Health care generated more spending on lobbyists in California last year than any other non-government category, according to the California secretary of state.
Insurers, hospitals, physicians and other health care groups spent $35.7 million to influence California's decisions in 2011. The second and third biggest spending industries among the state's 19 categories lagged considerably. Manufacturing and industrial interests spent $23.8 million on lobbying, and education spent $19.4 million.
The only categories with bigger totals than health care were government and miscellaneous at $48.6 million and $47 million, respectively, according to quarterly reports filed and made public by the secretary of state's office.
All told, lobbyists earned more money from more clients than ever last year in California. The 2011 total of $286.6 million was 6.8% higher than the previous year. Lobbyists were hired by 2,768 organizations and individuals -- also a record.
Health care's position at the top of the lobbying list is neither new nor surprising, even during an economic recession, according to Dylan Roby, a veteran lobbyist watcher who teaches health politics at UCLA Fielding School of Public Health.
"Health care lobbyists always have a rosy outlook," Roby said. "If you look at a list of legislation dealing with health care in California and you see 20 pieces of enabling legislation -- some of them but not all of them responding to federal law -- you get a sense of why health care lobbyists stay busy."
Kaiser, Hospital Association Top Spenders
The two top spenders in health care lobbying in California last year were Kaiser and the California Hospital Association. Kaiser Foundation Health Plan spent $3.5 million. CHA and its parent organization, the California Association of Hospitals and Health Systems, spent $2.6 million.
Kaiser's lobbying expenses "are driven primarily by fixed costs -- maintaining an office and staff in Sacramento," according to Kaiser's written response to questions from California Healthline.
"The time spent on working with our regulators has been growing extensively as California works to quickly and comprehensively move forward with federal health care reform provisions, many of which have been left to the states to implement," Kaiser officials said.
Although Kaiser officials did not specify which issues it lobbied on, the organization was almost certainly involved in one of the most contested and heavily lobbied issues last year -- a bill proposing to give the state authority to reject increases in health insurance premiums. The bill, AB 52 by Assembly members Mike Feuer (D-Los Angeles) and Jared Huffman (D-San Rafael), was passed by the Assembly and by the Senate health committee before it died in the Senate.
Jan Emerson-Shea, spokesperson for the hospital association, said one of the biggest lobbying expenses for hospitals last year "was working to enact another round of the hospital provider fee."
In 2009, California hospitals began taxing themselves to help the state secure more money from the federal government for subsidized care in Medicaid and Medicare.
"Because the state has not been able or willing to put up enough money, California has been leaving about $2 billion a year on the table in federal matching funds," Emerson-Shea said. "That requires state legislation to get those provider fees enacted. That was probably the biggest piece of legislation for us," she said.
Kaiser officials and Emerson-Shea expect lobbying efforts to hold steady or possibly grow in coming years.
"We have been in the top 10 (in lobbying expenses in California) for the last several years, and I don't see that changing," Emerson-Shea said.
"It's what we do. We are a lobbying organization. Issues regarding health care aren't getting smaller, they're getting bigger and I would expect lobbying to reflect that."
California Lobbying 'Relatively Transparent'
Public reporting of lobbying activity in California gets high marks from Roby.
"California is pretty transparent," Roby said. "Secretary of State Debra Bowen's office does a good job of collecting and displaying lobbying activity. It's definitely better than most states in terms of transparency, Roby said.
"You can look up individual lobbyists and lobbying firms and track things by industry. In a lot of other states, you have to go to consumer advocates' websites to get anything close to that kind of information," Roby said.
State Health Care Lobbying May Be Growth Industry
As health care reform moves away from the national sphere into state legislatures, the flow of health care lobbying money will probably move with it.
"When something as big as health care reform is discussed at the national level, you can expect most lobbying money to be pointed in that direction," Roby said. "Even now, a year after the law was signed, you'll probably find most expenditures will be at the federal level, but that could be changing," Roby said.
"You'll see more and more health care lobbying in states and you've already seen that in California. It will probably continue to grow here as well," Roby said.
Whatever the Supreme Court decides about the Affordable Care Act, it will probably mean work for health care lobbyists, Roby predicted. "If the individual mandate is struck down, you'll probably see a lot a lot of insurance activity trying to get states to pass their own individual mandate laws.
"You'll see a lot of lobbying of health benefit exchanges. That's definitely a growth area," Roby said.