Health Care Fight Swells Lobbying

Nov. 23, 2009 -- Companies and groups hiring lobbying firms on health issues nearly doubled this year as special interests rushed to shape the massive revamp of the nation's health care system now in its final stretch before Congress.About 1,000 organizations have hired lobbyists since January, compared with 505 during the same period in 2008, according to a USA TODAY analysis of congressional records compiled by the nonpartisan CQ MoneyLine.

Overall, health care lobbying has increased, exceeding $422 million during the first ninth months of the year, according to the Center for Responsive Politics, which tracks money in politics. That's more than any other industry and a nearly 10% jump over the same period in 2008. The center's Dave Levinthal said the frenzy of new lobbying activity makes financial sense.

"If lobbying didn't work, people wouldn't do it," he said.

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The vast scope of the health care legislation, which cleared a major hurdle Saturday when the Senate voted 60-39 to begin debating it, has spurred some to lobby for the first time. Gaylord Hospital in Wallingford, Conn., a 137-bed long-term care facility, decided it needed professional help after scrambling last year — aided by state lawmakers — to avoid losing Medicare payments, said Janine Epright, hospital chief financial officer.

"It was an eye-opener," she said of the Medicare fight. "We realized that we didn't have enough pull individually or as an industry to drive the process" in Washington. Epright said the non-profit hospital will spend about $50,000 on lobbying.

Others are beefing up their lobbying presence. Language Line Services, which has spent $90,000 on federal lobbying since 2007, hired a second firm this year as it pushed to boost federal funding for medical translation services. The firm, which employs 8,000 translators, says interpreters can reduce medical errors for patients who don't speak English.

The lobbyists arranged meetings between company executives and House staffers, said Marty Conroy of Language Line. The health bill passed by the House this month requires Medicaid to match up to 75% of translation costs, up from 50%.

The American Beverage Association hired a fifth lobbying firm this year as it worked to kill a proposed federal excise tax on sugary drinks to help pay for the bill. The group spent $7.3 million on lobbying during a three-month period, federal records show. That included $5 million on advertising to fight the tax, spokesman Kevin Keane said.

By comparison, the group spent nearly $668,000 on lobbying last year

So far, the group has been successful in keeping the tax out of the latest House and Senate bills.

But Keane said the group is not easing off its lobbying efforts yet. "You never relax until a piece of legislation, especially one of this magnitude, has reached the president's desk and you are not in it."

Interest groups have a lot at stake in health care debate

The effort by President Obama and the Democrats in Congress to revamp the nation's health care system by expanding coverage to millions of uninsured people and seeking to contain future costs is now in the Senate, but major issues remain unresolved. If it passes, industry groups that have spent more than $422 million this year lobbying on health care will have much at stake in the final negotiations with the House, which passed its version earlier this month. USA TODAY's Richard Wolf takes a look at how each group has fared so far and what's to come.

Doctors

What they get: New patients would be added because of a mandate in the House and Senate that most people buy insurance. Both bills include billions of dollars in subsidies to help the uninsured. The Congressional Budget Office (CBO) estimates 36 million people would be added over the next decade in the House bill; 31 million in the Senate version.

What they give up: Their earnings per patient could decline as more payments are made on the basis of quality, not quantity of services, and as preventive care is stressed. Cost containment efforts in the bills range from pilot projects designed to compare the effectiveness of medical treatments in different regions to creation of a Medicare commission that could force votes in Congress to cut health care spending.

What's next: The American Medical Association wants a 10-year deal that would prevent annual reductions in the fees Medicare pays physicians. It would add at least $210 billion to the deficit over that time, something President Obama has vowed not to do, so it must be passed separately. The Senate voted down its version last month; the House passed its version Thursday.

Hospitals

What they get: Under both bills, hospitals would see 15 million new people on Medicaid, the nation's health care program for the poor and people with disabilities, as well as 18 million to 19 million more who receive tax credits to help pay for insurance. That means the number of uninsured people going to emergency rooms who can't their bills would decline.

What they give up: Three major hospital associations agreed with the White House to forfeit up to $155 billion over 10 years in Medicare reimbursements and other payments. Some of that would come from payments now made to hospitals serving large numbers of uninsured patients. The groups are the American Hospital Association, Catholic Health Association and the Federation of American Hospitals.

What's next: Hospitals won a 10-year exemption in the Senate bill from any additional Medicare reductions that might be recommended by a new advisory board to force cost-cutting action by Congress. The House bill does not include such an advisory board so this issue will issue will be resolved by congressional negotiators.

