It is common for health organizations, including hospitals, to hire lobbyists who represent tobacco interests. In our study in the Journal of Public Policy, we test various hypotheses for why health organizations hire tobacco interests. Such hires seem counterintuitive: tobacco lobbyists are typically among the highest paid lobbyists, so they may prioritize the interests of their tobacco clients, and health organizations may suffer reputational losses from hiring them. What explains such seemingly bizarre hires?

First, how often do health organizations hire tobacco lobbyists?

According to lobbyist registration records, very often. We examined registration records from the American states produced over several decades. It was unusual for health organizations to hire tobacco lobbyists in the early 1970s: only two percent hired a tobacco lobbyist then. However, by the late 1980s, nearly nine percent of health organizations hired lobbyists who also represent at least one tobacco interest. Twenty years later, nearly 13 percent of health organizations hired tobacco lobbyists. In other words, out of the 6,700 health organizations registered to lobby state legislators in 2009, 850 hired one or more tobacco lobbyists.

Although there is much reason to be concerned about the simultaneous representation of health and tobacco interests by individual lobbyists, we found evidence that such hires are based on strategy. Generally, organizations that lobby face a tradeoff between their own agency and the political access they wish to achieve. Often, organizations give up agency over how they are represented by hiring contractors who provide access to legislators. Inversely, although the leaders of health organizations may lobby, they may not achieve the access that established lobbyists can achieve, and so their message is not conveyed successfully to lawmakers. In the context of health and tobacco lobbying, although health firms sometimes rely on single-client or in-house agents, lobbyists who represent tobacco are overwhelmingly multi-client contractors.

So why do health organizations hire tobacco lobbyists?

They hire tobacco lobbyists when there is little reputational risk and local political environments encourage such hires. Recall that health organizations may suffer reputational harms from hiring tobacco lobbyists. By examining the numbers of tobacco lobbyists hired by nearly 10,000 health organizations, we found that membership-based groups hired the fewest tobacco lobbyists, on average. Organizations like the American Cancer Society, American Diabetes Society, and others have reasons (i.e., membership recruitment and fundraising) to preserve their reputations. Hospitals, insurance companies, and health businesses have less to lose from reputational losses.

Moreover, context matters. As part of the strategic tradeoff, health organizations hire tobacco lobbyists more often when there is greater intergroup competition for legislator attention and where there are no anti-conflict laws in place. Anti-conflict laws require lobbyists to disclose to clients the emergence of inter-client conflicts. Our analyses found that health organizations hired between 73 and 78 percent fewer tobacco lobbyists in states with anti-conflict laws.

Why do these findings matter?

Political scientists have previously said little about conflicts of interest in the lobbying profession, but both ostensible and actual conflicts occur. Multi-client lobbying is more prevalent than ever, so the potential for conflicts is greater than ever. Organizations can protect themselves from opportunistic lobbyists but institutional contexts matter. In states where numerous interests compete for the attention of relatively few legislators, organizations rely more often on multi-client lobbyists with conflicted clienteles. Anti-conflict laws can help with this somewhat, but it is problematic that organizations hire multi-client lobbyists to achieve access. Such lobbyists can charge more and exacerbate inequalities in the groups that are heard and achieve influence.

– James M. Strickland, Arizona State University

– Naimisha Chakravadhanula, Arizona State University

– The author’s Journal of Public Policy article can be read open access here.