Which State Has The Highest Number Of Registered Lobbyists? Study Blue

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JAMA Intern Med. 2020 May; 180(v): one–10.

Lobbying Expenditures and Entrada Contributions by the Pharmaceutical and Health Product Industry in the United States, 1999-2018

Olivier J. Wouters

¹Department of Wellness Policy, London Schoolhouse of Economics and Political Scientific discipline, London, Great britain

Received 2019 Nov 20; Accepted 2020 January 29.

Supplementary Materials

Supplement: eTable. Top 20 Recipients of Campaign Contributions From the Pharmaceutical and Health Product Industry in Presidential Elections, 1999 to 2018

GUID: C1C3B2A1-AD35-4D5A-96FB-91071F5F80F6

Primal Points

Question

How much coin did the pharmaceutical and health product industry spend on lobbying and campaign contributions in the US from 1999 to 2018?

Findings

This observational study, which analyzed publicly bachelor data on campaign contributions and lobbying in the US from 1999 to 2018, establish that the pharmaceutical and health product industry spent $4.7 billion, an boilerplate of $233 million per year, on lobbying the US federal government; $414 million on contributions to presidential and congressional balloter candidates, national party committees, and outside spending groups; and $877 million on contributions to land candidates and committees. Contributions were targeted at senior legislators in Congress involved in drafting health care laws and state committees that opposed or supported key referenda on drug pricing and regulation.

Significant

An understanding of the large sums of money the pharmaceutical and health production industry spends on lobbying and campaign contributions tin inform discussions about how to temper the influence of industry on Usa health policy.

Abstract

Importance

Government efforts to lower drug costs and other legislative and regulatory initiatives may be counteracted by campaign donors and lobbyists in the pharmaceutical and wellness product industry.

Objective

To review how much money the pharmaceutical and health product industry spent on entrada contributions and lobbying in the United states of america from 1999 to 2018 at the federal and country levels.

Pattern and Setting

Assay of federal-level and country-level data obtained from the Center for Responsive Politics and the National Institute on Money in Politics, respectively. These nonprofit, nonpartisan organizations track federal and state entrada contributions and lobbying expenditures by individuals and groups.

Exposures

Lobbying expenditures and contributions to political campaigns.

Main Outcomes and Measures

Total spending, inflation adjusted to 2018 dollars using the United states of america Consumer Toll Index, on lobbying and campaign contributions by year, source, and state.

Results

From 1999 to 2018, the pharmaceutical and health production manufacture recorded $4.7 billion—an boilerplate of $233 1000000 per year—in lobbying expenditures at the federal level, more whatever other manufacture. Of the spending, the trade grouping Pharmaceutical Inquiry and Manufacturers of America deemed for $422 million (9.0%), and the other nineteen top companies and organizations in this industry accounted for $2.two billion (46.viii%). The industry spent $414 million on contributions to candidates in presidential and congressional elections, national party committees, and outside spending groups. Of this amount, $22 1000000 went to presidential candidates and $214 million went to congressional candidates. Of the twenty senators and 20 representatives who received the most contributions, 39 belonged to committees with jurisdiction over health-related legislative matters, 24 of them in senior positions. The industry contributed $877 million to state candidates and committees, of which $399 meg (45.5%) went to recipients in California and $287 million (32.7%) went to recipients in 9 other states. In years in which key state referenda on reforms in drug pricing and regulation were being voted on, in that location were big spikes in contributions to groups that opposed or supported the reforms.

Conclusions and Relevance

From 1999 to 2018, the pharmaceutical and health production industry spent large sums of money on lobbying and campaign contributions to influence legislative and election outcomes. These findings can inform discussions nigh how to temper the influence of industry on US health policy.

Introduction

In 2018, the US spent an estimated $3.6 trillion, or 17.6% of its $twenty.5-trillion gross domestic production, on health care, including $345 billion on prescription drugs sold in retail pharmacies.¹ Adjusted for inflation, per-person spending on prescription drugs sold in US retail pharmacies increased from $520 in 1999 to $1025 in 2017.^two Although both Democrats and Republicans consider lowering prescription drug prices a priority,³ lobbyists and campaign donors in the pharmaceutical industry may counteract efforts by federal and state governments to decrease these costs.

