Asked whether there are more coalitions of interest groups and businesses trying to influence the current California healthcare debate, Anthony Wright, executive director of Health Access California, laughs out loud. "Yes," he says. "However wary one is of the various coalitions, I think the rise of all these coalitions is a signal that something big is happening this year."

There are six main coalitions now weighing in on healthcare reform at the state level. These six include three with a large business component--the Together for Health Care Coalition, the Coalition to Advance Healthcare Reform and the California Small Business Health Coalition, which opposes the leading proposals. The remaining three, generally noncommercial, coalitions are Divided We Fail, It's Our Healthcare and Having Our Say.

The Together for Health Care Coalition is made up largely of professional and advocacy organizations, along with insurers. The California Medical Association has thrown its weight behind this coalition. The group does not currently support any specific legislation, although it intends to "keep up the momentum for getting something done this year," says David Seldin, a spokesman for coalition member Blue Shield of California. The group's next step is the June launch of an advertising campaign promoting healthcare reform, he says.

Even though it has no favorite proposal, some of the Together for Health Care Coalition's preferences are clear from its stated principles for comprehensive healthcare reform, which are universal coverage, shared responsibility, affordability and stable long-term funding. In addition to the CMA, other members include AARP, California Federation of Labor, California Teachers Association, Health Net, Kaiser Permanente, Service Employees International Union, and the Silicon Valley Leadership Group.

The Coalition to Advance Healthcare Reform has the most large companies of the six groups, including a few traditional reform antagonists--insurers, drug companies and large retail employers--who have bonded over shared values. Its preferences for reform are: market-based healthcare; universal, mandatory coverage; financial assistance for the poor; an emphasis on prevention with financial incentives; and tax-exempt insurance premiums for individuals.

Among the Coalition to Advance Healthcare Reform's 38 members are Safeway, Kraft Foods, HJ Heinz, PepsiCo, Aetna, Cigna HealthCare, Kaiser Permanente, PacifiCare, GlaxoSmithKline and Eli Lilly.

The California Small Business Health Coalition stands as the only one of these six groups with a statewide focus that opposes employer contributions. The coalition's membership list is a mixture of 20 business associations, such as the California Restaurant Association, 13 chambers of commerce, and 34 individual businesses--generally small to medium in size.

According to a California Small Business Health Coalition statement, the coalition hopes to "prevent decision-makers from shifting the costs of healthcare reform to small business." It is guided by four principles: Support solutions that lower costs and make coverage affordable; oppose proposals that disproportionately impact small businesses; expand access to existing programs; and support incentives for businesses to provide health coverage.

Divided We Fail is closely associated with AARP, but it also includes the Service Employees International Union and the Business Roundtable. The coalition's platform emphasizes healthcare affordability, prevention, and long-term care that helps people to live independently.

It's Our Healthcare is the largest state-focused coalition with a mostly nonbusiness membership. The group includes at least 56 advocacy organizations and unions, including Health Access, the Service Employees International Union and AARP.

According to a statement, the group promotes affordable healthcare, prevention, efforts to control costs, strengthening of healthcare facilities, comprehensive healthcare access, and risk-sharing among consumers, employers and government. The coalition also says it is opposed to requiring individuals to carry "unaffordable" health insurance.

The Having Our Say coalition is headed by the California Pan-Ethnic Health Network. It is an ally of It's Our Healthcare and is composed mostly of ethnic minority advocacy groups. The coalition's focus is on prevention, universal healthcare coverage, healthcare efficiency, high-quality care, and "equity of responsibility based on financial resources," according to a statement. Members include the Asian & Pacific Islander American Health Forum and the California Black Health Network.