How big is the US healthcare lobby?
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7366 (Published 12 December 2013) Cite this as: BMJ 2013;347:f7366
The size of lobby spending in all industries has grown steadily since the turn of the century, from $1.56bn (£0.95bn; €1.1bn) in 2000 to $3.55bn in 2010. In the past two years it has dipped slightly to $3.31bn in 2012 and though the figures are smaller, the trends are similar in health lobbying in isolation. Last year the total spend on health lobbying was just under $0.5bn
Federal lobbying in the US is a big business with a long history and a lot of mistrust. The first serious attempts to shine a light into the practice came about about 70 years ago under the Federal Regulation of Lobbying Act, passed by Congress in 1946.
This was variously challenged and altered and in 1995 was superseded by the Lobbying Disclosure Act, under which certain lobbying activities and their value must be publicly declared and all lobbyists compelled to register with the clerk of the House of Representatives since 2006.
The result is a good amount of data on activity in Washington, DC, with the Center for Responsive Politics probably holding the most complete database on its OpenSecrets website.1 The compiled data on here paint a good overview of the individuals and spending behind lobbying in the US.
Declared spending
Under the health banner there were 2991 reported lobbyists working on behalf of 1436 clients from five different healthcare subsets.⇓
Fig 1 Lobbying spend by types of healthcare organization, 20121
Manufacturers of pharmaceuticals and other health related products are by some distance the largest spenders on lobbying and the top 10 spenders in the sector will be well known to most people working in healthcare.⇓
Fig 2 Top spending in pharmaceuticals and health products, 20121
The lobbying tends to be done either by Washington based employees of the companies or by professional lobbying firms, often staffed by lawyers, to work on specific different campaigns and contracts. For example, roughly a quarter of Pfizer Inc’s lobbying spend in 2012 was on contracts with a dozen or so lobbying firms, with the contracts varying in value from $80 000 to $400 000.
Professional organizations
Whereas the spend from professional organizations is generally less than their pharmaceutical counterparts, many of them spend millions on lobbying activities, and the American Medical Association, with a spend of $16.5m invests more on lobbying the federal government than any single drug company in the world.
Although most of the figures for the top lobbying professional organizations are considerably less than those of their commercial counterparts, they still count their outlay in the millions with the Affordable Care Act being by far the biggest subject of lobbying over the past few years.⇓
Fig 3 Top spending professional organizations, 20121
Health professionals are also heavily involved in specific political campaigns donating to various different candidates for both Congress and president.
Organizations for health professionals were the fifth largest spenders on political campaigns during the 2012 election cycle. The industry contributed nearly $152.3m in the last election—a considerable leap from the $102m it gave during the 2008 election cycle.
However, according to OpenSecrets.org about a quarter of that amount, $42m, came from the Adelson Drug Clinic.1 According to the organization’s website, the drug clinic was founded by Miriam and Sheldon G Adelson, who own Las Vegas Sands, a casino and resort company. The Adelsons were the top overall individual contributors in the 2012 election cycle, contributing only to conservative causes and pro-Israel groups.
“Other key 2012 election contributors within the industry included the Cooperative of American Physicians, the American Dental Association, and the American Medical Association. The top recipient of health professional contributions was Grand Old Party presidential nominee Mitt Romney, who received nearly $13m, followed by President Barack Obama, who received nearly $11m. The industry favored Republicans over Democrats in contributions as it has in the past—57% of contributions went to Republicans whereas 43% went to Democrats.”1
The hidden industry
These figures, however, give a far from complete picture of all activity with much lobbying and spending happening outside the parameters of that which must be declared. The declared spend tends to be around the employment of lobbyists, but small amounts and less direct spending do not need to be declared. For an example of the latter, in 2010, when lobbying in general was at its peak, the American College of Surgeons declared lobbying spend of $173 896. But in the same year it opened its new base in Washington, DC, on Capitol Hill costing tens of millions of dollars, explicitly to better serve lobbying activities.
“Located on one of the last and best development parcels on Capitol Hill, the new building will serve as the location for the College’s Division of Advocacy and Health Policy,” said the press release.2 “Previously based in Georgetown, the ACS [American College of Surgeons] Division of Advocacy and Health Policy staff work to promote public policy initiatives of importance to surgeons and their patients.
“This building is a powerful statement that the College is very serious about working with policymakers and other health care leaders to identify solutions to improve and expand access to quality, culturally competent health care,” said ACS executive director David B Hoyt. “We’re fortunate to have a new, ideally situated facility in which to continue carrying out that goal.”
Notes
Cite this as: BMJ 2013;347:f7366
Footnotes
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.