# Patterns of Federal Lobbying by the Hospital Industry

## TL;DR

This study reveals that hospitals spent over $100 million on federal lobbying in 2024, with for-profit systems and large health systems leading the spending.

## Contribution

The study quantifies and analyzes hospital industry lobbying expenditures and ownership patterns in 2024, highlighting disparities in influence.

## Key findings

- Hospitals spent $116.13 million on federal lobbying in 2024, with 60.7% from hospitals and 39.3% from associations.
- For-profit systems comprised 8.5% of lobbying health systems but 27.8% of top spenders.
- 94.9% of hospitals used external lobbying firms, indicating reliance on professional lobbyists.

## Abstract

This cross-sectional study quantifies federal lobbying expenditures by the hospital industry in 2024 and compares variations in lobbying expenditures by hospital ownership status.

Which hospitals and hospital associations are most active in federal lobbying, who lobbies on their behalf, and what does this reveal about hospitals’ role in shaping health policy?

In this cross-sectional study of federal lobbying disclosures from 355 hospital-related organizations, the hospital industry spent $116.13 million on federal lobbying in 2024, with 60.7% from hospitals and the remainder from associations. Of all hospitals, 94.9% employed professional lobbying firms, many outspent their state hospital associations, and for-profits were overrepresented among top spenders.

This cross-sectional study found that hospitals invest substantially in lobbying, suggesting they are not merely influenced by health policy but actively shape it.

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.

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.

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.

Organization type (nonprofit, for-profit, and private equity–owned).

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.

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.

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.