One year ago today, President Obama signed the Patient Protection and Affordable Care Act into law. The legislative process that led to the bill's enactment proved to be a boon to lobbyists, including former aides to key members. Industry exerted influence on the administration and members of Congress from early on in the process, and continued lobbying after the bill was passed.



In 2009 and 2010, lobbyists for some 1,251 organizations disclosed lobbying on the bill, according to the Center for Responsive Politics. Those interests included pharmaceutical firms and their trade group, the Pharmaceutical Research and Manufacturers of America, insurers like Blue Cross/Blue Shield, the American Hospital Association, the American Medical Association, universities, retailers, restaurant chains, manufacturers, telecommunications firms and labor unions.





That lobbying continues in 2011. More than 180 firms have registered to lobby for new clients on health care issues so far in 2011, 16 of which disclosed the Affordable Care Act as a specific lobbying interest, according to Sunlight's Lobbying Registration Tracker.



Health care was a major issue in the 2010 campaign, in which outside groups spent more than $454 million. The newly elected Republican majority voted unanimously for a bill dubbed "Repeal the Job-Killing Health Care Law Act," but the measure, which would surely face a presidential veto were it to pass, remains stalled in the Senate, where Democrats have the majority.



While many of the act's major changes have yet to take effect, the administration has already exempted more than 1,000 groups from one of its requirements: the mandate to provide at least $750,000 in annual coverage per enrollee. About 2.6 million individuals with so-called "mini-med" plans are affected by these waivers.

The exemptions last for only one year, and are scheduled to be phased out in 2014, when states will be required to operate exchanges -- marketplaces where individuals can purchase coverage. The waivers are designed as a temporary stopgap to prevent beneficiaries from being dropped from coverage or priced out of it.



While small businesses were among those given the reprieve this year, including Captain Elliot's Party Boats, with 10 enrollees, and Hoosier Stamping and Manufacturing Corp., with 14, waivers were also granted to huge insurance companies. Aetna received an exemption for plans that cover over 209,000 enrollees, and Cigna's waiver affected 265,000.

&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;http://data.sunlightlabs.com/Government/Groups-receiving-waivers/vxvv-xvkb&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; _cke_saved_href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;http://data.sunlightlabs.com/Government/Groups-receiving-waivers/vxvv-xvkb&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; title=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Groups receiving waivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; target=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;_blank&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;Groups receiving waivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/a&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; Powered by Socrata

The political fallout from the waivers has fallen along party lines, with critics charging that they're an indication of the burdens imposed by the law and may encourage favoritism. Supporters say they indicate a flexible approach to implementation.

