WHEN the United States Senate gave a grudging nod of approval to President Clinton's budget plan this month, a cheer went up not only from the White House, but from the offices of scores of health lobbyists throughout Washington.
Physician, hospital, and senior-citizen groups, armed with lobbyists and political-action committee money, had spent the last two months pressuring Congress to reduce the billions in Medicare-spending cuts contained in the president's budget plan. Between January and June, health and insurance groups gave over $2 million to lawmakers, about a 20 percent increase over the same period last year, according to Citizen Action, a public interest group.
Their campaign hints at the clout health-care providers can wield when they want to - and certainly will mobilize in health-care debate this fall.
By their own yardsticks, the groups were successful, keeping out of the final bill the $67 billion in Medicare spending cuts proposed by the Senate Finance Committee. The Senate and House of Representatives ultimately agreed on $56 billion in Medicare cuts.
Public-interest groups worry that the trend toward bigger donations by more PACs makes it tougher for average voters to get in to see their elected officials.
"It's a way to get access and influence, not only in an election year but on the policy side," said Joshua Goldstein, project director of the Center for Responsive Politics.
Even though the "cuts" in the bill would merely translate into reductions in the annual raises in payments from Medicare to hospitals and physicians by a few percentage points, the fight was on. During the groups' two-month budget vigil, they were helped by key lawmakers who took up their cause from the inside. Many of these legislators have long accepted PAC campaign funds from doctors, hospitals, and senior groups.
In the 1992 election cycle, 400 health PACs gave more than $22 million to candidates, according to the Center for Responsive Politics, a nonpartisan group. (See chart below.) Seventy-two percent of the health PAC money was given to candidates already in office.
Many of the biggest recipients were lawmakers who regularly legislate on health issues.
The American Hospital Association (AHA), one of the three top health PACs, gave $507,538 to candidates in the 1992 campaign. The group, concerned about the budget's $20 billion-plus in spending cuts to hospitals, bombarded key legislators with letters and visits.
When the Senate Finance Committee first proposed trimming $67 billion from Medicare, Sen. Jay Rockefeller (D) of West Virginia, a Finance member, was quick to oppose the move. Senator Rockefeller is not a top health PAC recipient, but between 1979 and 1992, he accepted $586,495 from health special interests.
As the leading Republican on the Finance committee, Sen. Bob Packwood (R) of Oregon voted against President Clinton's plan. He also thought the Medicare spending cuts "were way too harsh," an aide said. Senator Packwood is the top health PAC recipient in Congress.
On the House side, the AHA, the National Council of Senior Citizens, and physician groups found friends in Rep. Henry Waxman (D) of California, chairman of the health and environment subcommittee of the Energy and Commerce Committee, and Rep. Pete Stark (D) of California, chairman of the Ways and Means health subcommittee.
Representative Waxman received more health PAC money in the 1992 campaign - $152,600 - than any other House member. Congressman Stark, at $151,751, was the runner-up.
The American Society of Internal Medicine lobbied to protect internists from spending cuts. Under its direction, ASIM members in the district of Rep. J.J. Pickle (D) of Texas called him to complain.
The fledgling ASIM PAC is likely to "respond favorably" to any fund-raising requests made by Waxman in coming months, because of his advocacy on behalf of primary-care physicians during the budget process, said Bob Doherty, ASIM vice president for government affairs.
When the battle was over, the AHA "achieved most of the goals we wanted. We were able to get the Senate numbers down a bit," said lobbyist Rick Wade.
The American Medical Association, the oldest and biggest health PAC, would not discuss its lobbying activities against the spending cuts. It contributed $3,237,153 to candidates in the 1992 campaign.