Competing demands in health overhaul

A look at 10 groups with the most influence, or most at stake, if the country's health-care system is overhauled, and what they want and are trying to avoid:

Workers

Some 60 percent of people younger than 65 get health care through an employer. But employers don't have to offer health insurance, and some are dropping it. Labor unions want to require employers to help pay for coverage for employees.

Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Obama and many Democrats, believe it would drive down costs for all.

People with conditions

Patients' advocacy groups want to require insurers to cover everyone, even people with existing health conditions, and limit their charges. They contend that would spread risk and costs throughout the population.

Older people

Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit.

Uninsured people

The liberal group Health Care for America Now, an advocacy group for the estimated 50 million uninsured people in the United States, says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.

Insurance companies

Private insurers contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, if Congress requires all Americans to get insurance.

Small businesses

Their top goal: Avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not only those who get coverage through an employer.

Big businesses

They oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on health-insurance benefits.

Hospitals

Hospitals worry that the fees they collect would be reduced. They support requiring individuals and employers to purchase insurance.

Doctors

Doctors want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors also want curbs on medical-malpractice awards.

Drug companies

The drug lobby opposes a public plan, instead proposing to cover more of the uninsured by expanding Medicaid. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance but oppose efforts to squeeze bigger discounts from them under Medicaid.