The US Chamber of Commerce, which represents businesses, invariably spends more on lobbying than any other single organisation. Many of the other organisations whose lobbying expenditures are among the highest in the country are members of the health sector. Although some groups are spending about the same amount as in recent years, others are spending more.

For example, the Pharmaceutical Research and Manufacturers of America (PhRMA), which represents pharmaceutical and biotechnology companies, has already spent US$20.2 million in the first 9 months of 2009 – just US$55,000 less than in all of 2008 – and ranked fourth among all organisations in spending on lobbying. Blue Cross Blue Shield, including the national association and local companies, ranked fifth (spending US$16.7 million (during the first nine months of 2009, about US$500,000 more than in all of 2008), and Pfizer, the pharmaceutical company, ranked sixth (spending US$16.3 million, about US$4.2 million more than last year). A spokeswoman for Pfizer said the company “wanted to make sure our voice is heard in this conversation”.

Table Source: NEJM.org

The US Center for Responsive Politics notes that “a special interest’s lobbying activity may go up or down over time, depending on how much attention the federal government is giving their issues”. Of course, the billions of dollars that healthcare interests stand to gain or lose because of healthcare reform and other federal actions dwarf their lobbying expenditures. As the Obama administration has focused on health care, it has engaged in discussions with drug and medical device companies, health insurers, physicians, hospitals, business groups, labour groups, and many other parties. Dozens of contentious issues have kept interest groups busy, including the role of comparative-effectiveness research in coverage decisions, government negotiation of Medicare drug prices, the targeting of additional Medicare savings, and the size of the programme’s payments to doctors. There has also been debate on many other topics, including mandates for obtaining health insurance, the creation of a national public health insurance plan that would compete against private carriers, coverage of abortion, other specifics of health insurance reform, the market-exclusivity period for biological drug products, and new fees, taxes, and tax credits.

Many interest groups support some aspects of reform but not others. The Obama administration has struck deals with the drug industry and hospitals that it claims will save the federal government and Medicare beneficiaries billions of dollars over the next decade. It has pursued such strategies in order to appease critics and gain endorsements from key groups.

AARP (formerly the American Association of Retired Persons), which represents people 50 years of age or older, and the American Medical Association endorsed the Affordable Health Care for America Act (H.R. 3962), which was passed by the House of Representatives on 7 November 2009. America’s Health Insurance Plans (the health insurers’ lobbying organisation), PhRMA, the Chamber of Commerce, and other employers’ groups opposed it. Lobbyists for Genentech, a subsidiary of Roche, and two Washington law firms ghostwrote at least part of the statements issued by more than a dozen lawmakers; an estimated 42 House members – 22 Republicans and 20 Democrats – used some of the talking points.

The health sector has historically spent substantially more money lobbying Congress and federal agencies than it has on campaign contributions. These expenditures complement each other; whereas lobbying is directed at government officials and often involves specific matters, campaign contributions are for elections and may be sent to any candidate, not just incumbents. Nonetheless, as healthcare interests have increased their lobbying expenditures, they have also reversed their long-standing pattern of favouring Republican candidates in federal elections. During the first nine months of the two-year 2010 election cycle, the health sector – as well as the insurance industry – contributed more money to US Democrats than to US Republicans. In some races, this shift could make a difference.

GaBI Editor-in-Chief Professor Arnold Vulto comments: “This article provides detailed insight in the lobbying industry on Capitol Hill. This is partly directed at healthcare reform, but by the industry for a great deal at keeping generics off the market and on patent extension for biologicals. The Biotechnology Industry Organization has spent US$5.5 million on lobbying during the past nine months, with in addition US$9.2 million by Amgen and many more millions of dollars by other companies. To me it feels sickening, but this apparently is what the Americans see as ‘democracy’. In addition, it seems that lobbyists/ghost-writers are drafting law-proposals for Congressman BBrrrrr.”

Reference:
Steinbrook R. Lobbying, Campaign Contributions, and Health Care Reform. NEJM.org. 2009 Nov 19;361(21).