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By Aman Kidwai
Workplaces Editor
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University of Vermont political science professor Alex Garlick began studying the influence of lobbyists after working as a Congressional staffer for Massachusetts Representative Joe Kennedy III.
“When I worked in Congress and didn’t know something, the answer was ‘check with the lobbyist,” he told Newsweek, about the approach taken by many congressional offices. “When Congress or their staff are relying on lobbyists for information, that gives lobbyists an opportunity to affect the way policymaking is going to go.”
Through his research and upcoming book, Pre-Existing Conditions: How Lobbying Makes American Health Care More Expensive, Garlick conducted quantitative and qualitative analysis around the impact of health care industry lobbying and its role in raising costs.
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“Political scientists were dramatically underestimating how important lobbying was for policymaking,” Garlick said. “In states where the health care industry makes up a larger share of everybody talking before the government, that’s what we consider to be a stronger lobby, and that is what’s related to more rapid increase in costs.”
Why It Matters
As a way to detect the size and strength of the health care lobby, Garlick said he looks at the volume of health care lobbying groups that register in all 50 states. Though health care costs have been increasing across the country, some states' costs have been lower than others.
The research estimates that for every new lobbying organization registered in a state, costs go up for health care consumers by $7. In states where the lobbies are strong, Garlick observed fewer bills focused on health care and proposed legislation focusing on cost containment.
“As the lobby gets stronger, the amount of attention that legislators are paying to the health care industry tends to go down,” he explained. “When you have a stronger lobby, it’s not so much that legislators are passing bills to make health care more expensive, but they’re not trying to pass bills to reign those costs in.”
What To Know
Garlick and other observers point to rising corporatization of the U.S. health care system as a net negative for consumers, especially if regulators are not motivated to take action. He praised the efforts of Maryland to regulate health care prices “more aggressively than some of their blue state peers,” and notes the slower inflation in that state as a positive sign.
Lobbyists seem mainly to be fighting against transparency, Garlick notes, “particularly in the pharmaceutical supply chain,” pointing to proposals in Colorado and Nevada around this topic that “inspired a lot of counter-lobbying.” Regulators are correct to look into that supply chain, Garlick says, because “the price of prescription drugs is a major driver of these high health care costs, and the ability of legislatures to look into that is going to be an important factor moving forward.”
He also notes that preventing monopolies will be a key goal for regulators looking to reign in health care inflation.
“Preventing the emergence of monopolies is a major thing that state legislators and bureaucrats can do to regulate their markets, particularly when these are for-profit hospitals, which are increasingly owned by private equity firms.”
What People Are Saying
Garlick: "One of the reasons US health care isn't cheaper than peer nations in Western Europe or Canada has been the corporatization of health care…as they’ve become more corporate, particularly insurance companies and hospitals, we’ve seen more profit seeking behavior and efforts by states to [regulate]."
Garlick: “Health care costs have been increasing in all 50 states, and so it’ s just a matter of degrees of what is causing it to increase more.”
Garlick: "A lot of this legislation is aimed at cost containment, when you have a stronger lobby, it’s not so much that legislators are passing bills to make health care more expensive, but they’re not trying to pass bills to reign those costs in."
CORRECTION 10/22/2025 at 3:15 p.m.: This story was updated to correct a quote from Alex Garlick.
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