House Republicans say healthcare groups that backed the Democrats’ overhaul bill are trying to rekindle their relationship with the GOP.
The health industry’s effort to make nice with Republicans is both reflective of how Washington works and how much the political winds have shifted since Barack Obama’s inauguration last year.
House Republicans felt shunned by their allies in the medical sector in 2009 as Democrats basked in their electoral victories that gave them control of Congress and the White House since 1994.
Nearly two years after Obama’s triumph and six months after the passage of health reform, the mood in the nation’s capital and beyond has changed dramatically.
"We had to find people to have meetings with us" in 2009, Ways and Means Committee Republican Kevin Brady (Texas) recently said with a smile. But that started to change soon after the health bill passed.
Since then, Brady told The Hill, healthcare groups have been much more interested in meeting with Republicans on the panel, which has jurisdiction on healthcare matters. Brady did not specify to which groups he was referring.
A former Ways and Means staffer said some pharmaceutical company CEOs have been meeting with three or four Republicans when they have made recent visits to Capitol Hill instead of the one or two they were meeting with earlier.
Whether Republicans are ready to forgive and forget if they take over the House is still an open question.
Some of the groups Republicans are meeting with, Brady acknowledged, endorsed the healthcare legislation, which barely passed Congress.
"They did [support the bill], and that's frustrating," Brady said, adding that the bottom line for Republicans is coming up with a better healthcare package than the bill Obama signed into law.
Republicans say what’s grating isn’t just the fact that traditional allies backed Democrats, but that their support helped push the bill over the finish line.
Throughout the drawn-out process, the bill barely survived. It passed 220-215 and again 219-212 in the House in November and March and survived a procedural vote in the Senate without a single vote to spare on Christmas Eve while many industry groups pressed for passage.
“I think we felt blocking this was within reach,” said one House Republican staffer. “And if there had been more support, more discussion of the real negative impacts … this would have never become law.”
Seven years ago, Republicans relied on support from industry groups and AARP to barely push their Medicare prescription-drug bill to passage. The endorsement from AARP infuriated Democrats, who believed the measure would have failed without it.
Rep. Joe Barton (R-Texas), ranking member on the Energy and Commerce Committee, told The Hill that he doesn't expect "reconciliation" with industry groups until after the election. He hinted at future tensions as Republicans try to repeal or defund the bill.
"A lot of the healthcare groups saw dollar signs, and they went with them," he said. "Well, the people don't like it."
Healthcare groups have shifted their political donations.
The insurance industry, which wants to scale back cuts to the Medicare Advantage program and change new regulations implementing the law, has spent three times more on Republicans than Democrats so far this year, the Chicago Tribune reported last week.
Last year, the insurance industry's political contributions were closer to 50-50.
Overall, healthcare-related industry giving still leans blue, according to data that the Center for Responsive Politics crunched for National Journal. But lobbyists are treating open races and those with Democratic incumbents differently.
Based on Federal Election Commission data released Sept. 13, healthcare industry campaign arms have spent $23 million this year on Democrats versus $15.8 million for Republicans.
When the GOP controlled Congress in 2006, Republicans received $25.9 million versus $13.5 million for Democrats. The data confirm traditional Republican allies have been giving more to Democrats this year: The Pharmaceutical Research and Manufacturers of America (PhRMA) has given three times more to the party in power, while the American Medical Association (AMA) and the Federation of American Hospitals favored Democrats 56 percent to 44 percent and 61 percent to 37 percent, respectively.
PhRMA says the 3:1 ratio only includes donations to individual members and not to leadership and other Political Action Committees. The association says the real ratio is closer to 2:1.
But most of that is going to defend embattled incumbents such as Sens. Harry Reid (Nev.), Michael Bennet (Colo.) and Blanche Lincoln (Ark.), National Journal reports. In open-seat Senate races, an opposite trend emerges.
For example, the AHA and the Federation of American Hospitals have made contributions to 10 Republicans and only one Democrat (Senate hopeful Rep. Brad Ellsworth of Indiana). And the AMA is supporting four Republican Senate candidates who favor repeal.
Barton said he expects industry groups to support the Republican agenda if the voters give them the majority.
