DAILY NEWS CLIP: November 25, 2024

Who’s paying the most to lobby CT legislators? One industry tops them all


Hartford Courant – Sunday, November 24, 2024
By Christopher Keating

As hundreds of cities, towns, nonprofits, businesses, and special interests compete each year for a piece of the state’s $26 billion annual budget, they all need help from lobbyists.

That need has prompted the hiring of more than 1,100 client lobbyists in a wide variety of industries, according to state records.

But the industry lobbying the most, by far, is health care, with three of the top five spenders and five of the top 10.

The entity that spent the most money on lobbying in 2023-2024 was the Connecticut Hospital Association at $3.2 million, while Hartford Healthcare and the Partnership for America’s Healthcare Future Action followed closely behind at $1 million each, according to state records. Connecticut Children’s Medical Center in Hartford spent nearly $700,000, while Yale New Haven Health system spent $584,000.

Other big players at the Capitol were traditional entities like Eversource, a heavily regulated electric utility, at $1.275 million, and the Connecticut Business and Industry Association at more than $700,000. The hospital association is a member of CBIA.

The hospital association ranked at the top partly because of the sheer size of the operations and the depth and breadth of the association’s interests. With nearly 100 members, the association is far larger than 27 acute care hospitals general public traditionally associates with the hospitals.

The association lobbies on bills far and wide because the membership includes nursing homes, clinics, the Whiting Forensic Institute, Gaylord rehabilitation hospital, Connecticut Valley psychiatric hospital, and Silver Hill Hospital in New Canaan that specializes in drug and alcohol treatment.

The lobbyists even get involved in the state’s spending cap and fiscal guardrails because the amount of Medicaid spending can change the state budget dynamics.

With so much on the plate, the association follows legislation on virtually every committee at the state Capitol, said Karen Buckley, vice president for advocacy.

“In the time that I’ve been here, I think we’ve been in every committee,” Buckley said in an interview. “The one committee that we always go back and forth about is the banking committee. That’s usually the one that doesn’t happen on a routine basis.”

Beyond the traditional hospital issues, the association monitors matters related to pharmacies, ambulances, health insurance, taxes, medical malpractice, and behavioral and mental health. The lobbying extends to bills on domestic violence because victims often are treated at hospitals and workers there must be trained on recognizing the signs of domestic violence.

The $3.2 million includes everything associated with lobbying, including the salaries for nine registered lobbyists, consultant costs, media spending, and office expenses. If the lobbyists bring an expert or consultant to meet with legislators, state officials or a working group, the value of their time is counted as part of the overall total under the state lobbying regulations.

Hospital lobbyists testified on nearly 140 bills during the past two years and monitored hundreds more, said Nicole Rall, an association spokeswoman.

The hospitals were involved in one of the most high-profile bills of the last legislative session, a move to regulate artificial intelligence that was passed by the state Senate but ultimately opposed by Gov. Ned Lamont. Artificial intelligence is highly important in the emerging world of health care.

With about 120,000 employees at the hospitals, plus another 125,000 indirect jobs, the association tracks every bill in the labor committee for potential impact on the workforce. That includes both minor measures and major bills like paid family leave.

In addition to directly lobbying legislators, the costs extend beyond the state Capitol building itself and include administrative lobbying of state agencies that are writing regulations and enforcing the law. They routinely deal with the departments of public health, social services, and consumer protection.

One of the few major issues that the hospitals do not touch is physician-assisted suicide because the doctors are split on the matter. With no universal, consensus opinion to advocate, the hospital lobbyists are not key players on the issue.

“Priority issues have included increasing access to care by advocating for sufficient Medicaid reimbursement, reforming a regulatory environment that can impede healthcare access, addressing the state’s behavioral health crisis, tackling the significant financial challenges and pressures hospitals are experiencing including burdensome commercial insurance practices, advocating for policies that support the growth and retention of the healthcare workforce, protecting hospitals’ ability to invest in and provide services within their local communities, and addressing social drivers of health – from access to nutritious food and diapers to job opportunities,” said Rall, describing the wide umbrella of issues tackled by hospitals.

The hospitals are interested in diapers, for example, because sometimes babies arrive at the hospital with health issues that are related to diapers.

