Hospitals, insurers, doctors, unions and pharmaceutical companies spent a record $19 million trying to sway Beacon Hill lawmakers last year, a reflection of the industry's political and economic muscle and a rapidly changing healthcare landscape.
In less than a decade, lobbying by the industry has nearly doubled from the $10.8 million spent in 2007, according to an Associated Press review of lobbying reports filed with the state secretary's office.
During those years the industry has had to adapt to the state's landmark 2006 healthcare law and the rollout of the federal law it inspired, signed by President Barack Obama in 2010.
The group that spent the most on healthcare lobbying last year was the Massachusetts Association of Health Plans, which represents 17 insurers providing coverage to more than 2.6 million Massachusetts residents. It reported spending more than $1 million.
MAHP President Lora Pellegrini said the industry has faced a number of challenges, from grappling with last year's failed launch of the new Health Connector website to the implementation of a 2012 law designed to overhaul the state's healthcare payment system.
"Our activities reflect the seriousness and volume of issues our industry tackled in 2014," Pellegrini said.
Tim Gens, executive vice president of the Massachusetts Hospital Association, echoed that frustration. He said nearly one in five of the 6,000 or so bills filed at the Statehouse touch on healthcare.
"The healthcare sector is the largest sector in the state," he said. "We are going through a dynamic period in which virtually every aspect of the delivery and payment systems is subject to change."
The group reported spending $882,470 on lobbying last year, the second most of any group.
An emerging trend in healthcare lobbying in Massachusetts is among companies hoping to grow and sell marijuana for medicinal use under a 2012 ballot question approved by voters.
No dispensaries have opened, but at least nine companies filed lobbying reports for last year, although less than half reported spending any money, a total of $143,000. That could expand in coming years as more dispensaries win licenses and begin opening their doors.
Lobbying reports typically detail a range of expenses, from the salaries of paid lobbyists to office costs like photocopying, rent, public relations, telephone bills and computer equipment.
Of the more than $1 million spent by the Massachusetts Association of Health Plans, for example, $701,000 went to salaries, $245,000 went to operating expenses and $110,000 went to meals, entertainment and transportation costs.
Companies are barred from making direct contributions to lawmakers, but the lobbyists they hire can donate up to $200 a year to lawmakers and candidates.
Government watchdog groups have warned that the millions of dollars spent by healthcare groups could crowd out the voices of citizens and patients who don't have the deep pockets of hospitals and insurers.
But the healthcare groups argue that the lobbying they are engaged in will also help patients by improving the overall delivery of care.
Rich Copp, a spokesman for Partners HealthCare, Massachusetts' largest hospital and physicians' network, said their top concerns include access to substance abuse treatment and mental health services and making sure the state offers adequate reimbursement for the care doctors and nurses provide to MassHealth, the state's Medicaid program.
"We have an obligation to ensure that our patients and employers have a voice in the ongoing healthcare conversation," Copp said.
Copp said a decision by Partners to abandon plans to merge with South Shore Hospital after a court rejected the agreement and Attorney General Maura Healey said she would try to block any future merger wasn't much of a factor in the $645,000 the company spent on lobbying last year.
One of the state's largest unions, the Massachusetts Nurses Association, was also among the top five in the industry measured by lobbying dollars. The group reported spending $576,000 last year.
David Schildmeier, a spokesman for the union, said the group was focused on a handful of initiatives last year, including one that sets strict limits on the number of patients that registered nurses who work in intensive care units can be assigned at a given time.
The law, approved by the Legislature last June, took effect in October.
"Our main concern has been to ensure safer care for patients," Schildmeier said.