Health industry lobbying spend on K Street has reached unprecedented levels, as companies pour record sums into influence operations.
The healthcare and health insurance companies are seeking to navigate a volatile regulatory environment under President Donald Trump’s second term, and recent federal disclosures and industry analyses suggest they are doing so with massive financial backing to the lobbyists.
The surge in spending follows a landmark year in 2025, where total federal lobbying activity surpassed $5 billion for the first time, representing a 14 percent increase over 2024. New disclosures for the first quarter of 2026 indicate that the health care sector, which invested a record $868 million in lobbying last year, is further accelerating its efforts, Politico reported.
The primary driver for the current spending blitz is a sweeping health care agenda directed by the White House, including aggressive moves to codify drug pricing deals and require greater price transparency from insurers. AHIP, the trade group representing health insurers, reported spending $5.3 million in the first three months of 2026, its highest quarterly tally on record.
Similarly, the Pharmaceutical Research and Manufacturers of America (PhRMA), the leading lobby for branded drugmakers, reported its second-highest quarter ever at $12.2 million. This follows a 2025 campaign where PhRMA increased its annual outlays by 20 percent to $38.2 million.
Individual pharmaceutical companies including Eli Lilly, Gilead, and Regeneron all reported their highest-ever quarterly spending in the first three months of this year.
“I don’t see it slowing down probably until the end of this administration,” said Susan Zook, founder of Mason Street Consulting, told Politico, noting that the Trump administration’s style necessitates a constant defensive and offensive posture for health firms.
The record outlays come as the health industry faces a dual-front battle in Washington. On one side, President Trump has ordered Congress to turn his first-year agenda—which includes direct health insurance payments to Americans—into law. On the other, companies are defending themselves against attacks from Health Secretary Robert F. Kennedy Jr., whose “Make America Healthy Again” movement has targeted ultraprocessed foods and the safety of various pharmaceuticals.
White House advisers have expressed frustration with the scale of the lobbying, which they claim is intended to stall the administration’s progress. Calley Means, a senior White House adviser, recently slammed K Street for being a town “built to make change very hard,” noting that vast sums of money are predicated on preventing disruption to existing business models.
A significant point of contention remains the “most-favored-nation” drug pricing policy, which would tie U.S. drug prices to the lowest costs available abroad.
While the administration has successfully struck deals with 16 drugmakers for tariff reprieves in exchange for lower prices, the industry at large continues to push back against the upending of their traditional business models.
The massive influx of capital has transformed the leaderboard of Washington’s lobbying firms. Ballard Partners, led by former Trump Victory PAC chairman Brian Ballard, shattered records by raking in $88.1 million in 2025, dethroning long-time leaders like Brownstein Hyatt Farber Schreck. The firm’s client list includes giants such as UnitedHealth Group and TikTok.
Newer, smaller firms with close ties to the administration have also seen meteoric growth. Checkmate Government Relations, led by Ches McDowell—a personal associate of Donald Trump Jr.—grew from just $70,000 in late 2024 to $22.2 million in revenue by the end of 2025. The firm has been hired by companies like Eli Lilly and Novo Nordisk to navigate the complex new regulatory landscape.
Hospitals and Health Systems Enter the Fray
While pharmaceutical and insurance giants dominate headlines, a shift is also occurring among hospitals and health systems. A recent study published in JAMA Health Forum revealed that hospitals spent $116 million on federal lobbying in 2024, with for-profit and private-equity-owned systems disproportionately represented.
Large, wealthy systems such as the Mayo Clinic, Ascension, and Advocate Health are increasingly outspending their state-level hospital associations to ensure their specific interests are heard in Washington. For instance, Mass General Brigham spent $1.22 million in 2024, dwarfing the $80,000 spent by its state association.
Much of the lobbying activity over the past year was centered on the “One Big Beautiful Bill Act” (OBBA), which was signed into law on July 4, 2025. This massive tax and spending package included provisions that restructured Medicaid and SNAP spending, drawing more than 2,300 organizations to report lobbying activity on the measure—three times more than any other bill.
Blue Cross Blue Shield and the American Hospital Association were among the most frequent lobbiers on the OBBA, citing the bill dozens of times in their disclosure filings as they sought to protect reimbursement rates and subsidies.
Outlook for the Midterm Elections
With the 2026 midterm elections approaching, industry experts expect the lobbying “fire” to intensify. Republican lawmakers are currently ramping up scrutiny of health care executives over high costs, partly as a strategy to blunt Democratic attacks on affordability.
As the administration continues to push for a second reconciliation package that could further cut health care spending to fund other priorities, including defense or tax breaks, K Street is bracing for a sustained period of record-breaking revenue.