“When families have to choose between diapers and food and formula, and just the general costs of living, diapers and formula are very expensive,” Buckley said. “Oftentimes they’re not able to buy those diapers, and as a result, children end up having health issues that they would otherwise not have that drives them to the hospital. Hospitals are trying to take a more proactive role with community organizations and the state.”

Beyond the association lobbying on common issues like financial stability for hospitals overall, the individual hospitals also lobby on matters that are unique and specific to that hospital only.

Medicaid payments

One of the longest-running issues in health care is that doctors, hospitals, and other providers say Medicaid does not pay the full amount for the health services that are provided to patients. The hospitals say that Medicaid pays only 62% of the actual costs, while Medicare for the elderly pays 74%.

The total underpayments added up to nearly $2.8 billion in the 2022 fiscal year, which included $1.55 billion for Medicare patients and $1.23 billion for those covered by Medicaid, according to the hospitals.

The shortages have been a continuing issue for the state legislature, which provides massive payments for Medicaid annually.

Senate President Pro Tem Martin Looney, a New Haven Democrat, said legislators are watching closely to see whether the incoming administration of President Donald J. Trump will attempt to cut Medicaid funding for the states.

“We’re obviously a small state, but if we were able to operate in concert with New York, Massachusetts, New Jersey or some other states, we could leverage it as a coalition,” Looney told The Courant in an interview.

Looney was not surprised that the hospital association had spent $3.2 million on lobbying in the past year.

“I think they’re always among the big spenders as a lobbying presence,” Looney said. “They have a concern, but we have a real concern in general about the individual medical providers that Medicaid reimbursement rates have not been systematically raised in about 15 years. We have more and more medical providers not taking Medicaid patients, and we partially addressed it in our last session where we put in some more money for mental health providers for children. We’re seeing kids are not able to get counseling or therapy outside of what they’re able to get in school from school counselors or school psychologists or school guidance people.”

Looney added, “There are now too many physicians and others opting out of Medicaid. The hospitals are also complaining that their Medicaid reimbursement rates are lower than what they get from Medicare and certainly lower than what they get from private insurance carriers, so they’re pressing on the Medicaid front as well. … The hospitals have to take people when they come to the emergency room, but individual doctors have discretion.”

The main reason for the shortfalls, Looney said, is “primarily tight state budgets going back to the Great Recession” in 2008-2009.

Lamont is scheduled to release his new budget proposal in February for the next two years, but the legislature traditionally does not finalize the spending plan until near the end of the legislative session in early June.
Yale-New Haven Hospital in New Haven is a member of the hospital association that also lobbies on its own behalf.
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Yale-New Haven Hospital in New Haven is a member of the hospital association that also lobbies on its own behalf.

Health care crisis

House Republican leader Vincent Candelora of North Branford said he was not surprised that the hospitals and the health care industry were the largest lobbyists.

“We’re in a health care crisis in this state,” Candelora told The Courant in an interview. “We don’t have maternity care up in Stafford Springs anymore. That came out last week. We have Waterbury Hospital that has been depleted. We have Medicaid overruns in our budget to the tune of a couple of hundred million dollars.”

Candelora added, “I think it speaks to government’s failure to respond quick enough to all of these issues, whether it’s certificate of need, whether it’s the private equity firms that are coming in and buying up our systems or the Medicaid reimbursement rates, where some of these reimbursements haven’t been touched in 20 years. I think we have to look at rates, but we can’t just keep moving food around on the plate. I’m more concerned that there’s been too much time being spent justifying the same old process as opposed to justifying increasing our Medicaid rates.”

The top 10 and top 20 lobbying lists vary from year to year, but none of the top spenders in the past year was involved in gambling or the legalization of recreational marijuana since those issues have largely been resolved after years of intense debates. Previously, those industries hired numerous lobbyists who worked on legislation from various angles before the legislature voted on the issues.

“They’re settled in the sense that the industry got what they wanted,” Candelora said. “So we now have commercialized marijuana, and we have gaming at your fingertips on your phones. What you see the legislature now continuing to grapple with is all the societal impacts of that. We’re starting to see legislation to continue to try to curb advertising and to continually try to curb illegal operation of drug factories. So that’s where you’re going to see more and more activity that may or may not need paid lobbying efforts. It’s more about what we’re hearing from our constituents and how we can make Connecticut healthier and safer for people.”

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Communications Director, Connecticut Hospital Association
110 Barnes Road, Wallingford, CT
rall@chime.org, 203-265-7611