By Megan R. Wilson

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In today’s issue:

• The hospital industry largely increased its advocacy spending in Washington so far this year — and I explain why it’s unlikely to slow down
• Take a look at the top 10 health care lobbying spenders — and why flat spending doesn’t mean lobbyists aren’t engaged
• WaPo exclusive: The CDC blocked release of a vaccine report showing reduced hospitalizations and emergency room visits, raising concerns about interference

Good afternoon, and welcome to the Health Brief newsletter. The nation’s largest health care companies, industry groups and advocacy organizations poured hundreds of millions of dollars on lobbying the federal government in the beginning of 2026.

I’ll walk through the top-line numbers below, with deeper dives on the major players in the coming days — starting with hospitals.

More than a dozen of the top-spending hospital groups, facilities and health systems boosted their advocacy spending in the first quarter, and that momentum is likely to build as Washington zeroes in on affordability and rising health care costs.

That scrutiny isn’t lost on hospital executives, who gathered at the American Hospital Association annual membership conference in D.C. this week. Let’s get into it.

Do you have any health policy tips or scoops? Don’t hesitate to reach out. I’m at megan.wilson@washpost.com. Or, if you’d prefer to message me securely, I’m also on Signal at megan.434.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence.

"It's important that policymakers and all stakeholders understand the environment hospitals are operating in and the pressures that they're facing," American Hospital Association President and CEO Rick Pollack said at the industry group's annual membership meeting this week. (Chip Somodevilla/Getty Images)

	The Lead Brief

In the first three months of this year, hospitals ramped up their advocacy in Washington as lawmakers on Capitol Hill continued to battle over federal funding and policies such as the extension of certain telehealth flexibilities, the fate of enhanced health insurance subsidies and additional price transparency measures.

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While the industry notched some losses — hospitals are likely to encounter more uninsured patients without the extension of the enhanced Affordable Care Act premium tax credits — it successfully pushed back a Trump administration pilot program that would have overhauled a federal discount drug program nonprofit hospitals view as essential to their survival.

Now regulators are going back to the drawing board, which is likely to prompt additional engagement from the hospital industry.

The flurry of lobbying activity at the beginning of the year is likely to be an opening salvo to what’s to come for the rest of 2026: Rising health care prices and voter concerns about affordability have put every sector of the health care industry in the crosshairs ahead of November’s crucial midterm elections.

Why it matters: Hospitals sit at the center of health spending in the United States, representing the single largest category of costs in the system. They also hold a large amount of influence on policy because hospital facilities or health systems can represent the largest employer in a state.

While Congress may not be rushing to pass sweeping policy fixes this year, policymakers are laying the groundwork for potential changes to the 340B discount drug program and there’s growing momentum to usher in more hospital price transparency requirements. The industry will also need to be on guard for annual Medicare payment changes made by federal regulators.

	Health on the Hill

The House Ways and Means Committee is hauling health system CEOs to Capitol Hill next Tuesday to testify about the role hospitals play in the affordability equation.

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It was a major topic of discussion during the American Hospital Association’s annual meeting this week. The group is aiming to influence a debate that is increasingly adversarial — and comes with billions of dollars at stake.

“We must step into a convening role to address affordability in a meaningful way,” Marc Boom, the president and chief executive of Houston Methodist and chair of AHA’s board, told a room of hospital executives at the Marriott Marquis in Washington, D.C.

“Instead of pointing fingers, we all need to share accountability. We have to have honest, open collaboration,” he said. “I firmly believe that if hospitals and health systems do not lead this necessary conversation, no one will.”

At the same time, Boom framed the current system as structurally broken — pointing to chronic government underpayment, high drug prices and insurer barriers.

The American Hospital Association spent about $6 million on federal lobbying during the first three months of this year, a drop from the same period in 2025, according to disclosures. However, the figure is on par with what the group has historically spent during the first quarter in other years.

Although the group declined to provide specifics on its spending, advocacy expenditures often increase during the first year of a new president’s term — the decline this year could represent a relative return to normal. For now.

Other major hospitals – including 

What to watch: Next week’s congressional hearing will come after the Paragon Health Institute, an influential conservative think tank with ties to the Trump administration, released a report Wednesday that pushes back on hospital claims that they operate in financial uncertainty.

Instead, Paragon’s John R. Graham argues that federal policies encourage overpayments to hospitals, reward inefficiency and shield facilities from competition in a way that results in higher prices for patients.

Paragon is run by Brian Blase, who served as a White House official during President Donald Trump’s first term and played an impactful role in shaping the debate around the enhanced Obamacare tax credits in Congress. 

Drew Keyes, a senior health policy staffer for Speaker Mike Johnson (R-Louisiana) is a Paragon alum, as is Theo Merkel, who leads health policy at the White House’s Domestic Policy Council.

