Congress and Big Healthcare – An Unholy Alliance

More than 11,000 organizations spent $3.12 billion  on lobbying the federal government in 2016.  Below is a representative list with healthcare areas of interest.   Not all of the spending   in the totals was for healthcare issues:

  1. S. Chamber of Commerce — $75.52 million

Repeal of the tax on payers under the ACA and repeal the tax on medical device manufacturers, as well as the 21st Century Cures Act and the World’s Greatest Healthcare Plan Act, an ACA replacement plan put forth by Sen. Bill Cassidy, MD, R-La., and Rep. Pete Sessions, R-Texas.

  1. S. Chamber of Commerce Institute for Legal Reform — $27.71 million

Lobbied on Medicare, Medicaid and health issues including  the 21st Century Cures Act, regulations to strengthen Medicare anti-fraud measures and issues related to Medicare Secondary Payer reporting requirements.

  1. American Hospital Association — $18.83 million

Lobbied on the 21st Century Cures Act, issues related to oversight of surgical practices, hospital reimbursement, health IT transparency, unique device identifiers, improving care for patients with chronic diseases and a bill that would remove the 96-hour physician certification requirement for critical access hospital payments.

  1. American Medical Association — $18.77 million

Lobbying on the Medicare Access and CHIP Reauthorization Act, Zika funding, Stark Law modernization, opioid addiction treatment and 21st Century Cures.

  1. Business Roundtable — $15.7 million

The group lobbied on issues related to the repeal and replacement of the ACA, the Cadillac tax and the GOP-led House Health Care Task Force “A Better Way” project, among other issues.

  1. AARP — $8.71 million

Lobbied on healthcare issues for seniors including Medicare and Social Security; advocated for limited age rating for private health insurance; and among other issues, supported the FAIR Drug Pricing Act, a bill that would require drug manufacturers to report price increases if they exceed a 10 percent increase over 12 months.

  1. National Association of Manufacturers — $8.49 million

Lobbied on ACA implementation, Medicare Advantage, Medicare Part D, drug price transparency and a bill that called for the repeal of the ACA’s Independent Payment Advisory Board, which was created to develop proposals to reduce Medicare spending growth.

  1. Blue Cross Blue Shield Association — $8.43 million

Lobbied  on an array of healthcare issues in 2016. Some of those issues included the Cancer Moonshot Initiative, legislation to address the opioid epidemic, the ACA’s risk corridor program, health savings accounts, ACA reform and the GOP replacement plan, A Better Way

The Healthcare industry accounted for the greatest share of spending by any industry in 2016.   About 16 percent of total lobbying spending — or more than $509 million — was paid for by healthcare organizations last year, according to CRP.

Federal campaign contributions from Healthcare Providers

Physicians and other health professionals are traditionally the largest source of federal campaign contributions in this sector, which contributed a record $260.4 million to federal candidates during the 2012 election cycle. Aside from doctors’ associations, pharmaceutical companies and HMOs are consistently generous givers. Certain industries within the sector, such as nurses, give more generously to Democrats, but on the whole Republicans traditionally have gained the most from contributions by health interests.

These are a selected list of some of the healthcare industry  contributors, together with the amount of the donation.  Some of the donations were made specifically to candidates and some  were made to Political Action Committees:

  • Besilu Stables (Benjamin Leon Jr., Leon Medical Centers, a Medicare provider) $3,500,000
  • Platinum Health Care $2,450,125
  • Unitedhealth Group $2,246,642
  • American Society of Anesthesiologists $1,855,050
  • American Hospital Assn $1,788,172
  • American Medical Assn $1,746,884
  • American Assn of Orthopaedic Surgeons $1,689,853
  • Blue Cross/Blue Shield $1,685,950
  • American College of Emergency Physicians $1,290,700

All donations took place during the 2015-2016 election cycle and were released by the Federal Election Commission on Monday, November 27, 2017.

Top 20 Recipients

Finally below is a list of the 20 top recipients of donations from healthcare industry for the same election cycle:

Rank Candidate Office Amount
1 Clinton, Hillary (D) $22,171,168
2 Trump, Donald (R) $4,789,833
3 Sanders, Bernie (D) Senate $4,298,036
4 Cruz, Ted (R-TX) Senate $3,190,902
5 Rubio, Marco (R-FL) Senate $2,252,771
6 Carson, Ben (R) $1,906,371
7 Van Hollen, Chris (D-MD) House $1,653,447
8 Ryan, Paul (R-WI) House $1,414,218
9 Portman, Rob (R-OH) Senate $1,305,600
10 Burr, Richard (R-NC) Senate $1,260,215
11 Schumer, Charles E (D-NY) Senate $1,223,237
12 Bush, Jeb (R) $1,210,239
13 Young, Todd (R-IN) House $1,188,055
14 Bennet, Michael F (D-CO) Senate $1,113,377
15 Toomey, Pat (R-PA) Senate $1,073,609
16 Blunt, Roy (R-MO) Senate $1,073,059
17 Wyden, Ron (D-OR) Senate $1,028,435
18 McCarthy, Kevin (R-CA) House $975,985
19 Brady, Kevin (R-TX) House $965,901
20 Murray, Patty (D-WA) Senate $925,440


