Trump Upended Health Care. Lobbyists Are Raking It In.

The biggest players in the health care industry are pouring record sums into K Street, Washington’s lobbying corridor, as the Trump administration intensifies scrutiny of their business practices ahead of the midterms.

Newly filed lobbying disclosures reveal that some of the largest health care trade groups in Washington have continued to budget historic sums for lobbying. AHIP, which represents health insurers, shelled out $5.3 million in the first three months of 2026, its highest tally for any quarter on record.

The Pharmaceutical Research and Manufacturers of America, the lobby for branded drugmakers, spent $12.2 million, the second-highest quarter for the trade association on record, only behind the first quarter of last year. The American Medical Association, which represents doctors, spent nearly $8 million, its second-highest quarter in the past decade.

Individual companies have also ramped up. U.S. drugmakers Eli Lilly, Gilead, and Regeneron reported their highest quarterly spending on lobbying on record last quarter. Health insurer Humana, meanwhile, reported its highest lobbying spending on record for that period: $2.6 million.

The record spending arrives as President Donald Trump orders Congress to turn his first-year agenda on health care into law. In a sweeping directive announced in January, he told lawmakers to codify his drug pricing deals, send money directly to Americans for health insurance and require more price transparency from insurers. Companies, meanwhile, continue to defend themselves from attacks by Health Secretary Robert F. Kennedy Jr. and his Make America Healthy Again movement questioning the safety of ultraprocessed food and drugs.

Susan Zook, founder of Mason Street Consulting, a health care and technology-focused lobbying shop, expects the high level of activity to stay.

“I don't see it slowing down probably until the end of this administration. That’s just not [Trump’s] style,” said Zook, who previously served as the health care policy adviser for Sen. Mike Crapo (R-Idaho), who now chairs the powerful Finance Committee.

The White House and Republican lawmakers are also ramping up scrutiny of health care companies over the high cost of care as part of an effort to blunt Democrats’ attacks on affordability in the midterm elections, which will determine the extent of Trump’s power in his final years in office. Republican lawmakers have held a series of hearings with health care executives in recent weeks, and on Tuesday, Centers for Medicare and Medicaid Services Administrator Mehmet Oz announced a nationwide crackdown on Medicaid fraud at POLITICO’s Health Care Summit.

The high lobbying spending from health care companies in the first quarter follows a record year for lobbying by the sector where lobbyists’ efforts largely revolved around the nearly $1 trillion in cuts to Medicaid in Trump’s One Big Beautiful Bill Act and the expiration of enhanced Obamacare subsidies.

Chris Bond, an AHIP spokesperson, said in a statement the group will “continue advocating for consumer-focused solutions to make health care more affordable for Americans.”

Health care companies are preparing for the possibility of a second reconciliation package, where lawmakers could look again to cut health care spending to fund top agenda items or help pay for the war in Iran.

On Tuesday at POLITICO’s summit, senior White House adviser Calley Means slammed K Street for stalling progress on Trump’s agenda. “This town is built to make change very hard,” he said. “There’s a lot of incentives, there’s a lot of jobs, and there’s a lot of money predicated on change not happening.”

Means also attacked PhRMA Chief Executive Steve Ubl, who earlier had spoken against Trump’s drug pricing policy, known as most-favored-nation because it would tie the U.S. price to the lowest cost abroad. So far, 16 drugmakers have struck deals with the White House to lower prices for some drugs in exchange for tariff reprieve.

Trump’s intervention into the pharmaceutical industry’s pricing practices marks a sharp departure for the Republican Party, long seen as a defender of business and free markets.

“It's quite unusual where you have a Republican administration on full attack on the pharmaceutical industry, and in a way that would upend their entire business model,” said one health care lobbyist, granted anonymity to speak candidly.

Still, the health care industry has secured significant policy wins. Earlier this year, Trump signed into law an overhaul of pharmacy benefit managers’ pricing practices. PBMs are middlemen who negotiate prices between insurers and drugmakers. PhRMA has pushed for years for a crackdown on PBMs.

Oz’s agency also decided this month to increase what it will pay privately run Medicare Advantage plans next year by 2.48 percent, up from a proposed 0.09 percent bump.

Health care companies are reporting solid results in early first-quarter earnings reports. On Tuesday, UnitedHealth, the largest U.S. health insurer, raised its profit expectations for the year after a bruising 2025 that resulted in the company missing its first earnings estimates in more than a decade. Drugmaker Johnson & Johnson also reported strong first-quarter results, with sales up nearly 10 percent year over year.

Among the top lobbying shops for pharmaceutical companies include Todd Strategy Group, BGR Group, and Tarplin, Downs & Young. The top shops for insurers were Mehlman Consulting, Continental Strategy, and ALB Solutions.

All boast well-connected executives.

Dan Todd, former health counsel for Republicans on the Senate Finance Committee, leads Todd Strategy Group, while Remy Brim and Brent Del Monte, lead BGR’s health and life sciences practice. Brim was a senior Food and Drug Administration policy adviser for Democrats on the Senate Health, Education, Labor and Pensions Committee, and Monte was formerly FDA counsel for Republicans on the House Energy and Commerce Committee.

Tarplin, Downs and Young was founded by Linda Tarplin, a former HHS official under President George H.W. Bush, as well as Raissa Downs and Jennifer Young, former HHS officials under President George W. Bush.

Mehlman Consulting was founded by Bruce Mehlman, a former George W. Bush appointee. Continental Strategy is led by Carlos Trujillo, who served in the first Trump administration, and ALB Solutions is led by Adam Buckalew, who was a deputy health policy director for Republicans on the Senate Health, Education, Labor and Pensions Committee.