The fresh round offers a clear signal that the industries and advocacy groups most likely to be affected view the coming weeks as the final battle in determining whether Democratic proposals become law.

Their efforts suggest a return to the frenzied pace of last year's health-care debate, which prompted more than $200 million in advocacy ads and broke records for lobbying. Companies and trade groups last year hired more than 4,500 lobbyists to influence health reform -- amounting to about eight lobbyists for each member of Congress, according to an analysis released last week by the Center for Public Integrity.

Reacting to President Obama's recent statements that he will move ahead with legislation, health insurance companies have enlisted hundreds of lobbyists in a full-court press against the proposed overhaul, which would force dramatic cuts and increased regulation on the industry. At the same time, insurers are pushing back against a separate bill approved by the House last week that would remove the industry's antitrust exemption.

Pharmaceutical lobbyists are also targeting Obama's plan, which includes administration proposals to secure an extra $10 billion in cuts from the industry and to ban deals between brand-name and generic drugmakers that keep cheaper medicines off the market.

The ramped-up effort is particularly evident among conservative advocacy organizations, many of which had optimistically halted spending after Democratic reform plans were cast into doubt by the January loss of a Senate seat in Massachusetts. The 60 Plus Association, a conservative group, announced a $500,000 television advertising campaign last week aimed at 18 centrist House Democrats, all of whom voted in favor of reform legislation last fall but whose support is now seen as wobbly.

The National Right To Life Committee -- which strongly opposes the Senate version of the health-care package -- has launched its own grass-roots campaign to pressure dozens of antiabortion Democrats in the House, who are crucial to passage of a final bill. Americans for Prosperity, a conservative Arlington-based group, also says it bought $250,000 worth of television advertising last week and is laying plans for more ads and rallies in March.

"I think a lot of people thought we had it licked, so it was natural to let up a little bit," said Tim Phillips, president of the Arlington group, which organized hundreds of antireform demonstrations over the past year. "All those thoughts are gone now. We are re-engaged in a big way."

Democratic and liberal activist groups, meanwhile, are rallying with their own efforts in hopes of pushing legislation across the finish line.

MoveOn.org, for example, said that a "virtual march" organized Tuesday bombarded lawmakers with more than 1 million pro-reform e-mails. The group also released a television ad Friday targeting House Minority Leader John A. Boehner (R-Ohio) for opposing the antitrust bill.

"We have the votes; let's get it done," said Ilyse Hogue, the group's political advocacy director. "We're focused on sending that clear message to the House and Senate."

One glaring exception to the renewed activity is AARP, the 40 million-member seniors group, which has spent millions on advertising and other efforts over the past year in favor of Obama's health-care plans. A. Barry Rand, the group's chief executive, called on other groups last week to lower the temperature in the debate so that "compromise is possible."

"We promise to make no new statements, send no new letters, run no new ads about health reform, and we are urging all other interest groups to do the same," Rand said in a statement. "Let's turn down the volume on the outside noise so that our leaders might actually listen."

Others are staking a middle ground. The Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful drugmaker lobbying group, is holding back on ads for now but will continue to work closely with lawmakers and the White House on specific issues, one senior industry official said. PhRMA, which agreed to $80 billion in cuts in exchange for protection from other steps, has concerns about Obama's proposal to add another $10 billion to that amount, the official said.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, the top insurer trade group, said the industry is making "a big effort" to counteract attacks from Obama and other Democrats, who have pointed to hefty premium increases as a key justification for the health-care overhaul. "We're working really hard to set the record straight on what's driving health-care prices in this country, which is underlying medical costs and not health plans," he said.

Organizing for America, the grass-roots arm of the Democratic National Committee, is tapping into Obama's 13 million-deep e-mail list to solicit campaign volunteers on behalf of Democrats who support health-care legislation, according to Lynda Tran, a spokeswoman. The effort has so far resulted in nearly 9 million hours of pledged volunteer work, Tran said; the idea is to guarantee electoral support for lawmakers nervous about the November midterm elections.

The group also launched a new campaign last week aimed at helping Obama supporters make their views known on talk-radio stations around the country, Tran said.

Richard Kirsch, national campaign director for the pro-reform group Health Care for America Now, said the organization plans a large-scale demonstration in Washington on March 9 targeting a policy conference by AHIP, the insurance lobby.

The group also ended an eight-day march last week from Philadelphia to Washington in honor of Melanie Shouse, an Obama supporter whom activists say died of breast cancer because she had no access to health insurance.

"The message we have is simple: Congress should listen to us, not the insurance industry," Kirsch said. "They have to make a decision and decide whose side they're on."

www.washingtonpost.com/wp-dyn/content/article/2010/02/27/AR2010022703253_pf.html

Feb. 2, 2010