Senators Drafting Secret Health

Drafters of the bill to repeal the Affordable Care Act 

Those in Congress who in 2017 participated in the drafting of the bill to repeal the Affordable Care Act collected an average of $214,000 in campaign contributions from health insurance and pharmaceutical industries between November 2010 and November 2016: – nearly double the amount received by colleagues excluded from the process.   Four of the senators working on the bill have received more than $300,000 from the insurance and pharmaceutical industries.[2]   

Orrin G. Hatch $471,560
Addison “Mitch” McConnell $433,400
Rob Portman $382,100
Patrick J. Toomey $354,616

Democrats Also Benefit

In the spring 2017,  Sen. Dianne Feinstein told her constituents at a San Francisco town hall event that she’s not ready to support a single-payer health care system — an idea that had been gaining steam at the state level in California: “If single-payer health care is going to mean complete takeover by the government of all health care,” the California Democrat said, “I am not there.”

A week later, Feinstein benefited  from a fundraising event at the Washington, D.C., office of Avenue Solutions, a lobbying firm that represents major health insurers, pharmaceutical companies and the primary trade association for doctors. The industries have historically opposed efforts to create a universal, government-run health care system.            Between January and March, 2017, Feinstein’s campaign committee received $655,822 in donations.  Donors to Feinstein include former Democratic Senate Majority Leader Tom Daschle, who lobbies for Blue Cross Blue Shield Association; Brian Griffin, who represents  the Pharmaceutical Research and Manufacturers of America (PhRMA); and Fred Graefe, who lobbies for the Federation of American Hospitals.   She also received donations from political action committees run by PhRMA and pharmaceutical companies Merck & Co., Amgen, and AbbVie.[3]

Lobbyists are Former Congressional Aides

267 former aides who worked for four congressional committees pivotal in approving new healthcare legislation are registered lobbyists for clients from the health sector or health insurance industry, according to the Center for Responsive Politics’ analysis of Senate lobbying data.  In addition, 18 former lawmakers also swung through the revolving door and now serve health care clients as lobbyists, partners or counsel at well-known firms such as Arent Fox LLP, Alston & Bird or Greenberg Traurig LLP.

Some lobbyists and lobbying clients disclose their positions voluntarily. One such lobbyist, Mary Tirrell, was formerly an aide to Sen. Pat Toomey (R-Penn.) and now lobbies on health care issues as vice president of government and legislative affairs for Lehigh Valley Hospital and Health Network. Tirrell’s most recent lobbying report from the first quarter of 2017 shows she advocated for repealing the Affordable Care Act and replacing it with the House of Representatives’ American Health Care Act. Her past lobbying reports show a history of involvement with various health care issues. Previously, Tirrell served as director of community and economic development for Rick Santorum when he was a senator for Pennsylvania.

Another revolver also worked for one of the Senate’s “swing votes.” Amanda Makki was a legislative aide to Sen. Lisa Murkowski (R-Alaska) for almost eight years, and eventually became her top healthcare adviser. Before that she was a health policy adviser to Rep. Jeff Fortenberry (R-Neb.). In 2014, she left her work in Congress to become a lobbyist. Now, she is director of external affairs and FDA for Novo Nordisk, a global diabetes care company. Her most recent lobbying report from the first quarter of 2017 shows her involvement in issues such as prescription drug use and diabetes prevention. She also lobbied on the House of Representatives’ American Health Care Act.

Some organizations have taken public positions on the AHCA and the Senate’s still-under debate Better Healthcare Reconciliation Act. The American Medical Association, which represents doctors, opposes both the House and Senate healthcare packages. Three of its lobbyists have insider connections.  Sage Eastman and Lauren Aronson both used to work for the House Ways and Means Committee and now lobby for Mehlman, Castagnetti et al. Andrew Wankum, one of the AMA’s staff lobbyists, worked for Rep. Kevin Brady (R-Texas) prior to lobbying.

The largest trade association for the insurance industry, America’s Health Insurance Plans (AHIP) issued a more measured response to the AHCA, supporting some revisions in the House plan but expressing concern about others. AHIP had three revolving door connections to the health care committees or members.  Blue Cross/Blue Shield, the largest insurance company in the US, issued a similar statement, and has 15 connections.

Reference: Saslow, Alec, Care Bill Backed by INsurance and Pharma Campaign Money  June 21, 2017










































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