Hospitals, insurers, doctors and unions are spending tens of millions of dollars trying to make sure their voices are heard on Beacon Hill as Massachusetts lawmakers weigh sweeping changes to the way the state pays for health coverage.
In 2011 alone, the health care industry, one of the largest economic sectors in the state, doled out more than $11.6 million on lobbying.
And during the five years since the state passed its landmark health care overhaul, from 2007 to 2011, the total amount spent on lobbying by the industry topped $51.6 million, according to a review of state records by The Associated Press.
By contrast, the casino gambling industry spent $11.4 million on lobbying during that same stretch.
The flood of health care lobbying comes as lawmakers debate whether to create systems designed to reward health care providers for keeping patients healthy rather than paying them piecemeal for treating illnesses.
House Speaker Robert DeLeo and Senate President Therese Murray have both said they hope to deliver a payment overhaul bill to Gov. Deval Patrick this year.
This month, DeLeo said the goal of the House bill — which has not been introduced — would be to bring the annual growth in health care expenses more in line with Massachusetts’ overall economic growth rate of 3.7 percent.
Health care costs have been rising at an annual rate of 6.7 to 8 percent in recent years, said DeLeo.
“Costs are coming down, but we need a long-term sustainable plan,” said DeLeo, D-Winthrop, during a recent speech. “Health care is a $70 billion industry in Massachusetts, and we need to be more thoughtful in how these dollars are spent.”
The size of the industry and the high stakes involved in the proposed overhaul could account for the massive and sustained lobbying push.
Nine of the top 10 health care groups broke the $1 million lobbying mark during the past five years, the AP review found.
The top spender was Partners HealthCare, which spent more than $2.9 million on lobbying in that five years.
Much of that went to pay the salaries of more than a dozen lobbyists and companies working to make sure Partners’ message reached lawmakers. A smaller portion went to operating expenses.
Partners was followed by Blue Cross Blue Shield of Massachusetts and Massachusetts Association of Health Plans, both of which spent more than $2.1 million, followed by the Massachusetts Nurses Association, which spent about $2 million and Harvard Pilgrim Health Care, which spent more than $1.6 million.
They were followed by the Massachusetts Medical Society ($1.51 million), Tufts Associated Health Plans ($1.46 million), Vanguard Health Systems ($1.42 million), Children’s Hospital Boston ($1.38 million) and Baystate Health ($992,000).
Rich Copp, a spokesman for Partners HealthCare, defended the amount spent on lobbying, as did representatives for some of the other groups.
It’s critical that the health care provider keeps the lines of communication with lawmakers open as they consider new options to control the soaring costs of health care, he said.
“There’s been an intense effort in recent years to rein in health care spending,” Copp said. “We have a responsibility on behalf of our patients and employees to engage in that dialogue with government leaders on health care cost control.”
Copp said the lobbying is even more important given the reach of Partners.
The health care provider is one of the largest employers in the state, with more than 60,000 employees and nine hospitals.
Sharon Torgerson, director of public relations for Blue Cross Blue Shield of Massachusetts, said the sweeping changes to the state’s health care system required the insurer to stay involved on Beacon Hill.
“As Massachusetts’ largest health plan, we have a long and proud history of community and civic engagement,” she said. “It is important that during public policy debates we advocate to reform the way health care is delivered and paid for in order to keep it more affordable.”
Eric Linzer, a senior vice president at the Massachusetts Association of Health Plans, said the nonprofit group also wants to maintain a voice on Beacon Hill during the health care cost debate.
The group represents 13 health plans that provide coverage to more than 2.3 million Massachusetts residents.
Specifically, Linzer said in a statement that the group wants to make sure that any new laws and regulations curb what he said was the lopsided influence of better-known hospitals and other health care providers on the cost of care.
A 2010 report by Attorney General Martha Coakley found that higher-priced hospitals help drive up health costs in Massachusetts.
The report found that prices hospitals charge for the same services vary widely within the same geographic area and those changes that can’t be explained by quality of care. The report also found that higher-priced hospitals have gained more market share, forcing lower-priced hospitals to close or consolidate.
David Schildmeier, spokesman for the Massachusetts Nurses Association, said the union’s lobbying is different from the lobbying by insurers and hospitals.
Schildmeier said the union’s main concern is making sure that the welfare of nurses, staff and patients don’t get lost in the push to curb health care spending.
One bill the union has been pushing on Beacon Hill would create nurse-to-patient ratios that the union said are needed to ensure patient safety and comfort.
“Every time they try to change the payments system, they end up hurting patients,” Schildmeier said. “Our money was spent on protecting the public and protecting nurses.”
DeLeo’s speech came more than one year after Patrick unveiled a cost containment plan that sought an end to the traditional fee-for-service approach that charges patients on the basis of the tests and procedures.
Patrick’s plan called for the creation of so-called accountable care organizations and a system of payments that are tied more closely to patient outcomes.
Patrick has said that while the landmark 2006 health care bill signed by his predecessor, Republican Mitt Romney, has made health care almost universally accessible in Massachusetts, it has not made it any more affordable.
DeLeo declined to say whether the House plan would include elements of the governor’s proposal.
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