Drug companies

What they get: Millions of additional people with health insurance would mean billions more in drug sales. In addition, both bills would protect biological drugs -- made from living organisms rather than chemical compounds -- from competition from generic drugs for 12 years.

What they give up: The Pharmaceutical Research and Manufacturers of America agreed with the Senate to contribute up to $80 billion in Medicare prescription drug costs over 10 years. That would include $23 billion in new fees.

What's next: House Speaker Nancy Pelosi and other liberal Democrats want more concessions. The House bill requires additional rebates for people enrolled in both Medicare and Medicaid. It also would allow Medicare to negotiate for lower prescription drug prices.

Insurance companies

What they get: An estimated 31 million to 36 million people would be added to the insurance rolls because of the mandates in both bills -- even if these people don't use doctors, hospitals or prescription drugs.

What they give up: America's Health Insurance Plans, the industry's trade group, accepted new rules that would prohibit companies from denying coverage based on pre-existing conditions. The House bill would wipe out a long-standing antitrust exemption covering market allocation, price-fixing and bid-rigging. The Senate bill includes a new tax on high-end insurance plans costing more than $8,500 for individuals, $23,000 for families.

What's next: The industry opposes a government-run health plan, with is included in different forms in the House and Senate bills, because it claims the government could subsidize premiums. The House bill would attract about 6 million people into the plan. The Senate bill, which allows states to opt out, would attract 3 million to 4 million, according to the CBO.

Employers

What they get: New patients would be added because of a mandate in the House and Senate that most people buy insurance. Both bills include billions of dollars in subsidies to help the uninsured. The Congressional Budget Office (CBO) estimates 36 million people would be added over the next decade in the House bill; 31 million in the Senate version.

What they give up: The House mandates that businesses with payrolls above $500,000 provide health insurance or pay a hefty fee, up to 8% of their payroll tax. The Senate bill mandates that companies with more than 200 workers provide insurance coverage. Those with more than 50 workers that don't provide coverage would pay $750 per full-time worker if any worker qualifies for a federal subsidy.

What's next: The penalties on employers who don't provide insurance need to be worked out in a final bill. Employers also would benefit from further cost containment, such as the Senate's creation of a Medicare advisory board to recommend future savings in Medicare.

Insured people

What they get: Both bills would allow the majority of Americans who get health insurance through their employers to keep their coverage. Those who pay high premiums could find a better deal through a menu of insurance plans, called an exchange, including one offered by the government. People could not be denied coverage because of pre-existing conditions.

What they give up: New taxes would be levied to help pay for the expansion of insurance. The House bill includes a new 5.4% tax on people with incomes above $500,000 and couples above $1 million.? The Senate bill includes a tax on high-cost insurance plans — those costing more than $8,500 for individuals and $23,000 for families. It also includes a 0.5% Medicare payroll tax increase on income over $200,000 a year for individuals, $250,000 for couples.

What's next: The financial impact on those currently insured remains unclear. Premiums could rise or fall depending on other factors, according to the CBO. The House and Senate still must decide which of the various tax increases to include in a final bill.

Seniors

What they get: The House bill would gradually eliminate the coverage gap in Medicare's prescription drug program, which affected more than 8 million seniors in 2007. The Senate bill would provide a 50% discount. There would be no copayments for preventive care under Medicare. The program, set to run out of money in 2017, would be made solvent for about five more years.

What they give up: Both bills cut Medicare's projected growth by more than $400 billion over 10 years. Government aid to popular Medicare Advantage plans, which combine medical and drug benefits, would be reduced by $118 billion in the Senate bill and $170 billion in the House bill.

What's next: The reductions in Medicare spending are not binding, meaning future Congresses could restore them. Even if the cuts are upheld, they may not be enough to prevent big premium increases or benefit cuts in the future to sustain Medicare for decades to come.

Uninsured people

What they get: The Senate bill would provide about 19 million people with government subsidies and add 15 million parents and adults without children to Medicaid. The House bill would give about 18 million people subsidies and add 15 million to Medicaid.

What they give up: The penalty in the House bill for those who don't get insurance would equal 2.5% of their income. The Senate bill's fine would be $95 in 2014, $350 in 2015 and $750 in 2016, then indexed to inflation. Anyone who pays more than 8% of their income on health insurance would be exempt. The subsidies would not kick in until 2013 in the House bill; 2014 in the Senate version.

What's next: The House and Senate need to compromise on the subsidies. And if a government-run insurance plan is part of a final bill, Congress will have to negotiate on whether states can opt out, as only the Senate provides for that now.