In the U.s.a., citizens and organizations, including corporations, have the right to petition politicians and elected officials to try to influence policy decisions.⁴ Citizens and organizations may practise so individually or collectively through interest groups. They can exert their influence through lobbying (ie, contacts past paid lobbyists with officials or their staff to disseminate information most regulatory or legislative matters).^iv,5 Apart from lobbying, individuals and organizations may contribute coin to political campaigns to support their preferred candidates and better their access to successful candidates.^{6,seven,eight} Campaign contributions and lobbying expenditures differ and are subject to different regulations.^8,nine

There is evidence that campaign contributions and lobbying expenditures may influence election and legislative outcomes.^{10,11,12,thirteen,14,xv} However, few studies accept analyzed such spending past the pharmaceutical and health production industry, and near of the research is from 2009 or earlier.^{sixteen,17,18,xix,20,21,22} Prior inquiry has primarily focused on lobbying and campaign contributions by the wellness care sector as a whole in individual years at the federal level. Trends over time take received less attention, as accept contributions to candidates and committees in state elections, where money may exist used to influence the outcomes of referenda on measures aimed at lowering drug costs.

This report analyzed lobbying expenditures and patterns of election contributions past the pharmaceutical and health product manufacture at the federal and state levels from 1999 to 2018.

Methods

Federal-level and state-level data were obtained from the Eye for Responsive Politics²³ and the National Constitute on Money in Politics,²⁴ respectively. These nonprofit, nonpartisan organizations rail federal and state campaign contributions and lobbying expenditures by individuals and groups.

Both organizations categorized all contributions and expenditures by sector and industry within each sector; the categories were modeled on the federal regime'south standard industrial classification system. The pharmaceutical and health product industry includes manufacturers of pharmaceutical and biological products, diagnostic tests, medical devices and equipment, and nutritional and dietary supplements as well every bit pharmacy benefit managers.

On September 30, 2019, the databases of the 2 organizations were searched for campaign contributions and lobbying expenditures by individuals and groups in the pharmaceutical and health production manufacture from January one, 1999, to December 31, 2018. State-level information on entrada contributions from January 1, 1999, to December 31, 2002, were incomplete for some states owing to lack of reporting. As no data were collected from human participants and the information were publicly available, the study was exempt from institutional review lath approval at the London School of Economic science and Political Scientific discipline.

Federal-Level Data

Data on lobbying expenditures were based on disclosure reports filed with the Senate Function of Public Records. Lobbying firms are required to provide the office with quarterly estimates of lobbying incomes (rounded to the nearest $10 000) from clients who spent $3000 or more in a given quarter. Organizations that rent lobbyists as direct employees are required to study lobbying-related expenditures to the nearest $ten 000 if outlays were $12 500 or more in a given quarter.²³

The data on election campaign contributions were based on disclosure reports filed with the Federal Election Commission. From these reports, the Heart for Responsive Politics extracted all records of (one) cash contributions of $200 or more than to federal candidates and national political party committees from individual donors and political activeness committees; (2) soft money contributions from individuals, corporations, labor unions, and ideological groups to national party committees; and (three) donations to outside spending groups, which operate independently of and non in coordination with candidates' committees and can spend coin on communications with the public. Soft coin contributions from individuals, corporations, labor unions, and ideological groups to national party committees are donations that cannot be used to directly support the election bids of federal candidates but rather fund other initiatives, such as voter registration drives.^xvi

In 2002, the Bipartisan Campaign Reform Act²⁵ banned soft money contributions merely allowed donations to state and local political parties for use in activities related to voter registration and participation in federal elections, known as Levin funds. Congress acted in response to concerns that soft money contributions, which were non subject area to federal limits on campaign contributions, were being misappropriated.^sixteen The 2010 Supreme Court example of Citizens United v Federal Election Commission ²⁶ (and related court decisions) legalized contributions by corporations and unions to new types of exterior spending groups, including and so-chosen super political action committees. Prior to the ruling, no donations to these groups were recorded; the ban on soft money contributions remained in result.

