Physician specialty groups facing billions of dollars in Medicare cuts and managed-care groups fighting off federal regulation engaged in a lobbying spending spree last year, federal records show.
Just as in 1996, the American Medical Association led the way in 1997 with more than $17 million in total lobbying expenses. The AMA spent more than twice as much as the American Hospital Association, which finished second among health and insurance groups at $7.8 million in 1997, according to federal lobbyist disclosure forms filed with the clerk of the House of Representatives and the secretary of the Senate (See chart).
The AMA terminated its longstanding contract with the influential Republican lobbying firm of Timmons and Co., which had close ties to former Senate Majority Leader Robert Dole (R-Kan.). The association has not engaged a new outside lobbying firm.
While the AMA was reducing its use of outside lobbyists, the AHA was using more contract lobbyists than ever. In 1997 the hospital group's spending on outside lobbyists jumped to $685,000 from $260,000 in 1996, accounting for most of the $600,000 increase in total lobbying costs.
Much of that funding went to a firm called Policy Impact Communications, which has ties to former Republican National Committee Chairman Haley Barbour.
But the AHA's percentage increase in lobbying costs was not nearly as high as the increases of some physician specialty groups.
In 1997 the American College of Cardiology increased its lobbying spending to $423,000 from $146,000. It was fighting a provision of last year's balanced-budget law that would shift billions in Medicare reimbursements from specialists to general practitioners by changing the way Medicare pays for routine office visits. In total, about $4 billion was at stake.
The lobbying didn't avert the change, but it did delay its implementation. Legislators agreed to implement only 10% of the total dollar shift in fiscal 1998, with the remaining 90% spread over four years.
According to HCFA estimates, cardiologists will lose about 17% of their Medicare income from the change.
The college was also part of an umbrella group called the Practice Expense Coalition, which was formed last year specifically to fight the change. The coalition spent $700,000 in 1997, according to its filing with Congress.
Another specialty group that stepped up its lobbying effort is the Society of Thoracic Surgeons. Its members will lose between 18% and 28% of their total Medicare income under the new formula, HCFA estimates.
According to its disclosure form, the society had no lobbying expenses in 1996. However, in 1997 the group hired Republican lobbyist Deborah Steelman, paying her nearly $200,000. Steelman, who also represents a number of insurance and pharmaceutical companies, was appointed late last year by Senate Majority Leader Trent Lott (R-Miss.) to the National Bipartisan Commission on the Future of Medicare.
Another sector that saw its spending increase significantly was managed care. HMO groups were fighting Medicare reimbursement cuts during the balanced-budget debate and continue to fight proposals that would increase HMO regulation.
The largest managed-care organization, the Washington-based American Association of Health Plans, increased its lobbying spending to $1.8 million in 1997 from $1.4 million in 1996.
In addition, a number of large HMOs expanded their lobbying activities. For example, Minneapolis-based United HealthCare Corp. spent $840,000 in 1997, up from about $120,000 in 1996.
Kaiser Foundation Health Plans increased its lobbying spending to $1.1 million last year from $650,000 in 1996.
The groups were able to reduce their losses from the balanced-budget law by several billion dollars.
The jury is still out on managed-care legislation, however. Last week a group of Democrats, with the support of the White House, introduced a far-reaching reform bill that would tighten state and federal controls on managed-care plans.