We are Jay Hancock ＆ Emmarie Huetteman from Kaiser Health News - We're here to talk about our new database ＆ ongoing reporting showing how pharma industry tries to influence Congress with millions in political donations. Ask Us Anything!

Does this database include ALL political contributions? Or do lobbyists have other ways of funneling money to Congress that aren't captured here?

Terrific question. Industry in general and pharma in particular have LOTS of ways to influence the political process. Our database is a start, but it doesn't include money given directly by pharma executives to campaign committees. Individuals are allowed to give up to $2,700 per candidate per election. Lots of pharma execs are expected to chip in that way and do. Nor does our data include political money spent independently of the candidates. Many of the political ads you are seeing are paid for by "dark money" groups that don't have to reveal their backers. PhRMA -- the industry trade group -- gives millions to dark money groups that aren't captured in our data. Those donations are eventually disclosed in IRS filings, but not until long after elections are over. Of course pharma and other industries also spend huge amounts of money on lobbyists and funding patient-advocacy groups. For a look at the latter, check out our other DB project, Prescription for Power, showing how much pharma money is behind patient advocacy groups such as the American Diabetes Association and the Arthritis Foundation.

Have you identified any patterns or trends to pharma political donations as far as why more is given to some than others? At least in New Jersey, I noticed more was given to senators and representatives who sit on certain committees.

Yes that pattern generally holds for Congress. Committee chairs are powerful chokepoints for legislation -- one member can make the difference in whether a particular measure gets to the floor or not. So pharma companies -- and industry political donors in general -- focus their fire on those folks. Utah's Orrin Hatch, chairman of the Senate Finance Committee these days, has gotten $854k in pharma political money over the last decade. Party leaders tend to get more money too, such as Paul Ryan. Some companies donate more widely. If you check the site you'll see that Amgen spread its contributions around the most. The maker of blockbuster biologic Enbrel contributed to 57 senators and 158 representatives this cycle, spending $945,750.

What do drug makers expect in return for their donations?

Emmarie here -- great question! Though the many drugmakers may have many different expectations (hoping to push a particular piece of legislation, for instance), they can generally expect that their donations will open the door to a relationship with that lawmaker.

What does that relationship look like? Often it’s a lobbyist (or three) asking for a phone call or meeting with a lawmaker or his/her staff. That lawmaker may be in a position of power -- say, the chairman of a key committee -- and so a few minutes of their time can prove very useful to help shape legislation.

Our (brand new!) analysis of 10 years’ of drugmaker political action committee contributions to members of Congress shows much of the money flows to those key lawmakers. For instance, Greg Walden, a Republican congressman from Oregon, saw the biggest increase in pharma contributions between the 2016 election cycle and this one. Why? It probably has something to do with the fact that he became the (powerful) head of the House Committee on Energy and Commerce after the last election.

It’s tempting to think of donations in terms of votes bought, but campaign finance experts say it’s really access that drugmakers (and other industries who give to Congress) earn.

The database is interesting. Is there a way to separate out campaign contributions by party? Or by House/Senate? Is there a branch of Congress where we see more money flowing?

Thanks! Unfortunately the interactive is only searchable by member or company. However, we made a breakdown by party for the story: https://kaiserhealthnews.files.wordpress.com/2018/10/2-money-2018-by-party_corrected.png?w=1024&h=1043

Who gives more? Republicans or Democrats?

Our database shows contributions "TO" members. Collections by party vary by who is in power. Generally the party controlling Congress and the members chairing powerful committees get the most love. So now money is largely going to Republicans. Right now Democrats -- as Cory Booker did last year -- are also most likely to reject pharma money and back legislation that pharma hates, such as something that pharma would call price controls. If Democrats take control of the House in November, pharma donations (and all industry/biz contributions for that matter) would go up. Our DB shows that when Dems were last in control of both houses -- 2010 -- they received slightly more pharma money than Republicans.

Why didn't you include McKesson, Cardinal Health, Walgreens, or CVS on the lists? Those companies are part of the pharmaceutical distribution system - and were definitely partially responsible for the current opioid crisis.

Great ask. We decided to include only pharma manufacturers because they generally have parallel interests and incentives. Making it a pure-play pharma project puts the focus on high drug prices, one of the primary challenges facing the health system. That said, even within the pharma set there is divergence. Generic drugmakers are often at odds with the brand companies with patents to protect, for example. But your point is a great one -- the drug industry includes wholesalers, distributors and retailers, all of which affect health care consumers and society generally and all of which try to influence Congress. We also didn't include insurance companies including pharmacy benefit managers, which have their own powerful lobbies.

