A Living, Breathing Lobby

Barbara Rogers in the Hart Senate Office Building last week. For a day, she was part of the oxygen industry's lobbying effort. (By Leah L. Jones -- Associated Press)

"We don't know how these are going to impact us," Rogers said. "It's time for patients to take these issues into their own hands." She and the other members of her lobbying team came from all over the country, including California, Florida, Texas, Arizona and Arkansas.

Members of Congress have grown accustomed to patients groups descending on Washington to echo the views of industry. "It's a gimmick the providers have used for years. I think it's hokey," said Rep. Pete Stark (D-Calif.), chairman of the health subcommittee of the House Ways and Means Committee. "I like to think we are able to make an objective decision based on facts. I don't want to make these decisions based on an emotional appeal."

Still, the industry has found that patients make effective lobbyists. "Members of Congress and their staffs will always care more about patients than providers," said Frederick H. Graefe, a lobbyist for Invacare, a large medical-device manufacturer.

Rogers said that her colleagues were not paid by any industry group to lobby and that their views were entirely their own.

But the group was not without industry support. Apria Healthcare, a major home-health-care company, gave Rogers's lobbyists free oxygen, a subsidy that made the event financially feasible, she said. Apria is a member of the two largest oxygen lobbying groups, the American Association for Homecare, which highlighted the patients' visits on its Web site, and the Council for Quality Respiratory Care.

In addition, health-care lobbyists said the industry regularly collaborated with groups like Rogers's, briefing them about legislation and regulations in the hope that the patients would be able to get a more sympathetic hearing.

The home-medical-supply industry is made up mostly of small companies, many of them family-owned. The American Association for Homecare says there are 20,000 such firms that sell and rent medical devices. A handful of national companies are also in the business, including Apria and Lincare. The industry also includes manufacturers of medical equipment. Some of the largest are Invacare, Pride Mobility Products, Inogen and Respironics.

The medical-device industry is a significant contributor to federal election campaigns. Donations from people involved with medical-supply companies have risen steadily in the past decade and have reached $2.7 million in the current election cycle, according to the nonpartisan Center for Responsive Politics.

The American Association for Homecare normally has one "fly-in" a year that brings owners and managers of medical-supply companies to the capital from more than 20 states. This year's event, in March, was its largest ever, with 350 people from 35 states. Attendees heard speeches from prominent federal officials, were briefed about the issues affecting them in Congress and traveled to Capitol Hill to lobby their elected representatives. So much is happening that the association is holding a second fly-in this month.

The industry is stepping up its professional lobbying, as well. "The oxygen guys have hired every lobbyist in town," Stark said. Pacific Pulmonary Services, an equipment provider in California, plans to open a lobbying office in Washington soon.

Between fly-ins, the association keeps in steady contact with lawmakers through its smaller member companies. Stark even had a visit last week from a long-lost cousin -- who is a medical supplier in Tennessee.

"There are oxygen suppliers in almost every district, and members of Congress hear from them," said Weems, Medicare's acting administrator. Although he wants to see reimbursements reduced, he said, "This will be a heavy lift."