For each of the 20 senators and 20 representatives who received the nearly contributions from the pharmaceutical and health product industry from 1999 to 2018, records from the The states Regime Publishing Office²⁷ were searched to determine whether these members served at any point during this period on a committee with jurisdiction over health-related legislative matters, a wellness-related subcommittee of one of these committees, or both.²⁷ It was also noted if a member served as chair, vice chair, or ranking member of any of these committees or subcommittees or held a political party leadership position (Speaker of the Firm, majority leader, minority leader, bulk whip, or minority whip in the Business firm; president pro tempore, majority leader, minority leader, majority whip, or minority whip in the Senate). Some committees and subcommittees changed names over the study menses.

For the House of Representatives, the committees were Energy and Commerce; Ways and Means; Oversight and Reform; Upkeep; Education and Labor; Appropriations; and Veterans' Affairs. For the Senate, the committees were Finance; Aging (Special Commission); Budget; Health, Education, Labor, and Pensions; Appropriations; and Veterans' Affairs.

The subcommittees included in the House were (1) Health (Energy and Commerce); (2) Health (Means and Means); (3) Wellness Care, Benefits, and Administrative Rules (Oversight and Reform); (four) Health, Employment, Labor, and Pensions (Didactics and Labor); (5) Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Appropriations); (6) Labor, Health and Man Services, Instruction, and Related Agencies (Appropriations); (7) Department of Veterans' Affairs (Appropriations); and (8) Health (Veterans' Affairs). In the Senate, the subcommittees were (ane) Health Care (Finance); (2) Main Health and Retirement Security (Wellness, Education, Labor, and Pensions); (iii) Agriculture, Rural Development, Food and Drug Assistants, and Related Agencies (Appropriations); (4) Labor, Health and Homo Services, Teaching, and Related Agencies (Appropriations); and (5) Military Structure, Veterans' Affairs, and Related Agencies (Appropriations).

Land-Level Information

Data on lobbying expenditures at the state level were unavailable for near states and thus were excluded from the assay. Yet, the National Establish on Money in Politics²⁴ collects information from all fifty states on campaign contributions from individuals and organizations in the pharmaceutical and health production industry to the following state-level candidates and committees: (1) gubernatorial or other statewide candidates; (2) firm, assembly, or senate candidates; (three) supreme court candidates; (4) political party committees; and (5) ballot mensurate committees. Ballot mensurate committees raise funds to oppose or support election measures, which are proposals that are voted on by the electorate to pass or repeal state laws or amendments to the state constitution.²⁸ The National Institute on Money in Politics²⁴ acquires the data from various state regulatory offices.

Information Analysis

Descriptive statistics were used to report total campaign contributions and lobbying expenditures by the pharmaceutical and wellness product industry, with results broken down by year, source, recipient, political party, and state. For comparison, aggregated information on federal lobbying expenditures past the top 10 industries and organizations were also collected, every bit were data on expenditures past the 4 industries in the wellness sector in addition to the pharmaceutical and health product manufacture (ie, hospitals and nursing homes, health professionals, wellness services and wellness maintenance organizations, and miscellaneous wellness organizations). Because health insurance companies are grouped with life, property, and car insurance firms, they were excluded from the wellness sector for this analysis. Federal campaign contributions were recorded over 2-year cycles, reflecting the timing of congressional elections.

All dollar figures were aggrandizement adapted to 2018 dollars using the US Consumer Price Index. Stata version xv (StataCorp) and Excel 2016 (Microsoft) were used for all analyses.

Results

Federal-Level Lobbying Expenditures

From 1999 to 2018, across all industries, a total of $64.3 billion was spent lobbying Congress and federal agencies in the U.s.a.. During this time, the pharmaceutical and health product industry recorded the highest spending of all industries ($4.7 billion [7.iii%]), followed by the insurance manufacture ($3.2 billion [5.0%]), the electric utilities industry ($2.eight billion [iv.four%]), and the electronics manufacturing and equipment industry ($2.6 billion [four.0%]). Within the health sector, total lobbying expenditures were $9.7 billion. Expenditures in addition to those by the pharmaceutical and health product industry were recorded by hospitals and nursing homes ($one.nine billion), health care professionals ($1.7 billion), health services and health maintenance organizations ($1.3 billion), and miscellaneous health organizations ($139 million).

Pharmaceutical and health product industry spending on federal lobbying averaged $233 million per year. From 1999 to 2009, annual spending increased, earlier decreasing briefly and increasing once more (Figure 1). Expenditures peaked at $318 million in 2009, the year before the Patient Protection and Affordable Care Act was signed into constabulary.

