Buying Amendments? Lobbyists' Campaign Contributions and Microlegislation in the Creation of the Affordable Care Act

• Published date: 01 May 2020
• Author: Amy Melissa McKay
• Date: 01 May 2020
• DOI: http://doi.org/10.1111/lsq.12266

327

LEGISLATIVE STUDIES QUARTERLY, 45, 2, May 2020

DOI: 10.1111/lsq.12266

AMY MELISSA MCKAY

University of Exeter

Buying Amendments? Lobbyists'

Campaign Contributions and

Microlegislation in the Creation of the

Affordable Care Act

When do campaign contributions matter? This article advances the claim

that a group that gives campaign contributions to US Members of Congress is

more likely to achieve legislative success when (1) a single legislator can deliver to

the group (2) a private benefit (3) without attracting negative attention. Using an

original dataset based on the written comments of nearly 900 interest groups lob-

bying the US Senate Finance Committee on health reform legislation in 2009, I

link group requests to corresponding legislation. The analysis shows a significant

relationship between lobby groups’ campaign contributions and their legislative

success, and at distinct units of analysis—the group, the side, and the group-sen-

ator dyad. The relationship is particularly strong in predicting senators’ amend-

ments in committee. The rare data presented here offer compelling evidence that

interest groups’ legislative victories are sometimes connected to campaign contri-

butions in a way that previous studies could not identify.

A long line of research provides surprisingly little evidence

that interest groups consistently use money to secure policy out-

comes. A major reason for this failure is the lack of observable

data. Campaign contributions and lobbying disclosure reports do

not go far enough to expose relationships between groups’ politi-

cal spending and actions taken by legislators. It is quite challeng-

ing, for example, to link donations from individual Washington

lobbyists to the interest group clients these lobbyists represent.

Moreover, specific details about what lobby groups want, as well

as the contents of what I call microlegislation—small pieces of bill

drafts and amendments that benefit a narrow set of interests—

are quite difficult to come by (Burstein 2014). The constant drive

for reelection makes politicians risk averse, and as such they as-

siduously avoid the appearance of corruption. For lobbyists, their

This is an open access article under the terms of the Creative Commons Attribution

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the original work is properly cited.

© 2019 The Authors. Legislative Studies Quarterly published by Wiley Periodicals,

Inc. on behalf of Washington University in St. Louis

328 Amy Melissa McKay

reputations are paramount, and their continued access to politi-

cians requires sharing legislators’ political concerns. As a result

of these technical and intentional challenges, identifying relation-

ships between contributions and legislators’ actions on contribu-

tors’ behalf is notoriously difficult (see literature reviews by, e.g.,

Baumgartner and Leech 1998; Smith 1995; Stratmann 2005).

However, consideration by the US Congress in 2009 of the

health reform legislation that became “Obamacare” presents a

unique opportunity to analyze data that link campaign contri-

butions and legislative actions more closely than is usually pos-

sible. In deliberate contrast to the exclusive way in which Bill and

Hillary Clinton’s health reform proposal was drafted in 1993, con-

gressional Democrats and Barack Obama pledged to write health

reform legislation in a transparent, collaborative way. This com-

mitment, along with a new law requiring registered lobbyists to

report directly to the House and Senate their personal federal cam-

paign contributions (in addition to long-required disclosure of

contributions from political action committees or PACs), yields an

exceptional opportunity to evaluate documents and information

about possible links between lobby groups’ preferences, legislative

actions, and lobbyists’ contributions.

Having generated quantitative data from uncommon data

sources, I model the data at multiple levels of analysis while con-

trolling for important alternative factors. The results are consistent

with the theory advanced that lobbyists’ contributions and legisla-

tive favors are more likely to be related when a legislator can offer

to a group a private benefit under minimal scrutiny. Specifically, the

data suggest that (1) lobbyists who make contributions to senators

on the key committee writing health reform legislation tend to have

a greater proportion of their requests satisfied in the bill; (2) con-

tributing lobbyists are more likely than other lobbyists to persuade

senators to introduce their preferences as amendments to the bill;

and (3) contributions are better predictors of senators’ willingness

to introduce group-requested amendments than contributions are

in explaining groups’ level of success more generally. These results

go significantly further than previous research to explicitly link lob-

byists’ influence attempts to corresponding actions by legislators.

Theory

The ability of interest groups to influence legislation is

not absolute, if it occurs at all. Lowery (2013) offers a dozen

329Buying Amendments?

explanations for why researchers so seldom find evidence of the

influence of interest groups and their money on policy decisions,

including the possibility that groups actually have little influence

over politicians. Yet even in that case, Lowery identifies a fac-

tor on which influence is conditioned: issue salience (2013, 17).

Alternatively conceived of as the visibility or ideological content

of a proposal, issue salience has often been studied as an impor-

tant variable in explaining policy outcomes and interest groups’

roles in them. Some scholars focus on decision-making processes

in which public visibility is expected to be low, such as in the bu-

reaucracy (Drope and Hansen 2004; Haeder and Yackee 2015) or

behind closed committee doors (Evans 1996; Schroedel 1986). A

small body of research directly tests the effects of issue salience on

interest groups’ ability to influence policymaking (Fellowes and

Wolf 2004; Jones and Keiser 1987; Neustadtl 1990; Witko 2006).

The present study’s contribution is to specify several conditions—

including public visibility—under which influence is more likely to

occur and to test these hypotheses using particularly fine-grained

data. The exclusive rather than broad nature of the legislative ben-

efits, and the ease with which they can be given, are also important

predictors of a tighter relationship between political money and

policy outcomes. I theorize more specificallythat interest groups

that financially support legislators are more likely to be successful

in legislation when (1) the lobbyist seeks a private policy good,

(2) from a single legislator, (3) without attracting public atten-

tion.Thesethree factors are discussed next.

Private Benefit

A private benefit is one that is narrowly tailored to highly

specific interests. The microlegislation found in one-page or even

one-sentence amendments offered by committee members writing

the Affordable Care Act is replete with rent seeking and other pri-

vate benefits. For example: “include geriatricians in the definition

of primary care providers for the purposes of the primary care

bonus”; “reinstate reimbursement for dual energy x-ray absorp-

tiometry (DXA) and vertebral fracture assessment (VFA)”; “in-

crease the Medicare payment rate for nurse-midwives for covered

services from 65% of the rate that would be paid were a physi-

cian performing a service to the full rate”; “adjust the Puerto Rico

Medicare inpatient hospital rate to 100% of the national payment

rate.” These rewards are clearly directed at narrow populations.