The industry response: The American Hospital Association shot back, saying that the report “ignores or downplays fundamental truths.”

This includes the rising cost of overhead for hospitals and the expense of treating a growing number of sicker patients, alongside challenges with payments involving both federal and commercial insurers.

“The proposals it puts forth would only make it harder for hospitals and health systems, especially those in rural and underserved areas, to provide around-the-clock care and essential services to their patients and communities,” the spokesperson said.

	Chart check

Here are the hospitals and industry organizations that spent the most on lobbying at the beginning of this year:

HCA Healthcare, the nation’s largest for-profit hospital system, spent more than $1.8 million to lobby the federal government during the first quarter of this year — a 285 percent jump over the same time in 2025. It did not respond to an inquiry about its lobbying spending.

While it’s not unusual for HCA Healthcare to spend roughly $1 million on federal lobbying in a given quarter, the first quarter figure is the most it has ever recorded spending on lobbying in a three-month period, according to an analysis of disclosures.

Ascension, a Catholic health system, and for-profit hospital systems Tenet Healthcare and Select Medical didn’t respond to an inquiry about their lobbying spending.

Advocate Health said its disclosure reflects the consolidation of previously separate entity filings into a single, unified report, rather than an increase in advocacy activity.

	Lobbying Ledger

Here are the top lobbying spenders in the first quarter of this year:

Although relatively flat lobbying spending doesn’t appear impressive, context matters. As I’ve written previously, investments in advocacy often spike during the first year of a new presidential election. That’s exactly what happened in 2025.

Maintaining higher levels of spending in 2026 actually illustrates that companies are staying engaged as the Trump administration tries to make its mark on health policy.

For context: Lobbying spending in the first quarter of 2026 is up for most companies and groups when compared to 2024, according to my big ol’ spreadsheet.

→ During the first three months of 2026, just more than 100 health care companies, associations and groups spent $500,000 or more on lobbying, totaling nearly $166.5 million, according to my analysis of federal lobbying disclosure filings. During the same time last year, these entities spent a total of $159 million on advocacy.

Pharmaceutical interests made up nearly half (42) of these top lobbying spenders, and the other most prolific sectors included health insurers (18), the medical device and diagnostics industry (12) and hospitals and health systems (11).

	Immunization Update

A previously delayed federal report showing the benefits of the covid-19 vaccine has now been blocked from publication altogether, a move that’s raised concerns inside and outside the Centers for Disease Control and Prevention, as WaPo’s Lena H. Sun exclusively reports.

The analysis showed that the vaccine cut emergency department visits and hospitalizations among healthy adults by roughly 50 percent during the most recent winter wave.

Lena recently reported that Jay Bhattacharya, who is temporarily overseeing the CDC, had concerns about the report’s methodology, even after it had cleared the agency’s scientific review process involving dozens of scientists. What had initially been framed as a delay in the release — prompted by Bhattacharya’s concerns — is now a full rejection.

Why it matters: The decision — which former health officials told Lena is highly unusual — lands at a politically sensitive moment for the Trump administration’s moves on vaccine policy, which have proven largely unpopular with voters.

Scuttling the report risks deepening concerns among current and former officials that scientific findings are being shaped by the interests of Health Secretary Robert F. Kennedy Jr. Former CDC officials told Lena that publishing findings showing the vaccine’s effectiveness would be at odds with the administration’s moves to restrict its use, particularly for children.

An outspoken critic of the coronavirus vaccines, Kennedy has been dodging questions from lawmakers about his views on vaccines during appearances before multiple committees as part of the congressional budget process. Kennedy told members on Capitol Hill that he isn’t anti-vaccination, merely questioning the way in which some are developed.

“There are going to be people who don't vaccinate. The vaccination levels dropped during covid because people stopped trusting the American government. I am here to restore that trust,” Kennedy said Wednesday during an appearance before the Senate Finance Committee.

Andrew Nixon, a spokesperson for the Department of Health and Human Services, had previously confirmed to Lena that the report was being deferred by Bhattacharya, saying it was routine for agency leadership to review papers submitted to the CDC’s Morbidity and Mortality Weekly Report (MMWR).

But on Tuesday, Nixon shifted his explanation, saying instead that MMWR’s own editorial process identified methodological concerns and declined the manuscript — a characterization disputed by people familiar with the review.

Read more: “CDC won’t publish report showing covid shots cut likelihood of hospital visits.”

	What We’re Reading

“Moderna launches mRNA bird flu vaccine trial after HHS cancels funding,” WaPo’s Rachel Roubein reports.

“HHS seeks employee reassignments to tackle months-long reasonable accommodation backlog,” writes Jory Heckman at the Federal News Network.