US health lobbyists outnumbered members of Congress by eight to one in 2009

BMJ 2010; 340 doi: (Published 01 March 2010) Cite this as: BMJ 2010;340:c1203
  1. Bob Roehr
  1. 1Washington DC

    Lobbyists outnumbered US congressmen and women by more than eight to one in 2009 during the debate over health reform, and total spending on lobbying on health issues reached $544m (£370m; €400m), two watchdog groups have found.

    US law requires lobbyists dealing with Congress to file annual disclosure forms. The non-profit Center for Public Integrity created a searchable database from these filings of 4525 registered lobbyists whose activities cost at least $5000 (

    It broadly grouped their affiliations and found that trade, advocacy, and professional organisations led the pack in lobbying on health, with 745 lobbyists. Among the most active were AARP (formerly the American Association of Retired Persons), the membership group representing the interests of people aged 50 or older, which employed 58 lobbyists. Other big players included the US Chamber of Commerce (47), the Business Roundtable (40), and the American Medical Association (33).

    Hospitals were the second busiest group, with 207 lobbyists. The insurance industry ranked fourth (105); drug makers eighth (66); and medical services (51) rounded out the 10 largest groups of lobbyists.

    Another watchdog group, the Center for Responsive Politics, reported that $3.47bn was spent on lobbying on all kinds of issues in 2009, including $544m on health issues (

    A cursory examination of individual quarterly listings in the database at the Center for Public Integrity indicates that the US Chamber of Commerce spent the most on health lobbying (more than $130m); labour unions (more than $25m) and the AARP ($27m) were other major players.

    Wal-Mart, the retail giant and the nation’s largest employer, spent close to $10m. It has concerns about health insurance coverage of its workforce, is a major vendor of pharmaceutical products, and has experimented with “doc in a box” walk-in clinics in its stores that provide basic medical services, usually by a nurse practitioner.

    But the numbers alone tell an incomplete story; not all of the health activities were related to health reform legislation. Lobbyists often split their time between various clients and topics.

    Furthermore, the filings seldom include activities outside Washington, DC, such as advertising on television and radio, or grassroots activities, ranging from a simple email to members asking them to contact their Congressman or woman to elaborate “astroturf” campaigns that seek to create the illusion of real grassroots support.

    These competing interests have brought health reform to a grinding halt while President Obama and Democratic leaders ponder how to extricate themselves from this quagmire (BMJ 2010;340:c1176, doi:10.1136/bmj.c1176).

    The country is split, with 43% in favour of passing health reform legislation and 43% opposed, according to the latest tracking poll from the health research charity the Kaiser Family Foundation. The survey of 1201 broadly representative adults was conducted in the middle of the month and released on 23 February.

    Although there is broad agreement on some individual elements of reform, consensus breaks down over specific details and when those elements are combined into a single package.

    The Kaiser poll found that 32% of Americans want to move quickly to finalise existing legislation passed by the House and Senate; 20% want to pull out a few key provisions and pass something less than comprehensive reform; 22% want to put reform on hold until later in the year; and 19% want to stop working on health reform this year.


    Cite this as: BMJ 2010;340:c1203

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