Reporting from Washington — David Nexon had a big problem. An early version of national healthcare legislation contained a $40-billion tax aimed squarely at members of the medical device trade association he represents.
Nexon, a former advisor to the late Sen. Edward M. Kennedy (D-Mass.), went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the healthcare overhaul.
When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. Though still large, the tax on device makers was halved.
Nexon's team is an illustration of how deeply the healthcare industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.
An analysis of public documents by Northwestern University's Medill News Service in partnership with the Los Angeles Times Washington bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in healthcare legislation.
At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping healthcare overhaul legislation, along with at least 13 former lawmakers, registered to represent at least 338 healthcare clients since the beginning of last year, the analysis found.
Their healthcare clients spent $635 million on lobbying over the last two years, the study showed.
The total of insider lobbyists jumps to 278 when non-healthcare firms that reported lobbying on health issues are added in.
Part of the pressure on current members and staffers may come simply from the prospect of post-congressional jobs.
"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with healthcare, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors, " said Emory University political scientist Alan Abramowitz.
Lobbyists' earnings can dwarf congressional salaries, which top out at $174,000 annually for members and $156,000 for an aide, though committee staffers can earn slightly more.
In the healthcare showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, said Rutgers University political scientist Ross K. Baker.
"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer. "The effect of it, for example, was to make single-payer a nonstarter from the very beginning."
The lineup of insiders working for clients with healthcare interests includes at least 14 former aides to House Majority Leader Steny H. Hoyer (D-Md.) and at least 13 former aides to Senate Finance Committee Chairman Max Baucus (D-Mont.), a key overseer of the healthcare overhaul.
Nexon, now senior executive vice president of the Advanced Medical Technology Assn., is among at least half a dozen former Kennedy aides lobbying on healthcare.
Nexon said congressional connections had value, "but in the end, it's not who I know, it's what I know."
It makes sense to hire former staffers for the healthcare showdown, Nexon said, because they tend to be "more generalists, dealing with a broad range of issues" -- something in demand for legislation that sprawls across at least half a dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates.
But specific issues also get specialized help. This year the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all Capitol Hill veterans. The firm has been paid at least $110,000 to push a provision requiring insurers to consider covering Christian Science prayer treatments.
The largest insider lobbying cadre belongs to the Pharmaceutical Researchers and Manufacturers of America, which employs at least 26 former members and staffers, according to the Medill/CRP research. Two other drug interests, biotech firm Amgen and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among entities that reported hiring former staffers or members over the last two years involved in healthcare issues.
"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."
But Bob Edgar, president of the citizens watchdog Common Cause, said "a toxic cocktail of insiders and money" had short-circuited a government-run plan that would have competed with private health insurers.
"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.
Tom Hamburger and Joe Markman of the Washington bureau contributed to this report.