The specter of Medicaid cuts and expiring Affordable Care Act tax credits stoked first-quarter lobbying by hospital and insurer trade groups, a review of new 2025 disclosure forms shows.
Why it matters: The numbers offer the first glimpse at how health care industries are aligning and trying to shape policy in the second Trump administration and with a GOP trifecta in charge.
By the numbers: The American Hospital Association boosted year-over-year Q1 lobbying spending by more than $1 million.
- Insurers also ramped up activity, with AHIP putting up $4.8 million in 2025, compared with $4.2 million in the first quarter of 2024.
Many hospital groups are warning that reduced Medicaid payments and a phaseout of ACA subsidies could be ruinous, especially to rural facilities.
- The Federation of American Hospitals, which represents for-profit hospitals, increased its spending to $1 million from $650,000 a year ago.
- America's Essential Hospitals, which represents safety-net hospitals, upped its spending by $230,000.
The big picture: Republican lawmakers have been weighing a variety of Medicaid cuts as they try to offset the cost of their massive tax-cut package.
- The policies with the best odds of being considered when lawmakers return from recess are work requirements, more frequent state eligibility checks, and reducing the federal share of costs for the expansion population, with incomes up to 138% of the federal poverty level.
- The prospect of Congress allowing ACA tax credits to expire at the end of the year is also a concern.
- Hospitals and insurers are worried the policy changes will not only reduce provider payments but also drive up the uninsured rate, which could hit both industries' bottom lines.
- Some hospital and insurer advocacy groups have recently launched seven-figure ad campaigns advocating for both Medicaid and the ACA subsidies, targeting their pitches at swing-district Republicans.
Follow the money: The threat of pharmaceutical tariffs has also led drug companies to ramp up their lobbying, hoping to stem the severity and extent of the levies.
- PhRMA spent over $3 million more in the first quarter of 2025 than in the first quarter of 2024. That brought the trade association's total Q1 spending this year to almost $13 million.
- Eli Lilly, a big GLP-1 manufacturer, almost doubled its spending from the year before, to $3.4 million in Q1 2025, as policymakers debated whether to expand Medicare coverage to anti-obesity treatments.
Between the lines: Another focus of lobbying is efforts to remedy an almost 3% Medicare payment rate cut for physicians that took effect in January. A "doc fix" could be included in the GOP reconciliation package.
- The American Medical Association increased its lobbying by more than $700,000 from Q1 2024 to Q1 2025.
