BOSTON — Last fall, the Massachusetts Association of Health Plans hosted its annual conference at Boston's Seaport Hotel, bringing together hundreds of industry officials and a handful of lawmakers, administration officials and legislative aides. Attorney General Martha Coakley addressed the crowd.
The tab for the Nov. 15 event, $104,544, turns out to be just a tiny slice of the tens of millions of dollars the health care industry has spent in recent years making sure its voice is heard on Beacon Hill.
In 2013 alone, hospitals, insurers, doctors, unions and pharmaceutical companies doled out more than $18.8 million lobbying state officials, according to an Associated Press review of state records.
That's a 74 percent jump compared with the nearly $10.8 million the industry — already an economic powerhouse in Massachusetts — spent in 2007, the year Massachusetts' landmark health care law took effect.
That, in turn, is just a portion of the $103 million the industry has poured into lobbying in the seven years since the law took effect, according to the AP review.
"When people look at the amount of money spent, they're always shocked," said Pam Wilmot, executive director of Massachusetts Common Cause. "Interests spend a tremendous amount of money lobbying our elected officials in order to get either a seat at the table or to get their policies accepted."
Despite the eye-popping totals, the number of companies responsible for the spending is relatively small. Just 217 firms, for example, were responsible for the $18.8 million spent last year.
Some of the region's biggest health industry names were responsible for the heaviest spending, including Partner's Health Care, Blue Cross Blue Shield of Massachusetts, the Massachusetts Nurses Association and Children's Hospital.
Hospitals, health care providers, medical professional groups accounted for the bulk of the spending — $60.6 million since 2007 — compared with medical, dental and mental health insurance providers ($18.8 million), and pharmaceutical companies ($23.7 million).
The industry defended the spending.
Lora Pellegrini is president and CEO of the Massachusetts Association of Health Plans, which spent more than $4.2 million since 2007. She said the group's legislative agenda has focused on ways to make health care more affordable, including partnering "with the business community to hold the line on costly new mandates and other legislative proposals."
The surge in lobbying comes during a time when there have been major health care changes in Massachusetts — from the implementation of the state's 2006 law, to passage of President Barack Obama's 2010 federal health care law, to the state's push to rein in health care spending.
But the lobbying often has to do with more specific concerns, such as monitoring a certain bill or the annual state budget debate.
And while the lobbying doesn't include direct donations from companies to lawmakers, which is prohibited, many of the lobbyists whose salaries makes up the bulk of the lobbying spending are free to make contributions.
House Speaker Robert DeLeo, for example, collected nearly $48,000 in donations from hundreds of lobbyists representing all types of industries and organizations in 2013 while Senate President Therese Murray collected about $23,000.
Other lobbying costs include catering, rent, phones, staff salaries and events. Children's Hospital, for instance, reported spending $1,694 to cover the cost of a breakfast last April with elected officials and staff members.
And not everyone in the health care sector has the same agenda. Pelligrini's group, for example, is often at odds with doctors and hospitals, blaming what they charge for medical services as "the major factor for rising health care costs."
At the top of the health care lobbying pyramid is the Massachusetts Hospital Association, which doled out more than $4.7 million from 2007 to 2013.
The group defended the spending, pointing in part to changes in health care payment and delivery systems.
"It has been essential for the hospital community to take part in those public policy debates," the association said in statement, adding that it "works continually with state leaders, policymakers and other health care stakeholders" to ensure access to quality patient-centered care.
Doctors and nurses have also tried to catch the ear of lawmakers.
The Massachusetts Medical Society, which represents 24,000 physicians and medical students, pointed to the need to monitor hundreds of bills and regulations on everything from electronic medical records to medical marijuana. The group spent $2.3 million in the past seven years.
"It is critical that lawmakers and regulators hear the perspectives of those" on the front lines of patient care, the group said.
Donna Kelly-Williams, president of the Massachusetts Nurses Association, which spent more than $2.7 million between 2007 and 2013, said the group has been "trying to educate lawmakers to the fact that the hospital industry is putting profits before patients."