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Blue Cross Blue Shield of Michigan asked the Michigan state government for small group market rate reform already adopted in most other states. Officials responded with major restructuring proposals aimed specifically at the Blues. The Michigan Blues fought back with a massive lobbying campaign as vigorous as any mounted by opponents of health reform at the national level. The company was able to prevail over one of the most powerful governors in Michigan history, whose party controlled both houses of the legislature. This amazing political victory shared much in common with the Clinton health reform's defeat by the industry and the more recent success of the prescription drug industry in shaping Medicare prescription drug reform to its liking. The experience suggests that political savvy and lobbying skills have become core competencies in the health care industry.