Hi, thanks for doing this! I have two questions:

• What kind of bills have been introduced by the people getting these donations?

• In what ways has the 2010 Citizens United decision impacted the Pharma lobby?

Emmarie here -- thanks for joining us! For your first question, one example that jumps to mind is a congressman we highlighted on our new database, John Shimkus of Illinois. He’s a Republican member of the House Committee on Energy and Commerce, and we noticed he saw a sizable drop in contributions from drugmaker PACs between the 2016 election cycle and this one. (The biggest among lawmakers running for reelection, in fact!)

So, why did he get more money then? One thing we noted is that he wrote a handful of proposals integrated into the 21st Century Cures Act that would do things like speed up and ease the FDA approval process for medical devices. (Perhaps the bigger reason for all that pharma money, though, is that many expected he would become the next chairman of the Energy and Commerce committee. Spoiler alert: He did not.)

As for your second question… (cracks knuckles) Citizens United scrapped the long-standing ban on corporation (and union) spending in elections, giving them the green-light to spend as much as they want on their own to convince people to vote (or, as is more often the case, NOT vote) for a particular candidate, often through ads.

But that’s not the whole story, and it explains why we keep referring to drugmaker “PACs,” or political action committees: It remains illegal for corporations (and unions) to contribute directly to candidates. So, what do they do? They form PACs, typically funded with money solicited from employees and executives, and then those PACs can contribute to candidates (which is what our database tracks!)

There are limits on how much PACs can give -- $5,000 per election and per campaign committee (...and candidates can have more than one!)

I could go on and on about this one, but I’ll let the Center for Public Integrity take it from here.

Thanks for the replies! What can be done about this form of thinly-veiled bribery? What is already being done?

Emmarie here. For the sake of journalistic objectivity, I’ll interpret “thinly-veiled bribery” to mean campaign contributions here.

“Sunlight is said to be the best of disinfectants,” Justice Brandeis once said. (Can you see me standing on my soapbox?)

In the absence of more stringent campaign finance laws, what you can do is pay attention. Campaign contributions are subject to federal disclosure requirements, and while those documents are not always complete, on time, or easy to understand, they are out there on the FEC website, and organizations like the Center for Responsive Politics and the reporters here at KHN are always looking for ways to make that data more accessible.

And if this issue is important to you, you can always seek out candidates who are also concerned about reforming the campaign finance system.

Can you tie any specific votes in the House or Senate to these contributions?

Emmarie here -- oh, how I wish I could give a satisfying answer to this one! It’s difficult to tie specific votes to specific contributions, in part because we can’t read the “for” lines on the checks drugmaker PACs write. (I’m kidding. Kind of.)

There’s a bit of sleuthing (and hedging) that goes into this kind of reporting. We can look at factors like what drugmakers stand to gain from certain pieces of legislation; when they gave; and what they said on their lobbying disclosure documents.

(With help from our of our database experts, Sydney Lupkin…!) Those lobbying disclosures are imperfect, but sometimes companies will note that they are lobbying “on” a particular piece of legislation -- although, you may have noticed I say “on,” not “for” or “against.” They also don’t specify particular lawmakers, generally just “Senate” or “House.” You can see how difficult this becomes…

I’ve got you interested in lobbying disclosures now, haven’t I? Here, I’ll satisfy your curiosity -- check out this example, Pfizer’s latest disclosure (covering the second quarter of this year and $1.94 million). (Scroll down to #16, “specific lobbying issues.”)

I've heard so much about this in DC and I'd love to hear your opinion: How big a blow the decision by Congress to increase the discount provided by manufacturers of brand-name drugs in the Pat D coverage gap from 50 percent to 70 percent? Did you see you change of activity after that? Does industry think they can roll that back?

Emmarie here -- we leaned over the cubicle wall to our neighbor, Julie Rovner (KHN’s chief Washington correspondent), to get her take on this.

A pretty big blow, in short. Julie said the fight has been misrepresented, because it really has to do with whether drugmakers or insurers were going to pay, and the drugmakers lost. But they sure are trying to reverse it, she told me. (By the way, this very subject was discussed on our podcast today, which will be available later! Search for “What the Health?” in your podcast app of choice.)

