Eight months before President Barack Obama's health care law goes prime time, a confederation of industry and business groups is ramping up its lobbying apparatus for an 11th-hour assault on the web of new taxes and regulations.
Medical device makers, health insurers, retailers and restaurants are waging what lobbyists call a coordinated effort to gain Senate Democratic support for overturning $130 billion in taxes that will be used to fund the new law, and repealing a mandate requiring employers to provide insurance coverage for full-time workers or pay a fine.
The campaign is backed by two of the business world's lobbying powerhouses: the U.S. Chamber of Commerce and the National Federation of Independent Business, or NFIB. The latter had a leading role in 2012's failed attempt to overturn the Patient Protection and Affordable Care Act in the Supreme Court.
Known as Obamacare, the 2010 law will bring sweeping change to the $2.8 trillion U.S. health care industry starting January 1, 2014, including bringing health insurance to millions more Americans.
But with Congress mired in partisan gridlock, lobbyists are gearing up for a battle against the law's costs that is likely to intensify as lawmakers shift attention to the 2014 congressional elections and the campaign donations they may need.
"It's going to be a difficult uphill battle. This is the administration's signature law. We've got a split Congress. But there's an opportunity to make fixes. And if you can garner bipartisan support in the Senate, and find a way that the changes get paid for, I think it can get done," said Amanda Austin, NFIB's federal public policy director.
At issue are a 2.3 percent tax on medical devices valued at $30 billion over the next 10 years, a $100 billion health insurance premium tax and the employer mandate, which opponents say could cripple many small business with costly fines.
The critics used Saturday, the third anniversary of the passage of ACA, to warn that the provisions could undercut economic growth, sap technical innovation and raise costs for Medicare beneficiaries and other consumers.
America's Health Insurance Plans, a Washington-based trade group, told lawmakers that the premium tax, combined with a proposed cut in government payments to Medicare Advantage plans, could raise premiums for elderly and disabled beneficiaries by $50 to $90 a month.
Many small businesses have joined robo-call and email campaigns aimed at lawmakers, and grassroots supporters have begun visiting district offices. Lawmakers who oppose the health care law have joined industry letter-writing campaigns aimed at the White House.
"The (insurance) plans really haven't mounted a lobbying effort like this against any of provision of the ACA in a long time," said CRT Capital Group analyst Sheryl Skolnick.
Efforts to overturn or defund sections of the law have been regularly embraced by the Republican-controlled House of Representatives, which has held largely symbolic votes to repeal Obamacare more than 30 times.
But last week's budget vote in the Senate, and the potential for broad tax reform down the road, raised industry hopes of gaining the Democratic support needed to actually pass legislation. That task could become harder once the law is fully implemented - hence the current sense of urgency.
Neil Trautwein of the National Retail Federation said the focus is no longer on repealing the entire law: "We'll support particular rifle-shot bills as more of a focus on knocking out bad provisions or fixing ones that are less than artful."
Medical device makers on Thursday won a victory of sorts in the Senate, when more than 30 Democrats joined Republicans to approve a non-binding budget amendment calling for repeal of a 2.3 percent tax on medical device companies.
The device tax faces a difficult road to repeal. Similar amendments to overturn the health insurance tax and the employer mandate failed to reach a vote or win Democratic co-sponsors. But ever-hopeful lobbyists say those issues are drawing heightened interest from Democratic lawmakers.
"There seems to be an increasing level of sympathy and interest at looking at what can be done to mitigate the damages," said Katie Mahoney, executive director of health care policy at the U.S. Chamber of Commerce.
Industry representatives declare that they are prepared to continue the legislative fight for years. Separately, health care lobbyists are pressing at the agency level to pare back burdensome regulations through the rules-making process.
The health care industry has spent more than $700 million to lobby Congress and U.S. agencies from 2010 onward, according to the nonpartisan Center for Responsive Politics. Companies, executives and employees have poured millions more into the coffers of House and Senate members up for re-election in 2014.
Some experts called Thursday's bipartisan Senate vote on the medical devices tax a show of support for large campaign donors with major operations in states like Minnesota, Massachusetts, Indiana and Pennsylvania.
"This idea that we should make stuff in this country, that we should invent things, that we should export to the world - that is how we're going to get out the current situation we're in," Senator Amy Klobuchar, a Minnesota Democrat who favored the medical device tax repeal, said during the floor debate.
Klobuchar in 2011 invited the chief executive of Minnesota-based Medtronic, the world's largest stand-alone medical device maker, to the annual State of the Union address. Medtronic spent over $22 million on lobbying between 2008 and 2012, according to the Senate Office of Public Records.
Some experts say the chances are slim for meaningful change to the health care law.
"They certainly can't get past the presidential veto, even if they were to get through the Senate," said John Rother, president of the National Coalition on Health Care, which represents medical societies, businesses, unions and health providers.
"This is chest-pounding for the benefit of the constituency. It's a way to get people riled up and write checks. And if you're a lobbyist, it's a way to show you're on the job," said Rother.