While patients, taxpayers and lawmakers debate the impact of the health care reform law President Obama signed on Tuesday, one result of the epic battle is clear: a bonanza for K Street.

And among lobby firms that worked the issue, the richest generally got richer. A Center for Public Integrity ranking of the top dozen with the most clients involved in health care last year reveals a host of high-profile Washington concerns — companies like Patton Boggs LLP, Alston & Bird, LLP, Holland & Knight LLP and the Podesta Group.

About 1,750 businesses and organizations spent at least $1.2 billion in 2009 on lobbying teams to work on health reform and other issues, according to a Center analysis of Senate lobby disclosure documents. Since lobbyists are not required to itemize the amount spent on each issue, the precise amount that went to health reform remains unknown. But if only 10 percent of that lobby spending went toward health reform, the amount would total $120 million – and that’s likely a record for a single year’s spending on a particular issue, experts say.

The clients who hired these firms ranged from the most influential industry associations to small non-profit advocacy groups. Many companies and organizations hired more than one of the top firms to lobby its interests. Pharmaceutical Research and Manufacturers of America, for example, hired Capital Tax Partners LLP, Dutko Worldwide, Mehlman Vogel Castagnetti, Inc. and 22 other outside firms, in addition to its in-house lobbyists. Wal-Mart Stores Inc. hired Patton Boggs LLP, Podesta Group Inc, Mehlman Vogel Castagnetti, Inc, and Bryan Cave LLP. Narrative continues beneath chart.

The Top Twelve

Below are the top 12 firms, based on the number of clients they represented on health reform in 2009. However, the total dollar amounts listed for contracts may include lobbying on multiple issues beyond health care reform. The disclosure documents analyzed by the Center included “health reform” or similar wording but lobbyists are not required to delineate how much money in a given contract is devoted to a specific issue.

From former congressional aides to former agency heads, the firms unleashed highly connected lobbyists to push their clients’ agendas, including Thomas Scully, a former administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, and Colette Desmarais, a former top health policy aide to Republican Sen. Charles Grassley. Scully is now a lobbyist with Alston & Bird LLP and Desmarais works for Mehlman Vogel Castagnetti, Inc.

Paul Kim, a partner at Foley Hoag LLP — the only health lobbyist willing to speak to the Center on the record — downplayed the importance of personal connections with Congress and agency staff. Knowledge of the issues is more important, he said. “I think what we have found is it hasn’t been head count or access, necessarily, that is most important in serving clients,” Kim said.

Pharmaceutical companies, which stand to garner increased profits from the newly insured under the bill, made up the majority of Foley Hoag’s health reform clients. Kim said the lobby work sprang from other legal work the firm does for drug industry. “Foley Hoag is a law firm that is heavily concentrated on the life sciences,” he said.

In addition to direct lobbying, some of the top firms also reward members of Congress with campaign contributions funneled through firm political action committees, and by individual lobbyist donations. The political action committee at Patton Boggs LLP — the biggest lobby firm in Washington — contributed/donated more than $50,000 during the 2008 cycle, almost exclusively to Democratic candidates. more than $500,000 to candidates during the 2008 cycle, according to Center for Responsive Politics. John Jonas, a top Patton Boggs health lobbyist who declined to be interviewed,

James Thurber, director of the Center for Congressional and Presidential Studies at American University, said that among the major players there are “no surprises”. But the tremendous financial boost that health reform brought to lobby firms in 2009 was greater than even veteran observers expected. “I think it is unprecedented,” Washington lawyer and lobbying expert Ken Gross said about the amount of money spent on the health reform battle.

The length of the debate, paired with the more than 1,750 business and organizations that signed up to lobby on health reform bills, likely made it the strongest and most expensive lobby push ever, Gross said.

“First of all, it went on for so long,” Gross said. “Second of all, it was high stakes poker. It stands to reason that it would be a record-breaker.”

The Center for Public Integrity