Federal-Level Lobbying Expenditures by the Pharmaceutical and Health Product Industry, 1999-2018

Dashed lines indicate cardinal events that affected the pharmaceutical and health production industry. Data from the Center for Responsive Politics.²³ Amounts were inflation adjusted to 2018 dollars using the US Consumer Cost Index.

Over the 20-year report period, 1375 organizations in the pharmaceutical and health product industry reported lobbying expenditures. Seventeen of the xx highest spending organizations were manufacturers of biological or pharmaceutical products or their trade associations (Tabular array 1). The other 3 organizations were the Avant-garde Medical Technology Association (a merchandise clan for medical device companies), Medtronic (a medical device company), and the Seniors Coalition (an interest group that does non disclose its donors and lobbies for limited authorities intervention in drug and wellness care markets). The top spender, the trade group Pharmaceutical Research and Manufacturers of America (PhRMA), accounted for $422 million (ix.0%) of the $4.7 billion, and the other 19 acme spenders accounted for $ii.two billion (46.eight%).

Table ane.

Peak twenty Lobbying Spenders and Entrada Contributors in the Pharmaceutical and Health Product Manufacture at the Federal Level, 1999-2018^a

Rank	Organizationb	Expenditures, $ in millions
Lobbying spenders
one	Pharmaceutical Enquiry and Manufacturers of America	422.iii
2	Pfizer	219.2
3	Amgen	192.7
4	Eli Lilly and Company	166.two
5	Biotechnology Innovation Arrangement (BIO)c	153.4
6	Merck	143.0
7	Roche Holdingsc	135.nine
viii	Novartis	130.ii
9	Johnson & Johnson	129.nine
ten	Sanofic	116.7
eleven	Bayer	111.0
12	GlaxoSmithKline	110.8
13	Bristol-Myers Squibb	101.6
xiv	Abbott Laboratories	96.6
fifteen	Advanced Medical Engineering Association	79.4
16	Seniors Coalition	65.3
17	Medtronic	63.viii
xviii	Baxter International	58.4
19	AstraZeneca	54.vi
twenty	Teva Pharmaceutical Industries	53.3
Full		2604.three
Campaign contributors d
1	Pfizer	23.2
two	Amgen	xiv.seven
iii	Eli Lilly and Visitor	xiii.three
4	GlaxoSmithKline	12.six
5	SlimFast Foods	11.3
vi	Johnson & Johnson	11.ii
7	D.E. Shaw Research	eleven.0
8	Merck	x.6
9	Abbott Laboratories	10.0
10	Bristol-Myers Squibb	seven.vii
11	Exoxemis	6.ix
12	McKesson	6.eight
xiii	Ischemix	5.7
14	Pharmaceutical Research and Manufacturers of America	5.six
15	AstraZeneca	5.4
xvi	Pharmaceutical Product Evolution	5.2
17	Schering-Plough	five.1
xviii	AmerisourceBergen	4.9
19	Sanofic	4.3
20	Novartis	four.0
Total		179.five

Across all industries, but 5 organizations reported more than spending than PhRMA: the US Bedchamber of Commerce ($one.seven billion), the National Association of Realtors ($602 million), the American Medical Association ($462 million), the American Hospital Association ($426 1000000), and General Electrical ($423 one thousand thousand). Following PhRMA, the 7th and eighth ranked spenders were the Blue Cross Blue Shield Clan ($391 one thousand thousand) and AARP (formerly American Association of Retired Persons) ($334 million). Thus, 5 of 8 organizations with the largest lobbying expenditures were health intendance related.

Federal-Level Campaign Contributions

From 1999 to 2018, the pharmaceutical and wellness production industry contributed $414 1000000 to federal (presidential and congressional) candidates, national party committees, and outside spending groups (Figure 2). This included $152 1000000 in contributions from individuals affiliated with the health intendance manufacture, $165 million from political action committees, and $96 million in soft money contributions and donations to exterior spending groups.

Campaign Contributions past the Pharmaceutical and Health Product Industry to Federal (Presidential and Congressional) Elections by Source, 1999-2018^a

PAC indicates political activity committee.

^aInformation from the Heart for Responsive Politics.²³ Amounts were inflation adjusted to 2018 dollars using the Us Consumer Toll Index.

