Health systems are among healthcare's big spenders on federal lobbying, study finds

Hospitals and health systems spent $116 million on lobbying the federal government in 2024, with spending by some of the largest, well-known health systems dwarfing the spending by the state hospital associations, according to a study published yesterday in JAMA Health Forum.

Corresponding author Lauren A. Taylor, Ph.D., M.P.H., M.Div., an assistant professor in the Department of Population Health at NYU Grossman School of Medicine, and her colleagues also found that for-profit and private-equity owned systems were disproportionately represented among the 18 organizations that spent more than $1 million on federal government lobbying in 2024. Taylor and her colleagues noted that those hospitals and health systems may spend more because their interests are not emphasized by hospital associations.

The researchers also identified 169 lobbying firms that had were paid by hospitals and health systems to represent their interests. Merchant, McIntrye & Associates received the most money, $2.04 million, followed by Brownstein, Hyatt et al ($2.016 million) and Cornerstone Government Affairs ($1.99 million). The use of lobbying firms likely provides “greater reach and connections,” the researchers suggest, but they also share the observation that lobbying firms are “not neutral messengers but ‘political actors in their own right’ who can decide which issues to emphasize and even advance interests of their own.”

Taylor and her colleagues used data collected by Open Secrets, a nonprofit organization that assembles data on political donations and lobbying, to condcut this study. They note that hospitals and health systems have received little attention in the academic research into healthcare industry influence and political donations compared with the pharmaceutical and other industries. According to Open Secrets and figures compiled by Taylor and her colleagues, healthcare sector interests spent a total of approximately $750 million on federal government lobbying in 2024, with the pharmaceutical and health products spending the most, $387 million, or just over 50% of the total, followed by health services (which includes insurers) and HMOs, at $118 million, which is approximately 16% of the total, and then hospitals and health systems, at $116 million.

Among hospital and health system organizations, the American Hospital Association was, by far, the biggest spender on federal government lobbying, with expenditures of $24 million. Select Medical Holdings, a for-profit company headquartered in Mechanicsburg, Pennsylvania, that owns rehabilitation hospitals and clinics in 39 states, was the second biggest spender, at $5.5 million.

Mass General Brigham, a Boston health system with 16 hospitals, spent $1.22 million on federal government lobbying in 2024, far more than the $80,000 spent by the Massachusetts Health and Hospital Association, according to Taylor and her colleagues’ research. Similarly, Ascension Health, a health system headquartered in St. Louis that comprises 94 hospitals, spent $2.16 million, which, according to Taylor and her colleagues’ tally, is more than the aggregate spending of hospital associations in the states where it has hospitals.

Another example of a large health system outspending the hospital associations in states it operates in the Mayo Clinic. Taylor and her colleagues’ research shows that Mayo spent just over $1 million on lobbying compared to approximately $330,000 spent by the hospital associations for Minnesota, Arizona and Florida. In the discussion section of the study, Taylor and her colleagues say the pattern of the large health systems outspending the associations “raises the important questions about the concentration of political voice among a relatively small number of wealthier hospitals and health systems, potentially overshadowing the associations intended to represent hospitals collectively.”

Other health systems with large lobbying expenditures include Advocate Health, a non-profit system headquartered in Charlotte, North Carolina ($2.42 million); Tenet Healthcare, a for-profit system headquartered in Dallas ($2.2 million); and Trinity Health, a nonprofit system headquartered in Livonia, Michigan ($1.6 million).

The spending by large health systems doesn’t mean that hospital associations are absent from the large spender lists. The Greater New York Hospital Association spent $1.89 million in 2024, and the California Hospital Association, $1.53 million, according to the study. Although not in the same league as the American Hospital Association, other national hospital associations spent heavily, according to the tally by Taylor and her colleagues. The Children’s Hospital Association ($4.1 million), the Federation of American Hospitals ($2.38 million) and America’s Essential Hospitals ($1.96 million) made their list of the 18 industry organizations that spent more than $1 million on federal lobbying.

In discussing the use of lobbying firms, Taylor and her colleagues referred to a 2022 analysis that showed that only seven states require lobbying firms to disclose conflicts of interest.

“Internal lobbyists may align more closely with hospital values but often lack the political capital of multiclient firms, leaving hospitals to balance access against control of their agenda,” wrote Taylor and her colleagues.