Health care boosted K Street last year



Health care groups spent more than $500 million last year on lobbying Washington — more than any other industry and the highest total since the year after Obamacare passed, according to the Center for Responsive Politics.

Those impressive 2015 totals may not be matched again this year, lobbyists at top firms said. That's partly because Congress and federal agencies typically slow down during election years — but also because Congress last year finally eliminated the much-maligned Medicare physician payment system that had been a consistent lobbying bonanza.

More than 20 lobbying shops booked at least $2 million in health care contracts last year, according to a POLITICO analysis of disclosure reports.

Almost every K Street firm at least dips a toe in health care. There's too much money sloshing around to escape it. | POLITICO/Graphic by Sandhya Raman

At the top of the heap: Akin Gump Strauss Hauer & Feld, which pulled in more than $9 million in health care revenues from 37 clients. The firm had a pair of seven-figure contracts from two coalitions established to lobby on issues related to Medicare’s Disproportionate Share Hospital payments, which support facilities with high rates of uncompensated care.

Alston & Bird nabbed $6 million worth of contracts last year, while Tarplin Downs and Young and BGR Government Affairs each brought in more than $5 million. Seven more firms, including Peck Madigan Jones and the McManus Group, received more than $4 million.

Many of the firms with the most lucrative health care practices are K Street powerhouses with clients covering practically every policy area. But there are also boutique shops, including Tarplin Downs & Young and Avenue Solutions, focusing primarily on health care clients.

Solving the Medicare "doc fix" last year put an end to the regular deliberations that had created peril for health care interests because legislators always needed to find new revenue sources to stave off deep cuts in Medicare provider payments. The last thing lobbyists wanted to tell clients was that they’d be bankrolling the next patch for Medicare’s Sustainable Growth Rate.

“There was a lot of defense played on the SGR fix every time it came around,” said Raissa Downs, a founding partner at Tarplin Downs and Young.

Now, freed from that annual exercise, lobbyists say they have the time and energy to work onpolicy-focused proposals. They pointed to ongoing work on the 21st Century Cures package, the Senate Finance Committee's chronic care efforts and ongoing work on mental health reform.

"In the absence of a couple huge packages, that's really created an environment where stakeholders can work on more discrete, arguably issues of more substantive depth," said Dave Boyer, head of the health care practice at BGR Group, which netted $5.8 million from 28 health care clients last year.

Still, the path forward for those initiatives is murky. One positive about the doc fix: it was pretty much guaranteed to clear Congress. Lawmakers fearful of disturbing seniors' Medicare benefits always found time in the calendar to pass it, and lobbyists spent much of their efforts working to convince lawmakers to tack on one priority or another.

Lobby shops are also turning to regulatory issues — like forthcoming rules on the new Medicare physician payment system that will replace the SGR or on rate-setting regulations for the Medicare Advantage program.

Regulatory issues have “filled the vacuum,” said Tracy Spicer, a founding partner of Avenue Solutions, which received $4.2 million from lobbying on health care last year. “This year has been anything but quiet.”

Lobbyists are also spending this year building momentum for 2017, when big-tickets items will be on Congress’ agenda. That likely includes extension of the Children's Health Insurance Program, reauthorization of FDA user fees and several other expiring programs for steady business. Smaller priorities can usually get added to these larger legislative packages.

Exactly what priorities make it to the top of the list next year, however, will depend heavily on who wins the White House. There may be more appetite for Congress to consider changes to Obamacare with its namesake out of office. That could prove a windfall for K Street's health care lobbyists.