Will the Koch Brothers Save Obamacare?

The health-care lobby is out in force again, but this time the allegiances are scrambled and unpredictable.

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By ELIZA NEWLIN CARNEY

Progressives campaigning to defend Barack Obama’s signature health-care law may find their biggest assist comes from the unlikeliest of allies: the billionaire industrialists Charles and David Koch and their conservative network.

The Koch-funded group Americans for Prosperity, having spent tens of millions to oppose the Affordable Care Act, is now gearing up to throw more big money behind a campaign to block congressional Republicans’ health-care replacement bill. Deep-pocketed conservative groups such as the Club for Growth, FreedomWorks, and Heritage Action for America have also panned the House GOP health-care plan, and are mounting an aggressive counter-attack.

Of course, right-leaning and progressive activists are assailing the House GOP bill unveiled this week for completely opposite reasons. Conservatives say the Republican bill, officially the American Health Care Act, does too little to dismantle Obamacare. Progressives protest that the GOP bill goes too far in unraveling patient protections, and that it will increase out-of-pocket costs and strip insurance away from millions of Americans by replacing subsidies with tax credits, and slashing federal Medicaid funding.

Still, the bizarre convergence of left- and right-leaning activists who share the same goal—blocking the GOP health-care bill—underscores the unpredictable nature of health-care lobbying in 2017. In the 15 months before Obama signed the Affordable Care Act in March of 2010, health industry heavy hitters, from drug companies to hospitals, doctors, and insurers, spent literally more than half a billion on lobbying. Expenditures topped $557 million in 2009 alone, and industry lobbyists on Capitol Hill outnumbered members of Congress by more than six to one.

The health sector still spends more on lobbying than any other industry, according to the Center for Responsive Politics, with $509.6 million in expenditures last year. But the fight over this year’s GOP effort to repeal Obamacare is looking very different from the battle royal over the ACA’s initial enactment. The campaign to pass Obamacare brought leading health-care provider associations together in a strange bedfellows coalition with progressive advocacy groups, for one. The progressive group Families USA, for example, partnered with the Pharmaceutical Research and Manufacturers of America to mount a $70 million ad campaign to promote the health-care law that was underwritten by PhRMA.

This time, the major groups representing physicians, drug makers and hospitals are keeping their distance from progressive advocacy organizations, in part to ensure that Republicans who now control the White House and Congress do not slam the door in their faces. Moreover, the interests of health industry groups are not as clearly aligned today as they were in 2009 and early 2010. In mustering support for his health-care plan, Obama struck what some have called a Faustian bargain with insurers and drug makers, quietly dropping price caps and public health insurance in exchange for industry leaders’ agreement not to lobby against his bill.

Insurers still managed to spend millions opposing the Affordable Care Act. Bloomberg later disclosed that America’s Health Insurance Plans had secretly funneled $86.2 million to the U.S. Chamber of Commerce to lobby against the ACA, a maneuver that enabled the insurance lobby to outwardly support the bill while opposing it behind the scenes. Nevertheless, many health-care providers came together to back Obama’s bill, at least on the surface. Now, it’s not clear where many health industry groups will come down on the GOP health-care bill. Asked for comment, a PhRMA spokeswoman responded in a non-committal email that the group wants to ensure that “patients have access to the medicines they need,” and looks forward to continue working with Congress “to enhance the competitive market.”

There’s no question, though, that the health-care lobbying dollars are going to flow. Already, a progressive coalition dubbed the Alliance for Healthcare Security has launched more than $2 million in TV ads to convince Congress not to repeal Obamacare. Another coalition dubbed Protect Our Care has mounted a grassroots campaign to exert pressure on roughly a dozen Senate Republicans who have reservations about the pace and/or scope of GOP repeal efforts. Both coalitions include a broad array of labor, civil rights, and consumer advocacy groups.

“There is special emphasis being given to try to protect the Medicaid program,” says Ron Pollack, founding executive director of Families USA, which helped spearhead the Protect Our Care coalition. Pollack’s group is working to make sure that the stories of Americans helped by the ACA are shared publicly. Having worked alongside other progressive groups to help enact and then sell the Affordable Care Act, Pollack may find his task easier today. Support for the ACA has reached a new high, now that Americans realize it could be taken away.

“It is always far more difficult to take something away from someone than to give it to them in the first place,” says Pollack. “Here you have people who have experienced the benefit of having coverage, and who see it as a lifeline. And they are going to go out of their way to make sure that lifeline is not taken away.”

The list of influential lobby groups opposed to the GOP health care bill, moreover, is growing. The AARP, American Hospital Association, and the American Medical Association have all come out against the GOP plan. (Between them, those three groups spent close to $50 million last year on lobbying, CRP data show.)

Not to mention the “significant resources” Americans for Prosperity has pledged to spend on ads to defeat the GOP bill, and the 1,000 activists FreedomWorks says will “storm Congress” on March 15 to demand Obamacare’s full repeal. The far-right activists don’t share the same end goal as their counterparts on the left—but they may help derail GOP legislative efforts just the same. The situation is “too fluid” for predictions, says Pollack, but amid GOP disarray the chances of preserving key objectives of the ACA “have improved enormously.”