Six months after the passage of President Obama's landmark health care reform, health care industry groups are spending a record amount of cash on candidates and causes as the prospect of major Republican gains this fall puts the future of Mr. Obama's signature legislative accomplishment in doubt.
But even though Democrats are leading the race for cash from health care sector hospitals, drug companies and doctors, it's too early to tell whether the industry is fighting to protect or revamp the legislation.
"Remember that the party in power always tends to get more attention," said Wendell Potter, senior fellow for health care at the Washington-based Center for Media and Democracy. "And it's hard to say what the totals on cash to Republicans or Democrats mean without looking at the specific contributions. A lot of the [fiscally conservative] Blue Dog Democrats were as opposed to health care reform as the Republicans were," he said.
"People need to remember that we, the consumers, are actually the ones footing the bill for all this lobbying," Mr. Potter said. "We pay for all that. It's one of the reasons our premiums keep going up."
According to data on lobbyist spending for the first half of 2010 compiled by the Center for Responsive Politics, doctors, drug companies and hospitals are leaning Democratic this year, with 54 percent of their contributions going to Democrats versus 46 percent going to Republicans.
While corporate political spending is on pace to set another overall record for midterm elections, no one is spending more money this year than the health care industry.
Through the second quarter, the health care industry has spent $267 million on lobbying, topping the $260 million spent by manufacturing and retail, and the $252 million spent by the banking and insurance sector.
While that cash went to influencing lawmakers who are already in office, the health care industry is also a major player in the November races, contributing another $91 million to both Republicans and Democrats in the upcoming elections.
The top contributors to date in the 2009-2010 cycle are the National Community Pharmacists Association, the American Dental Association, the American Hospital Association and giant drugmaker Pfizer Inc., accord to the CRP.
The CRP's Dave Levinthal noted that many of the questions about where the money is going this cycle won't be answered for months or even years especially with the influx of "soft" money coming in the wake of the Supreme Court's "Citizens United" decision in January, a ruling that has made it easier for corporations to directly influence individual races.
A Democratic bill to require more disclosure on political ads funded by corporations, labor unions and independent advocacy groups which was already amended to take effect only after the November elections failed to overcome a Senate filibuster last week and is unlikely to be revived this year.
Democrats and many liberal groups have sharply criticized the campaign finance ruling, saying the decision gives deep-pocketed corporations the ability to pour huge amounts of money into the fall campaign.
With health care leading the way, campaign spending is likely to far surpass the estimated $2.8 billion spent four years ago on the 2006 midterms, according to Mr. Levinthal.
"It's clear that we are headed for a record. This cycle could top $4 billion in total spending," he said.
Newly formed independent "527" and "501(c)(4)" organizations nonprofit groups that spend money themselves rather than fund a candidate directly have already had a huge impact in this year's primary elections. Utilized extensively by Democrats in 2008, 527s have become a important tool in 2010 for Republican activists like Karl Rove and Ed Gillespie, who started the American Crossroads group.
The "tea party" movement, too, has its own third-party advocacy groups: the Tea Party Patriots and the Tea Party Express.
The free-wheeling spending on the November elections is, in part, according to Mr. Potter, a continuation of the struggle over the future of health care reform.
With a wave of candidates promising to repeal or roll back the law, and ongoing struggles over implementing and fine-tuning the legislation, the health care industry is determined to protect its interests.
"What's at stake for [the health care industry and the insurance industry] is profit," said Mr. Potter, a former insurance company executive who now works as a consumer advocate. "And by profit, I mean: Will these industries continue to rake in obscene profits or will they begin to see their margins squeezed? Because these reforms, if implemented as intended, will curb profiteering."
Some of the health industry money will be used to defend the new law or at least parts favorable to the interest group in question.
Dr. Ardis Hoven, chairman of the American Medical Association, said the legislation isn't perfect, but it's a good start.
"The new law covers millions of uninsured Americans and improves the health care system for those already insured, but there is much work to be done," she told The Washington Times. "Congress must stop the drastic Medicare physician payment cut scheduled for December 1 and fix the broken Medicare payment system to ensure seniors' access to health care."
The AMA, according to the CRP, has spent more than $15 million this year on lobbying and about another $500,000 on campaign contributions.
Still, others in the medical community are clearly campaigning against "Obamacare."
Anti-spending tea party activists have founded the Doctors Tea Party, headed by Dr. Jane Orient, head of the conservative Association of American Physicians and Surgeons. And the Physicians Hospitals of America, an association of small hospitals, has filed a lawsuit claiming that the health care overhaul, known as the Affordable Care Act, will put smaller facilities out of business.
The PHA contends that the millions spent by the big hospital chains and for-profit health care systems lobbying Congress over the past year paid off when the Affordable Care Act introduced new restrictions on smaller hospitals.
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