The Health Insurance Lobby: Tens of Millions to Block Reform

The Insurers: Profit Machines with a Lobbying Habit

UnitedHealth Group is the largest health company in America by revenue — over $370 billion in 2023. It insures more Americans than any other company, processes more claims, and employs more people. It also runs one of the most effective lobbying operations in Washington.

But UnitedHealth is just the biggest player in an industry that lobbies collectively and aggressively. Every major health insurer maintains a permanent DC lobbying presence, and their trade group AHIP (America's Health Insurance Plans) coordinates industry-wide strategy.

Medicare Advantage: The $400 Billion Cash Cow

No issue matters more to health insurers than Medicare Advantage — the privatized version of Medicare that now covers over 30 million seniors and generates $400 billion in annual government payments to insurance companies.

The insurance lobby fights ferociously to protect Medicare Advantage payment rates. When CMS proposed modest rate adjustments, AHIP mobilized an army of lobbyists and a grassroots campaign featuring seniors warning that their benefits would be cut. The strategy works every time: Congress routinely overrides CMS rate reductions under pressure from the insurer lobby.

The irony: Medicare Advantage costs the government 6% more per beneficiary than traditional Medicare, according to the Medicare Payment Advisory Commission. The insurance industry is being overpaid — and lobbying to keep it that way.

What Insurers Lobby On

• HCR (Health Issues) — ACA marketplace rules, public option proposals, coverage mandates
• MMM (Medicare/Medicaid) — Medicare Advantage rates, Medicaid managed care, dual-eligible programs
• INS (Insurance) — Prior authorization rules, network adequacy, claims processing
• BUD (Budget/Appropriations) — Healthcare spending levels, program funding
• TAX (Taxation) — Health insurance tax, employer mandate, premium subsidies

Killing the Public Option

Every Democratic president since Bill Clinton has proposed some version of a public health insurance option — a government-run plan that would compete with private insurers on the ACA marketplace. Every time, the insurance lobby has killed it.

The public option is an existential threat to the insurance industry. If a government plan could offer lower premiums (by cutting out insurance company profits and administrative overhead), millions of customers could switch — threatening the industry's entire business model.

AHIP's lobbying against the public option is well-documented in our data. The trade group consistently reports lobbying on "health reform," "government-run health insurance," and "competition in health insurance markets" — industry code for fighting the public option.

Drug Pricing: The Insurance Angle

Health insurers and drug companies are natural adversaries — insurers want lower drug prices, drug makers want higher ones. But the relationship is more complicated than it appears. Insurers actually benefit from high drug prices in some ways: pharmacy benefit managers (PBMs), many owned by insurance companies, negotiate rebates from drug makers that they don't always pass through to patients.

UnitedHealth Group owns Optum Rx, one of the three largest PBMs. Cigna owns Express Scripts, another giant PBM. These vertically integrated companies profit from drug pricing complexity — which is why their lobbying on drug pricing reform focuses on protecting the PBM model rather than truly lowering costs for patients.

The UnitedHealth Empire

UnitedHealth Group deserves special attention because of its sheer scale. The company insures 50+ million Americans, owns the largest PBM, runs one of the biggest healthcare analytics firms, and employs 70,000+ physicians through Optum Health.

With $4.68 million in lobbying across 52 filings, UnitedHealth lobbies on everything from Medicare Advantage rates to data privacy rules to telehealth regulations. The company's lobbying priorities mirror its business interests: protect Medicare Advantage revenue, preserve the PBM model, and prevent any regulation that could limit its vertical integration.

What This Means

Americans pay more for health insurance than any other developed country — and get worse outcomes. The industry that profits from this system spends tens of millions lobbying to preserve it. Every public option proposal killed, every Medicare expansion blocked, every PBM reform watered down represents billions in preserved profits for insurers.

The health insurance lobby isn't spending $45 million because it's ineffective. It's spending $45 million because the return — measured in hundreds of billions of preserved revenue — makes it one of the best investments in corporate America.