"I think once the people speak, the trade associations and the individual companies, they'll look at the election results just like we do... I think you'll see a different attitude, because the trade groups and the healthcare companies, their constituency ultimately is the American people, too.
"The healthcare groups who were for me seven or eight years ago, and then were against me the last three or four years, I have a feeling a lot of them are going to be for what we're trying to do," he predicted.
Republican efforts to repeal health reform will undoubtedly cause awkward moments for trade groups that endorsed the law.
"Whether they support repeal or not," Barton warned, "that debate's coming."
Much of the renewed attention paid to Republican lawmakers has to do with "parochial" issues such as regulations on insurance companies.
“There is a legitimate question to be asked as to how well they’ll be received,” the Republican staffer said. “When you come to plead your case about an individual provision you didn’t like to Republicans, they’ll turn around and say: ‘But you’re the one who helped put it into law.’”
The industry groups aren’t just looking to press their agenda.
They’re also looking for information about what newly empowered Republicans will want to achieve, said one lobbyist who requested anonymity.
“You have this repeal-and-replace moniker on healthcare reform,” the lobbyist said. “But when you’re done with that layer of the onion, that’s just the outside peel that falls away easily, and you never really think about using it in your soup. The other pieces of the onion are … What is it that you guys are focused on? What is it that you all really care about? What are you going to do that might impact coverage? Trying to get our hands around that is what we like to do so that we can figure out where we have alignment on issues.”
Hospitals are among the groups that could have most to lose if Republicans take over because the GOP is will target the healthcare law's individual and employer mandates. That could devastate hospitals' bottom lines because they'll have to rely on a massive increase in the number of insured — and thus paying — customers to make up for the health reform law’s cuts to federal payments.
Elizabeth Lietz, spokeswoman for the AHA, said her group is not a “single-issue organization” and has “worked extensively with both parties in Congress on a wide range of healthcare issues.”
She points to “broad support from a majority of both parties” since health reform passed, especially regarding hospitals’ concerns with incentive payments for health information technology upgrades.
The former Ways and Means staffer also points out that individual hospitals — just like local physicians’ groups — are regularly in touch with their lawmakers and senators regardless of how the trade groups handle things in Washington, D.C.
Insurance companies are also in a tough spot. While they have objections to the bill and hope Republicans will negate some of the cuts to Medicare Advantage plans, they’re dead set against repealing the mandate that people buy their product.
The physicians' lobby will also have a ways to go to mend fences with Republicans. House Republican Leader John Boehner (Ohio) has called the AMA's support for health reform "inconsistent at best," especially because it did not address physician — and Republican — priorities such as medical malpractice reform.
But the AMA also has to continue currying favor with Democrats because federal regulators' implementation of the new law can have huge repercussions on doctors' bottom lines.
AMA says it's a nonpartisan group that has reached out and will continue to reach out to lawmakers on both sides of the aisle.
Another group that has a lot of explaining to do: drugmakers.
The pharmaceutical lobby was once seen as a reliable Republican ally, but that changed during the health reform debate. The industry's $80 billion deal with the Obama administration last summer led to one of the most dramatic rifts with Republicans when Boehner accused PhRMA of choosing "to accommodate a Washington takeover of healthcare at the expense of the American people."
"When a bully asks for your lunch money, you may have no choice to fork it over," Boehner wrote to then-PhRMA President Billy Tauzin. "But cutting a deal with the bully is a different story, particularly if the 'deal' means helping him steal others' money as the price of protecting your own."
Replacing Tauzin with former Business Roundtable President and CEO John Castellani has also earned the group goodwill, the Republican lobbyist said.
“PhRMA focuses on policy issues, not political affiliation, when reaching out to members of Congress who share the mission of advancing patient health and medical innovation,” PhRMA Senior Vice President Wes Metheny said via e-mail. “Our political givings reinforce this as does our support for public policies that have been crafted by both Republicans and Democrats. When PhRMA President and CEO John Castellani came on board in September, he reinforced the fact that we’re not in the business of picking sides. We’re in the business of doing what is best for the patients we serve. Every day we strive to do just that and it is reflective in our outreach to members on both sides of the aisle.”