A two-term Republican from a rural district in Tennessee, Rep. Phil Roe, became a magnet during the last election for more than $90,000 in contributions from medical professionals from across the country, including thousands of dollars from political action committees representing ear and foot doctors in October and November.
The funds weren't urgent: Roe's Democratic opponent did not report spending anything, and Roe's seat has been in the hands of the GOP for more than a century. Roe even sent $4,500 back because he has long refused PAC contributions.
But the congressman, a physician who is now chairman of a House labor and health subcommittee, is considered a kindred soul by the medical industry, partly because he has twice introduced legislation to remove a provision in President Obama's health care law that is meant to rein in the growth of Medicare payments.
While it is well-known that health-care and health-insurance providers and companies donated heavily while the bill was being drafted, a new study of campaign spending makes clear that the health-care and health-insurance industries continued to give steadily after its approval, an apparent effort to influence its fate this year.
Roe's late-arriving contributions were part of a windfall of more than $42.7 million in health-care and health-insurance industry funds that have flowed to current Republican and Democratic lawmakers after each chamber voted on the Obama bill, according to the study of spending for that period.
That investment reflects the conviction of those affected by the bill that the fight over its consequences and key provisions is not over - it is just beginning. The steady spending late last year makes the donors well-positioned now to call on the members they helped reelect to assault or defend elements of the reform that matter to their bottom line.
The study, conducted for The Washington Post by the nonpartisan Center for Responsive Politics, also shows that Republicans have been heavily favored in this period. While Democrats got just more than half of the industries' money before the bill was approved in spite of uniform Republican opposition, the Republican attracted 60 percent after the votes were counted. The Republican total for that period was $25.7 million, while the Democrats was $17 million.
Of the more than 60 bills introduced in the current session on health care and related insurance, most have come from Republican lawmakers; at least 19 of the bills use the term "repeal."
It demonstrates that the industry "found a better date for the prom," said Sheila Krumholz, the center's executive director. "This is the party that showed they were clearly willing to go to bat for the industry's agenda. . . . I'd say they are going steady now."
After March 2010, when then-House Minority Leader John A. Boehner (R-Ohio) failed to block Obama's bill, he collected $386,665 from the two industries; as the current House speaker, he is in a powerful position to influence any changes. The new House majority leader, Eric Cantor (R-Va.), a key legislative gatekeeper, did even better, collecting $477,750 in the same period, according to the center's tally.
On the Senate side, after Senate Minority Leader Mitch McConnell (R-Ky.) failed to stop the bill in December 2009, he collected $137,500 from the two industries. Of this amount, $95,650 came after Obama signed the bill. All three Republican leaders distributed substantial chunks of the money to other candidates before the election.
Spokesmen for Boehner, Cantor and McConnell declined comment, as did a spokeswoman for Roe.
There has been some Republican disconnect with donors. Although McConnell and Boehner have led efforts to repeal the bill outright, health-insurance companies and medical providers are not uniformly supporting that goal, and many actually like a provision requiring universal coverage that has been the target of congressional and tea party fury, according to interviews with industry representatives.
Efforts to block universal coverage - either through legislation or the courts - have "really become almost pure partisan politics, more than anything else," said Ron Pollock, the executive director of Families USA, a prominent supporter of the law. "The key interest groups are divided within their ranks. In the insurance ranks, some would prefer stability more than a total makeover. "
"The strategy of choice," Pollock added, "is not so much a frontal attack but going after specific provisions."
With Congress bitterly divided, many companies are wary of angering either the Democrats who crafted the bill or the Republicans who seek a repeal. Spokesmen at eight drug or pharmacy companies - which together have given nearly $50,000 to McConnell's campaign and leadership committees since the bill was approved - either declined to say what they want to do or did not respond.
Wes Metheny, senior vice president for the Pharmaceutical Research and Manufacturers of America (PhRMA), said that among members "there is broad agreement that the bill is not perfect and can be improved."
The American Association of Clinical Urologists, which wrote a thank-you letter to Roe, gave $495,000 of its revenues to congressional candidates in the last cycle, mostly to Republicans.
"What does it mean to be a $1 million PAC? It means we have a real seat at the table. It opens even more doors for us and makes our voice louder," Gary M. Kirsh, a urologist and the group's PAC chairman, said in a winter 2011 newsletter to members.
A spokesman for the principal insurance trade group that sought to block the bill - America's Health Insurance Plans (AHIP) - also said that "we continue to believe that changes are needed." Robert Zirkelbach said his group particularly wants to change provisions that limit how much premiums can rise as people grow older. It also wants to pare back restrictions on Medicare payments, ease new limits on insurers' administrative expenses and expand pilot cost-cutting efforts by others.
The group gave $230,000 to candidates in the last cycle, mostly to Republicans, but Zirkelbach declined to discuss the underlying strategy. Since September, it has handed out $50,000, including $7,500 to seven current members for "debt retirement."
A Washington representative for one of the group's members, who asked not to be named because he was not authorized to speak, said disputes still persist over which health groups will be forced to bear the biggest cost-cutting burdens. Doctors, he said, "got an absolute pass," and hospitals were given some immunity for the next 10 years.
This suggests that the battle that lies ahead - since a repeal is unlikely - could be about who will be able to lighten the financial burdens for themselves by piling it onto others.