^bContributions from individual members, employees, or owners of companies or organizations in an industry or from their immediate family members; there are limits on individual contributions to candidates and national party committees during elections.

^cPACs puddle campaign contributions from members of corporations, labor unions, and ideological groups and disburse the funds to political candidates and national party committees; there are limits on PAC contributions to candidates and national political party committees during elections.

^dSoft money contributions (banned every bit of November half-dozen, 2002) and donations to outside spending groups and Levin funds. Outside spending groups, which include so-chosen super PACs, operate independently of and not in coordination with candidates' committees; spending by outside groups is largely unregulated and unlimited.

^eastwardEach year corresponds to a 2-year election cycle; eg, 2000 refers to January i, 1999, through December 31, 2000. Presidential elections occurred in 2000, 2004, 2008, 2012, and 2016.

Excluding contributions to exterior spending groups, the manufacture donated $367 one thousand thousand to party candidates and committees ($216 meg [58.9%] to Republicans; $151 1000000 [41.1%] to Democrats), with more than money going to Republicans than to Democrats in all but 2 ballot cycles (2008 and 2010). The 2000 and 2002 election cycles, 2 of 5 cycles with the highest spending levels, coincided with congressional debates on the introduction of Medicare Role D (a prescription drug benefit program for seniors) and the 2000 presidential ballot. The ii cycles with the highest spending (2012 and 2016) were presidential election years. The 2018 election cycle had the fifth highest spending.

Of the pinnacle 20 campaign contributors (Table 1), xv were manufacturers of biological or pharmaceutical products, and 1 was the merchandise grouping PhRMA. The other iv were AmerisourceBergen (a drug wholesale company), D.E. Shaw Research (a biochemistry enquiry company), Pharmaceutical Production Development (a contract enquiry organization), and SlimFast Foods (a producer of nutritional and dietary supplements). Five pharmaceutical companies were among the pinnacle 10 spenders for both entrada contributions and lobbying: Amgen, Eli Lilly and Company, Johnson & Johnson, Merck, and Pfizer.

Contributions to presidential candidates totaled $22 million. The eTable in the Supplement lists the 20 presidential candidates who received the most contributions from individuals and political action committees in the pharmaceutical and health product manufacture. Of the $nineteen.3 meg contributed to these candidates, the meridian recipient was Barack Obama ($v.5 million), followed past Hillary Clinton ($3.7 one thousand thousand), Mitt Romney ($3.0 million), and George W. Bush ($2.4 one thousand thousand). The next 16 candidates combined received $iv.seven million.

Contributions to congressional candidates totaled $214 million. Table 2 shows the summit 20 recipients, in each chamber of Congress, of contributions from individuals and political action committees in the pharmaceutical and wellness product industry. These 40 legislators jointly received $45 meg (21.0%) of all contributions to congressional candidates; 39 were members of committees with jurisdiction over health-related legislative matters, and 24 held senior positions in these committees. Of the xx members of the House, 17 served on the Energy and Commerce Committee or the Ways and Ways Committee. Of the 20 senators, xiii served on the Finance Commission.

Table 2.

Top Recipients of Entrada Contributions From the Pharmaceutical and Wellness Production Manufacture in Congressional Elections, 1999-2018^a

