeled off some tricks of her trade.

“I always write the legislation myself — it’s just faster and more effective that way,” Fennell said. That would be from her house in California, Md., a 90-minute drive from Capitol Hill, which doubles as her office.

And she had this to say about lawmakers who aren’t backing her: “I don’t have a hit list, because I know tomorrow, I’m going to need them for something else.”

With her simple, low-budget tactics, Fennell is a rare exception in a health care debate awash in special-interest money and campaign contributions, where success more often comes in direct proportion to the size of the lobbying retainers they pay and the prominence of the hired guns they tap.

Fennell has pocketed less than $25,000 over the last two years lobbying for the birth centers — spare change in the context of the nearly $750 million that insurers, drug makers and other medical interests have dumped into getting what they want out of the health care bill. Her only real opponent, the American College of Obstetricians and Gynecologists, has spent nearly $1.2 million lobbying during that time, including resisting reimbursement for birth centers without credentials and midwives trained to deliver outside of hospitals.

“To us, it’s a safety issue,” Gerald F. Joseph, ACOG’s president, said in an interview. “We just want birth centers and the providers in these birth centers to go through what we view as the proper credentialing.”

For now Fennell, who’s lobbied on behalf of the American Association of Birth Centers to make sure that Medicaid pays them back, appears to be winning. Three House committees have approved measures that would allow the reimbursement, and a Senate measure by Finance Committee Chairman Max Baucus, D-Mont., would require it.

Two years ago, the agency that oversees federal health programs abruptly stopped reimbursing states for birth center services after 20 years of doing so, saying it discovered it didn’t have legal authority to make the payments. There are about 250 of the centers throughout the country, and they serve a disproportionately high percentage of low-income women. Many have had to close because they’re no longer getting federal payments.

Fennell has succeeded in large part by highlighting the real people behind her issue — pregnant women, often without access to health insurance or facilities — and using her clinical expertise to answer the inevitable safety questions lawmakers and their aides have about deliveries outside the traditional venue of a big hospital. She comes to meetings armed with figures showing that these births are not only less costly for the government — resulting in only about one-fifth as many costly Cesarean sections on average as hospital births — but also healthier for mothers and children.

Fennell has enlisted the help of some influential players, meeting with Hoyer’s senior staff early on to plot strategy, and collaborating closely with Sen. Barbara Boxer, D-Calif., whose aides kept her apprised of fast-moving, closed-door machinations on Baucus’ bill as senators haggled over potential cuts.

When their proposal survived the bargaining sessions, one of Boxer’s aides e-mailed Fennell to report, “We’re in.”

But Fennell isn’t taking anything for granted. Should birth center reimbursement somehow be dropped from the health legislation or the bill should die altogether, she’ll try to get it attached it to a budget measure that could move at year’s end.

“I always have a backup plan,” she said.