Armand Legault must make a pretty persuasive lobbyist.

The 58-year-old Connecticut resident is knowledgeable, articulate and good-natured. But when it comes to his efforts to convince Congress to protect patients’ access to complex power wheelchairs, Legault’s best asset might be his physical presence.

In an ordinary electric wheelchair, Legault would be vulnerable to circulation problems and painful pressure sores.

“You can’t just get fitted for a wheelchair like this off the street,” Legault said. It can take 10 visits to a vendor to fit the chair properly.

Now Legault is worried that changes to a Medicare program designed to cut costs could affect the quality of service associated with these high-end wheelchairs.

An army of professional lobbyists is working toward the same goal as Legault, a retired state tax auditor and patient advocate, but their mutual success is far from assured.

In a series of lobbying meetings in April, organized by Quinn Gillespie & Associates and the National Coalition for Assistive and Rehab Technology (NCART), Legault and the lobbyists have sought to convince lawmakers to exempt complex wheelchairs from a new competitive bidding program for Medicare.

Perhaps foremost among the difficulties will be making lawmakers understand the difference between these Stephen Hawking-style wheelchairs and standard electric wheelchairs and scooters, which are costing Medicare hundreds of millions of dollars a year in spending. Those costs have raised eyebrows on Capitol Hill.

Under Medicare’s new program, durable medical equipment (DME) suppliers have to bid to be allowed to sell their products to Medicare beneficiaries. It is a business worth billions of dollars: the program covers items ranging from diabetes test strips and walkers to oxygen tanks and power wheelchairs, both simple and complex. In all cases, suppliers will get paid less than they are now.

NCART is a relatively small contributor to the high-stakes lobbying mission, which has been intensifying for almost five years.

Medicare will spend $468.1 billion this year. NCART says it would cost  $46 million over the next five years to exclude complex rehabilitative equipment from the program.

Medical equipment industry representatives and patient advocates will plead their cases at a hearing before the House Ways and Means Health Subcommittee on Tuesday. Centers for Medicare and Medicaid Services (CMS) acting Administrator Kerry Weems is expected to defend the program.

Influential corporate interests, especially wheelchair and oxygen suppliers like Invacare, are furiously working to get Congress to postpone the program. Lobbyists say CMS is mishandling the program, that the pay rates are too low to cover the cost of providing the supplies and that patients are going to be stuck with poor service from suppliers that low-balled their bids to win market share.

CMS says the program has adequate safeguards to guarantee access to high-quality equipment.

The challenge faced by Legault and NCART lies in trying to convince Congress that they are not just one more special interest complaining about Medicare payments – a popular sport in Washington.

“As you can probably imagine, the DME industry would love to have this be the face of their cause,” said Allison Giles, a Quinn Gillespie lobbyist who represents NCART. Giles was a senior staff member on the House Ways and Means Committee when the competitive bidding program was conceived.

NCART’s members should not have been included in the program in the first place, and were assured by CMS they would not be, said Richard Forman, the president of Tisport, a wheelchair manufacturer based in Washington state. Giles said lawmakers were not taking aim at complex wheelchairs when creating the bidding program.

A CMS spokesman flatly denied that complex wheelchair suppliers were ever told they would not be part of the program or that the agency went against congressional intent. “This is just not true,” he wrote in an e-mail.