I got into this in a different question (“Ctrl” + “F,” then search “sleuthing” on this page to find it), but in short, it’s difficult to tie contributions to specific pieces of legislation, so I can’t say that we saw a particular change connected to that.

However, I can tell you drugmakers have ramped up their giving in recent years. The 2016 election cycle saw a record (at least in the past decade, though likely longer) of $16 million in contributions from pharma PACs.

What is the weirdest interview you've had to do reporting on the politics of health care?

Not sure about weird, but a nonstop feature of health care reporting are interviews that are frustrating and heartbreaking. (This is Jay). Frustrating are the ones in which regular folks/ voters misunderstand the health system -- who pays, what the incentives are, how ineffective and harmful are many treatments and the enormous cost of it all. Heartbreaking are the interviews with people who have been let down, disenfranchised or mistreated by the health system -- often low-income urban and rural folks -- and interviews with people who have been financially devastated by medical bills. For a look at the latter, see the KHN/ NPR collaboration: "Bill of the Month."

Do you include PBMs in your data?

No -- we struggled a bit with this at first. PBMs for folks who don't know are pharmacy benefit managers. They process pharma claims and negotiate with pharma manufacturers, acting as middlemen between the medicine makers and the payers such as employers and insurance companies. Very controversial -- critics say rebates and fees paid by drugmakers to PBMs distort the market and might keep good, affordable medicines from reaching the patient. But we decided that PBMs are a different kind of cat and might complicate narratives we might tell about what pharma manufacturers are doing in aggregate.

Is it possible to create an universal centralized health database for patients and health providers to use? In other word, a huge cloud database that contains a patient’s medical info from the day they are born to the present.

It's a great idea and one that people have wished for/ talked about for more than a decade. The short answer is: No! The longer answer is that there are major barriers to a universal electronic health record. One is health care privacy laws. The HIPAA law makes custodians of medical information super wary about sharing. Some states such as Maryland are ahead of others in creating a health information exchange, but even that's patchy and it's only Maryland. Another roadblock is that health data is valuable. Few realize it, but many organizations holding patient records are making big money by de-identifying the data and selling it to researchers and marketers. So instead of sharing it they hoard it, which means it's inaccessible to many who could use it for public health or patient treatment. There is also the interoperability problem. Electronic health data systems tend not to talk to each other. They were designed by different engineers at different companies, which, as mentioned, had reasons to make them not interoperable.

How long did it take you to do this project?

Hi Chelsea: We worked on this on and off for more than a year, and when I say "we" I really mean KHN data experts Sydney Lupkin and Liz Lucas and the folks at Alley Interactive, who built the interface. Plan is to update it going forward and report on trends and news. thanks for asking.

If I won the mega millions, I would want to go back to school for medical science research and attempt to cure some diseases and help people get affordable medicine.

If I won, where should I start on this path? And would big pharma be trying to kill or sabotage me?

I love this question -- this is Jay. Unless you won the biggest lottery ever -- >$1 billion -- you probably wouldn't be able to finance the research and development by yourself. Pharmaceuticals are a big business -- it takes scale and capital to bring drugs to market. Not even Bill Gates, who has spent billions on health philanthropy, to my knowledge has tried to develop medicines on his own. Let's say you went to school, got funding for a lab and came up with a super-promising molecule. You ask: "Would big pharma be trying to kill or sabotage me?" The answer: Neither. Big pharma would be trying to co-opt you and profit off of your invention. As it so happens that KHN recently wrote about a situation that looks a lot like your hypothetical. Parents of kids with a horrible rare disease raised money to develop medicine that would improve their lives. It worked! They succeeded! A tiny biotech company with no revenue had acquired the rights, invested $80 million or so to get FDA approval and ended up pricing the drug as high as $1 million a year for each patient. The families were stunned and felt betrayed. You can read the story here.

Can someone tell if this is legit news or yet another veiled promotion of quackery and fraud known as alternative and supplementary medicine?

Its a bit hard to tell since I'm not very good at intrepreting american content. Could be either in similar european context.

Thanks for asking. Legit news. We are nonpartisan, nonprofit newsroom. Our stories run in the New York Times, Washington Post, National Public Radio, USA Today etc. Here is our website: https://khn.org/?utm_source=khn&utm_medium=internal&utm_campaign=nav-bar/