Patterns of Federal Lobbying by the Hospital Industry.

Importance: Hospitals are major stakeholders in US health policy yet receive less scholarly attention than other health care industries, such as pharmaceuticals and health professionals. Understanding their federal lobbying activity is critical to evaluating how hospitals shape health policy. Objective: To characterize federal lobbying by the hospital industry in 2024, including health systems and hospital associations, and to examine the concentration of spending and use of internal vs external lobbyists. Design, Setting, and Participants: This descriptive cross-sectional study used 2024 federal lobbying disclosure data filed under the Lobbying Disclosure Act of 1995, compiled by OpenSecrets, a nonprofit website that standardizes and publishes data on political spending. and included all organizations categorized as hospitals or hospital associations that reported federal lobbying activity in 2024, along with their affiliated lobbying firms. Exposure: Organization type (nonprofit, for-profit, and private equity-owned). Main Outcomes and Measures: The primary outcomes were total and mean lobbying expenditures, and use of internal vs external lobbyists. Lobbying firm outcomes included total hospital industry earnings and clients and the share of total earnings and clients attributable to the hospital industry. Results: In 2024, 355 hospital-related organizations reported $116.13 million in federal lobbying expenditures. Hospitals and health systems accounted for $70.56 million (60.7%), with the remainder from hospital associations. Eighteen organizations spent more than $1 million, including 12 health systems and 6 hospital associations. For-profit and private equity-owned systems comprised 8.5% of all lobbying health systems but 27.8% of the highest spenders (5 of 18 organizations). However, overall for-profit and nonprofit spending mirrored their share of US community hospitals. Nearly all hospitals and health systems (283 of 295 organizations [94.9%]) employed external lobbying firms. Lobbying by for-profit systems was highly concentrated among a few large organizations, while nonprofit lobbying was diffuse. Conclusions and Relevance: This cross-sectional study found that hospitals and affiliated organizations are major participants in federal health policy lobbying, relying on a small number of professional firms, with large health systems often outspending their state hospital associations. These patterns suggest lobbying influence is concentrated among well-resourced organizations and that not all hospitals have an equal voice in federal policymaking.