WASHINGTON -- Just before President Clinton spoke to the nation about health care reform last month, Families USA sprang into action. It parked an ambulance outside the Capitol with a sign counting off the numbers of Americans without health insurance.
News photographers snapped pictures, reporters scribbled notes, lawmakers commented.
Score another public relations coup for Families USA, a little group that charged out of obscurity this year to become a loud voice for health care reform. No advocacy group makes a bigger splash in the news media on this issue or is closer to Mr. Clinton.
If the administration gets its reform plan through Congress, Families USA executive director Ronald F. Pollack is sure to be invited to the bill-signing ceremony at the White House. He began working with Mr. Clinton before the Arkansas governor launched his campaign for the presidency, forging a relationship that has enhanced his group's influence even as it has raised questions about its independence.
Mr. Pollack is unapologetic about his ties to Mr. Clinton: "My honest assessment was nothing was more important to the achievement of health care reform than getting Bill Clinton elected."
The group uses a variety of tactics -- gimmicks like the ambulance, serious studies on health issues and sheer aggressiveness -- to get its message out. "We spent a lot of time working through the media, because that's how most people get their information," says Mr. Pollack, 49, a lawyer and lifelong social activist.
Friends and foes are in awe. "They get incredible press attention," says Susan Van Gelder, an official of the Health Insurance Association, a group of 270 insurers that skirmishes often with Families USA on health reform.
And yet most people hadn't even heard of this group a year ago. For a long time, it specialized in senior citizen issues, but was dwarfed by giants such as the American Association for Retired Persons.
Founded by French-born computer entrepreneur Philippe Villers
in 1981, Families USA has just 25 employees and a total budget of $3 million -- small change compared with the tens of millions of dollars spent by the special interest groups it fights, such as the Health Insurance Association of America and the Pharmaceutical Manufacturers Association.
The group's money comes mainly from foundations, the federal Administration on Aging -- which under the Bush administration gave Families USA $283,000 last year -- and big contributors such as Mr. Villers. He gave $40 million in stock, though it quickly depreciated in value. Now he's seeking money from other wealthy people, whom he refuses to name.
The group works out of a drab building on G Street, a few blocks from the White House. Photographs of rural poverty, evoking the conditions Mr. Pollack saw as a civil rights worker in the South in the 1960s, adorn some of the walls of the cramped offices. Stacks of paper grow like unruly bushes on the floor.
"We are a little David among a good number of Goliaths," says Mr. Pollack, who previously was dean of the Antioch University School of Law, which specialized in training attorneys for public interest law careers.
Families USA's clout grows from its media and political savvy. Mr. Pollack and his media relations director, Arnold Bennett, strike quickly whenever there's a chance of getting news coverage.
They pounced on the case of Benny Milligan of Louisiana. He was on his way to prison for fraud last January after switching identification with a severely injured friend, who needed extensive care after a fall but didn't have health
insurance. Families USA orchestrated protests, making Mr. Milligan a hero and a symbol of an unjust health system in which 37 million Americans lack benefits.
Says an admiring senior Clinton administration official: "In terms of hit per dollar and influence for size, nobody gets near to Families USA. They know how to drive a story. And they also do good research."
The group spews out reports on health care and insurance. Bearing titles like, "Nursing Home Insurance: Who Can Afford It?", they make a case for reform and frequently are cited in news stories.
But some of Families USA's targets, such as the insurance and pharmaceutical industries, accuse the group of playing fast with the facts.
"I've been at podiums time after time with Ron, and he cites old numbers and old statistics and he describes long-term care policies that existed in the mid-80s," Ms. Van Gelder complains. "But the policies have changed light years since, and the policies can't be sold in the manner they're describing."
But Families USA stands by its research. Mr. Pollack says, "We've got to make sure we're accurate in what we say."
Besides courting the national news media, the group sprays its message outside the Washington Beltway. It helps local reporters by supplying them with names of area residents -- compiled by Families USA -- whose individual experiences with the health care system would help illustrate stories.
Radio stations around the country can call the group's Washington office to hear tape-recorded comments on its reports and positions. When Families USA presented a study on Americans who lose health insurance, 1,000 stations picked it up, according to Mr. Bennett's assistant, Aviva Shlensky.
This Thursday, the group will stage its next event, more than 1,000 "house parties" in all 50 states. Families USA supporters will try to persuade neighbors and friends to write their members of Congress. Reporters will be invited, of course.
Mr. Pollack says the group's membership, 225,000 people who "pay what they can," is rising. Nine field organizers are working in 18 states, mostly the Southeast and New England, areas where the group believes that effective public pressure can be applied to Congress.
Nevertheless, John Rother, legislative director for the AARP, notes that Families USA is not a membership-driven group. "I think the one thing you have to be careful about is, who do they speak for?" he said. "The answer basically is they speak for themselves."
Other groups that advocate health care reform question the independence of Families USA, given its close relationship with the White House.
"Right now they're not a critical voice at all," says Sara Nichols, staff attorney for Public Citizen, the Ralph Nader group advocating a Canadian-style plan in which the government pays all health bills, an approach Mr. Clinton rejects.
"They really are seen as an extension of the White House," she says.
But Mr. Villers, the founder of Families USA and its president, bristles at questions about the group's independence
"I would not want to become an apologist for this administration or any other administration," he says. "The fact that we think the Clinton plan is a giant first step in the right direction doesn't mean we think it's a perfect plan. We have in the past, and will continue to, press for improvements."
But the group makes its complaints privately, says Mr. Villers, 58, "because we think that is the most effective way."