Rank	Candidate (party, country)	Contributions received, $ in millionsb	Active years	Fellow member of health-related committeec	Senior member of health-related committeed	Political party leadereast
Business firm elections
1	Eshoo, Anna (D, California)	ane.8	1993-present	Yesf	Nog	No
2	Upton, Fred (R, Michigan)	i.vi	1987-present	Yesf	Yes	No
three	Pallone, Frank (D, New Jersey)	1.5	1988-present	Ayef	Yes	No
4	McCarthy, Kevin (R, California)	i.iv	2007-present	No	No	Yep
5	Paulsen, Erik (R, Minnesota)	1.3	2009-2019	Yesf	No	No
6	Ryan, Paul (R, Wisconsin)	ane.3	1999-2019	Severalf	Yep	Aye
7	Ferguson, Mike (R, New Jersey)	1.3	2001-2009	Yeahf	Yes	No
8	Boehner, John (R, Ohio)	1.3	1991-2015	Yes	Yes	Yes
9	Walden, Greg (R, Oregon)	1.ii	1999-present	Several	Yep	No
x	Shimkus, John (R, Illinois)	1.2	1997-present	Yepf	No	No
11	Hoyer, Steny (D, Maryland)	1.1	1981-nowadays	Ayef	No	Yes
12	Barton, Joe (R, Texas)	1.0	1985-2019	Yesf	Yes	No
xiii	Burgess, Michael (R, Texas)	ane.0	2003-present	Yesf	Yep	No
14	Tiberi, Pat (R, Ohio)	i.0	2001-2018	Severalf	Yes	No
15	Dingell, John (D, Michigan)	i.0	1955-2015	Yepf	Aye	No
16	Lance, Leonard (R, New Jersey)	1.0	2009-2019	Yesf	No	No
17	Army camp, Dave (R, Michigan)	ane.0	1991-2015	Yeahf	Aye	No
18	Johnson, Nancy (R, Connecticut)	0.9	1983-2007	Yeahf	Yeah	No
nineteen	Cantor, Eric (R, Virginia)	0.9	2001-2014	Aye	No	Aye
20	Kind, Ron (D, Wisconsin)	0.9	1997-nowadays	Severalf	No	No
Full		23.7	NA	19	12	five
Senate elections
1	Hatch, Orrin (R, Utah)	two.viii	1977-2019	Severalf	Yes	Yes
2	Burr, Richard (R, North Carolina)	1.6	2005-present	Severalf	Yes	No
3	McConnell, Mitch (R, Kentucky)	one.4	1985-present	Yepf	No	Yeah
4	Casey, Bob (D, Pennsylvania)	1.three	2007-present	Severalf	Yes	No
5	Clinton, Hillary (D, New York)	ane.ii	2001-2009	Severalf	No	No
6	Murray, Patty (D, Washington)	one.1	1993-present	Severalf	Yes	No
7	Baucus, Max (D, Montana)	1.1	1978-2014	Ayef	Yes	No
eight	Schumer, Charles (D, New York)	1.0	1999-present	Ayef	No	Yep
9	Portman, Rob (R, Ohio)	one.0	2011-present	Severalf	No	No
ten	Specter, Arlen (R, Pennsylvania)	ane.0	1981-2011	Severalf	Yes	No
11	Grassley, Chuck (R, Iowa)	0.nine	1981-nowadays	Severalf	Yes	Yes
12	Menendez, Robert (D, New Jersey)	0.9	2006-present	Severalf	No	No
13	Cornyn, John (R, Texas)	0.9	2002-nowadays	Severalf	No	Yeah
14	Santorum, Rick (R, Pennsylvania)	0.8	1995-2007	Severalf	No	No
15	Wyden, Ron (D, Oregon)	0.8	1996-nowadays	Severalf	Yep	No
16	Harkin, Tom (D, Iowa)	0.8	1985-2015	Severalf	Yes	No
17	Alexander, Lamar (R, Tennessee)	0.8	2003-nowadays	Severalf	Yes	No
18	Toomey, Pat (R, Pennsylvania)	0.eight	2011-present	Severalf	Yes	No
xix	Isakson, Johnny (R, Georgia)	0.7	2005-nowadays	Severalf	Yes	No
20	Reid, Harry (D, Nevada)	0.7	1987-2017	Severalf	No	Yep
Full		21.iv	NA	20	12	six

State-Level Campaign Contributions

From 1999 to 2018, the pharmaceutical and health product industry contributed $877 million to state-level candidates and committees in 50 states and the District of Columbia, of which $661 million (75.4%) went to election measure committees. The remainder was contributed to business firm of representatives, assembly, and senate candidates ($99 one thousand thousand), state political party committees ($72 million), gubernatorial and other statewide candidates ($44 million), and supreme court candidates ($i one thousand thousand).

Over this period, total contributions exceeded $fifty million in 2 states, California ($399 million) and Ohio ($74 one thousand thousand), and were between $20 meg and $fifty million in 6 states—Missouri ($43 meg), New York ($33 meg), Oregon ($27 million), Florida ($26 million), Illinois ($23 million), and Texas ($22 million). Contributions totaled $10 million to less than $20 million in 7 states, $5 meg to less than $10 one thousand thousand in 7 states, $1 million to less than $five one thousand thousand in 20 states, and less than $1 million in eight states and the District of Columbia. Candidates and committees in California received 45.5% ($399 million) of all contributions, compared with 32.seven% ($287 million) for recipients in the other 9 states with the most contributions.

