As the war between Pittsburgh's two top health providers has intensified over the last two years, UPMC and Highmark Inc. have both dished out millions to lobby Harrisburg politicians and regulators -- but UPMC reports being the bigger spender.
Since the beginning of 2012, UPMC has spent more than $3 million on lobbying, and individual hospitals within the health system have spent hundreds of thousands more. The system's insurance arm, UPMC Health Plan, has spent an additional $450,000, according to financial records from Pennsylvania's Department of State, which tracks in-state lobbying expenditures.
Highmark, meanwhile, has spent at least $1.5 million since the beginning of 2012. One quarterly report appears to be missing from the state database; since 2012, Highmark has spent an average of $209,000 per quarter.
Highmark's West Penn Allegheny Health System, now part of the larger Allegheny Health Network, has spent about $150,000 total since January 2012.
The tabulations are not an exact science; reporting requirements differ from state to state and are subject to interpretation by those compiling and submitting the reports. "Issue ads" are another gray area, as they could be counted toward a company's "non-direct" communication spending -- that is, lobbying that solicits action from the general public, but not lawmakers themselves.
"UPMC broadly reports our time and expense -- in fact, we probably overreport out of an abundance of caution," said UPMC spokesman Paul Wood. "We include the time of our executives, time in planning and strategy meetings, as well as time face-to-face with government decision-makers."
The sums reported by the companies do not include what is spent on the companies' behalf, using their own contributions, by lobbying groups such as the Hospital and Healthsystem Association of Pennsylvania, and the Blue Cross and Blue Shield Association.
The figures are not surprising. What may be more surprising is that the companies didn't spend more. As a broad topic, health care accounts for the biggest piece of what's spent annually on lobbying in Pennsylvania.
In 2012, companies and advocacy groups of all sorts reported spending a total of $435.7 million lobbying state officials, regulators and the general public. Of that, $28.5 million was spent on broad "health care" issues; $9 million on managed care, or health insurance; $4 million on the topic of medical records; $10 million on hospital issues; $10 million on insurance issues; and more than $15 million on Medicaid issues.
More tangentially, $5.3 million was directed toward pharmaceutical lobbying, $3.7 million on biotechnology and $5.9 million on nursing home topics.
It's the same story nationally. Last year, about $480.3 million was spent on federal health care lobbying, according to the Center for Responsive Politics. That's actually down from the $552 million spent in 2009, during the run-up to the passage of the Affordable Care Act. At the height of the federal lobbying frenzy, there were 3,000 registered health care lobbyists on Capitol Hill.
"Leave aside that it's one-seventh of the economy," said Bill Allison, editorial director at the Sunlight Foundation, a Washington, D.C., nonprofit that advocates for government transparency. "It cuts across the economy. ... It affects everybody," from hospitals to insurers to pharmaceutical firms to just about any employer, big or small, that offers health coverage for its workers.
Even though the Affordable Care Act passed in 2010, the subsequent years have been spent shaping the regulations that kicked in as the law gradually took effect. Some of those regulations are still being written; others have already been written, but their implementation dates have been postponed. That includes the universal annual cap on out-of-pocket health care expenses and the requirement that all businesses with 50 or more full-time workers provide health coverage or pay a fine.
Meanwhile, insurers are still pushing for an extension of the reimbursement program that will help them cover losses if the policies they sell on the federal health care exchange lose money in the early years.
"There are so many unsettled issues around health care," Mr. Allison said. "Nothing is ever written in stone here. The lobbying interests are going to be pushing back against every single thing that affects their bottom line."
Lobbying money is not the same as campaign money.
Campaign spending comes in a variety of forms -- direct and indirect communications, gifts, hotels, meals and incurred transportation expenses. Most of that money is spent on communications: meeting with the policymakers and their staffs, or trying to influence third-parties to do their own lobbying.
Highmark uses Gmerek Government Relations Inc.; Ignite Strategies; Long, Nyquist & Associates; Obermayer Rebmann Maxwell & Hippel and others for its lobbying, including employed lobbyists, such as Michael Warfel, Highmark's vice president of government affairs, who is based in Harrisburg.
UPMC uses Bravo Group, Buchanan Ingersoll & Rooney, Cohen & Grigsby, and S. R. Wojdak & Associates. It also uses in-house lobbyists, including Scott Baker, who is married to Leslie Gromis-Baker, Gov. Tom Corbett's chief of staff.
Bill Toland: firstname.lastname@example.org or 412-263-2625.