If war is politics by other means, so is litigation. While there will be plenty of rhetoric today about President Obama's health care law on the second anniversary of its signing — including a new op-ed by Republican presidential candidate Mitt Romney, who was for the health care reform in Massachusetts before he was against it nationally — the big battle begins Monday, when the Supreme Court opens an unusual three days of argument over the constitutionality of the Patient Protection and Affordable Care Act.
In many respects, the mega-case — a compilation of six separate cases that have been wending through the judicial system — represents the latest development in the continuous effort by powerful interests to influence the health care law by petitioning Congress, regulators and the courts. Of the more than 130 parties that filed briefs, some are familiar faces: at least 16 show up on a list Open Secrets compiled of organizations that disclosed lobbying on the health care legislation.
Sunlight took a look at some of the players who are represented in the case the justices will hear next week and their money and influence profiles. Note that the total amount of money spent on lobbying covers all issues in 2011, not just healthcare.
In support of the health care law:
- The AFL-CIO: The big labor combine, which has been blogging about the perks of the Affordable Care Act, has spent $5.4 million lobbying in 2011 and has a super PAC, the AFL-CIO Workers' Voices PAC.
- The American Hospital Association spent more than $20 million on lobbying in 2011. In its brief to the high court, the AHA argues against dismantling the health care law: "While the legislation is not perfect, it would extend coverage to millions more Americans. To undo the ACA now would be to maintain an unacceptable status quo — a result that is neither prudent nor compelled by the Constitution," the association argued in a brief filed by a lawyer with one of its lobbying firms, Hogan Lovells.
- AARP spent $15.1 million lobbying in 2011 on all of its issues. The giant retirees' association favors keeping the health care law.
- The American Cancer Society spent $5.1 million on lobbying last year. On its blog, the group contends that the Affordable Care Act will help cancer patients.
- The American Nurses Association, which spent $1.7 million in lobbying in 2011, has been vocal about its support for the Affordable Care Act. The lawyer that filed the group's brief, Ian Millhiser, is a policy analyst and blogger for the Democratic-leaning Center for American Progress.
- The Service Employees International Union, spent $1.5 million on lobbying, and has, through its political action committee donated to the pro-Obama super PAC, Priorities USA Action. The union and the super PAC have teamed up to create an ad campaign that uses the potential repeal of healthcare reform as a reason not to vote for Romney.
- The HR Policy Association spent $1.5 million on lobbying. In 2011, the organization of human resource officers was lukewarm about the health care law but not in favor of repeal: "The Association does not believe the nation would be in a better place if the law were to be repealed outright without serious efforts at alternative attempts at health reform," the group wrote in a statement. Its brief did not state an opinion on the substance of the argument over the law, but asked for the Supreme Court to take the case for a speedy resolution to the case.
- The NAACP Legal Defense Fund has reported $353,920 in lobbying. The Defense Fund's parent organization, the NAACP, lobbied on the health care bill. The civil rights organization opposes repeal of the healthcare act or its provisions.
- The National Women's Law Center spent $190,000 lobbying in 2011. The law center has blogged about the benefits of the Affordable Care Act.
- Among organizations that lobbied on the health care bill and filed briefs before the Supreme Court on the law's constitutionality, the U.S. Chamber of Commerce has by far the biggest profile on Capitol Hill, at least in terms of dollars spent. So far in this Congress, the venerable business group has spent $62.2 million lobbying on health care and other issues. Declares a statement on website:, "the Chamber supports the repeal of the Patient Protection and Affordable Care Act" in case the law is not struck down, the Chamber would like to overturn provisions such as the employer mandate.
- The Family Research Council a conservative, Christian group that advocates against abortion and same-sex marriage, has spent $107,000 in lobbying this cycle. It is concerned about the bill's potential coverage of abortion and the requirement that Americans buy health insurance. "We have high hopes that the Supreme Court will recognize that the individual mandate is unconstitutional, and will act to safeguard the freedoms of all Americans by holding the individual mandate 'nonseverable,' and strike down every part of Obamacare," said FRC legal counsel Ken Klukowski has stated.
- Virginia Attorney General Ken Cuccinelli, who brought one of the cases to overturn the health care law, has collected some $3.7 million in political contributions since 2003, including $35,000 from Citizens United, the group whose successful challenge to campaign finance regulations set the state for the creation of super PACs, and $30,000 from Altria, the food and tobacco consortium that has spent more than $11 million lobbying this Congress on taxes, tobacco, health care and other issues.
The Affordable Care Act is a mixed bag for many interests. For insurers, the worst case scenario would be if the courts throw out the mandate for Americans to buy health insurance while still requiring insurance companies to cover people with preexisting conditions, which could lower their revenue while raising costs. For these companies, the biggest concern is whether the rest of the law can stand if the individual mandate is struck down.
- America's Health Insurance Plan (AHIP), the trade association representing insurance companies, has spent $9.7 million lobbying on this cycle on all of its issues. Its major interest in the court cases is severability. The group argues it was not the intent of Congress to have the law stand without the mandate. AHIP is a client of heavyweight legal and lobbying firm, Akin Gump, which so far this cycle has raked in $25 million in lobbying fees for a blue-chip client list that includes Dow Chemical, General Electric and Shell Oil.
- American Benefits Council represents a multitude of large corporations from AstraZeneca to Xerox, and describes itself as the "most effective advocate for employer-sponsored benefit plans." It has spent just under $1 million lobbying this cycle. In its brief, it raised concerns about severing the personal mandate and the employer mandate to purchase health insurance from the rest of the bill.
- The National Restaurant Association spent $2.5 million lobbying this cycle. It states on its website, that it has a "strong concern about the impact of the health care law on the restaurant industry." Its main issue with the court is severability.