Figure 3 shows trends in contributions in the 4 states that received the most coin. Of the $399 million in contributions in California, $197 1000000 (49.4%) and $123 million (xxx.8%) were spent in 2005 and 2016, respectively; in these ii years, there were three ballot measures intended to reduce drug costs, all of which were rejected by voters.^29,30,31,32 In 2005, 1 of ii defeated ballot measures was Proposition 78, which PhRMA and pharmaceutical companies supported. In the other years, contributions in California followed cyclical patterns, reflecting the timing of legislative elections. Of the $74 million donated in Ohio, $61 one thousand thousand (82.4%) was spent in 2017, the year of a election measure aimed at lowering prescription drug costs, which was voted down.³³ Of the $43 1000000 donated in Missouri, $34 million (79.1%) was spent in 2006, the year of a ballot measure on the legality of stem cell research, which was passed.³⁴ Contributions in New York followed a cyclical pattern in line with the timing of state senate and assembly elections. Trends in the other 46 states and the District of Columbia generally followed the pattern observed in New York, with a few exceptions.

State-Level Contributions by the Pharmaceutical and Wellness Product Manufacture to Candidates, Political party Committees, and Ballot Mensurate Committees in Elevation 4 States, 1999-2018

Dashed lines show years with key ballot measures that afflicted the industry. From 1999 to 2018, the pharmaceutical and health product industry contributed $399 million in California, $74 meg in Ohio, $43 million in Missouri, and $33 million in New York. Contributions from 1999 to 2002 may be underestimated because of incomplete information. Data from the National Plant on Money in Politics.²⁴ Amounts were aggrandizement adapted to 2018 dollars using the US Consumer Price Alphabetize.

Discussion

From 1999 to 2018, the pharmaceutical and health product industry spent large sums of coin on lobbying and campaign contributions. More than twice as much money was spent on elections at the land level than at the federal level. Federal entrada contributions were targeted at senior legislators serving on congressional committees that draft wellness care bills and at presidential candidates from both major political parties. At the state level, the manufacture focused its efforts on opposing major drug cost-containment measures by contributing to election measure committees in key states. Three price-containment election measures in California and 1 in Ohio were all defeated.^{thirty,31,32,33} In 2005, PhRMA and pharmaceutical companies supported 1 of the ballot measures, Proposition 78 in California; the proposition, which voters rejected, would have immune pharmaceutical companies to voluntarily provide discounts on drugs sold to individuals with an income below a threshold.³⁰

When considering legislative and policy initiatives, Congress and the executive branch benefit from fully considering the interests of all parties in guild, not just those who seek to meliorate their access to officials through campaign contributions and lobbying expenditures. In the health sector, several organizations, notably PhRMA, the American Medical Association, the American Infirmary Association, and the Blue Cross Blue Shield Association, accounted for a disproportionate share of spending on lobbying over the study period. PhRMA and the American Medical Association take historically lobbied together confronting government interventions in drug markets.^35,36,37,38 For example, although both groups supported the Affordable Care Act, they did so only after receiving commitments from the Obama administration and former Senator Max Baucus (D, Montana), then chair of the Senate Finance Commission, that parallel import of lower-cost medicines from Canada would not be permitted, Medicare would not exist allowed to negotiate drug prices, and Medicare payments to physicians would not be reduced.³⁵ With the exception of a few influential consumer groups that have lobbied Congress to lower drug prices—such as AARP—groups representing consumers spent far less on lobbying than manufacture trade groups and companies.

The $4.7 billion spent past the pharmaceutical and health product industry on lobbying and the $1.3 billion spent on entrada contributions from 1999 to 2018 was only well-nigh 0.ane% of the estimated $5.5 trillion (in 2018 dollars) spent on prescription drugs in the US over the same menses.³⁹ Every bit a pct of their revenues, well-resourced drug industry groups had to spend relatively little in their efforts to influence political and legislative outcomes. In dissimilarity, many organizations advocating for the interests of patients and consumers have more limited financial resources.

Legislative and regulatory changes might address some of the disparities highlighted by this analysis. Such changes might include restrictions on donations by individuals and organizations to election measure out committees at the state level. At present, in many states, including California^xl and Ohio,⁴¹ these committees are non subject to contribution limits. Transparency near financial associations might also be increased, particularly for congressional leaders and members of committees that draft legislation affecting the pharmaceutical and health production industry and other aspects of health care. For instance, Congress could mandate that chairs and ranking members of health-related committees publish online, in a readily attainable manner and in a format understandable to the electorate, records of scheduled meetings with lobbyists from relevant industries, as is required by the European Parliament.⁴²

Limitations

This analysis had limitations. First, information technology was not possible to verify the abyss of the data. However, the nonpartisan organizations from which the data were obtained conduct extensive validation and triangulation of sources to ensure accuracy.^23,24 Even and so, the data did not capture all lobbying activities considering some expenditures fell exterior of the disclosure requirements (eg, small outlays and certain indirect expenses, such every bit investments in buildings and infrastructure).

Second, at that place were inconsistencies among companies in the reporting of lobbying expenditures, which made it hard to ensure the comparability of figures. Organizations in the pharmaceutical and wellness product manufacture report federal lobbying incomes or expenditures to the Senate Office of Public Records through 1 of 3 filing methods.²³ The showtime two methods adhere to the definition of lobbying in the Internal Revenue Lawmaking (one method for for-profit groups and 1 for nonprofit groups),^43,44 whereas the third method follows the definition in the Lobbying Disclosure Act of 1995.⁴⁵ The 2 filing methods based on the Internal Revenue Lawmaking definition crave filers to disclose state and grassroots lobbying costs alongside federal lobbying costs, whereas the other method does non. Moreover, the Lobbying Disclosure Act of 1995 definition covers a larger number of public officials than the definition in the Internal Acquirement Code.

Third, in any given year, the Center for Responsive Politics²³ and the National Institute on Money in Politics²⁴ were unable to categorize approximately 30% and 15%, respectively, of dollars spent on campaign contributions from individuals by manufacture because of lack of information. Thus, contributions at both state and federal levels may have been underestimated for the pharmaceutical and health product industry.^24,46 The two organizations categorize contributions from individual donors based on cocky-reported employment information.

Fourth, at a state level, data on lobbying expenditures were excluded from this analysis owing to unavailability, and data on entrada contributions from 1999 to 2002 were likely underestimated because of incomplete reporting. Besides, state-level data on entrada contributions excluded independent spending (ie, coin spent on communications with the public by individuals or organizations that operated independently of and non in coordination with candidates' committees). This included spending on straight advocacy communications (ie, "a communication, such every bit a website, newspaper, TV or straight mail advertising that expressly advocates the election or defeat of a conspicuously identified candidate"⁴⁷), electioneering communications (ie, "any circulate, cable or satellite advice that refers to a clearly identified…candidate, is publicly distributed within 30 days of a primary or 60 days of a general election and is targeted to the relevant electorate"⁴⁸), and internal communications targeted to members of a marriage or arrangement. Legal definitions of each type of communication vary among states.

Fifth, the federal-level data only reflected campaign contributions to outside spending groups registered with the Federal Ballot Committee; this excluded contributions to outside spending groups that report to the Internal Revenue Service (eg, so-called 527 organizations, which can appoint in electioneering communications). The federal-level data on entrada contributions also excluded direct advancement communications paid for by corporations out of their own treasuries, which became legal following the ruling in the 2010 Supreme Courtroom example of Citizens United v Federal Ballot Commission ²⁶; straight advancement communications are referred to as independent expenditures in federal campaign finance regulations.

Conclusions

From 1999 to 2018, the pharmaceutical and health product manufacture spent large sums of coin on lobbying and entrada contributions to influence legislative and ballot outcomes. Understanding the spending of the pharmaceutical and health product manufacture on lobbying and campaign contributions can inform discussions almost how to temper the influence of manufacture on The states health policy.

Notes

Supplement.

eTable. Tiptop 20 Recipients of Campaign Contributions From the Pharmaceutical and Health Product Industry in Presidential Elections, 1999 to 2018

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Which State Has The Highest Number Of Registered Lobbyists? Study Blue,

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054854/

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