By John Fritze, USA TODAY

WASHINGTON — The largest medical insurers and drug companies spent 41% more on lobbying this year as Congress began debate on an overhaul of health care, which may include a public insurance plan the industries oppose.

The largest medical insurers and drug companies spent 41% more on lobbying this year as Congress began debate on an overhaul of health care, which may include a public insurance plan the industries oppose.

Despite an overall decline in lobbyist spending this year, a USA TODAY review of disclosure reports found 20 of the largest health insurance and drug companies and their trade groups spent nearly $35 million in the first quarter of 2009, up more than $10 million from the same period last year.

Drug and insurance companies support many changes Congress is considering but generally oppose government-run insurance, which President Obama touted Thursday in Green Bay, Wis. Public insurance is facing criticism from business groups and the American Medical Association, which will host Obama on Monday in Chicago.

Ken Johnson, senior vice president with the trade group Pharmaceutical Research and Manufacturers of America, said public insurance would stifle competition and force Americans to lose private coverage. He said his group is pushing for other changes instead.

"The overwhelming amount of money we have spent is in support of comprehensive health care reform," said Johnson, whose group spent $6.9 million in 2009, up 91% from 2008. "There are certainly aspects … troubling to us, including the public option."

Pfizer's lobbying more than doubled to $6.1 million, and Merck's increased 44% to $1.5 million.

"We believe that the private health care marketplace fosters competition, innovation and consumer choice," read a Merck statement. A Pfizer statement read, "We are committed to making our voice heard and to be constructively engaged" in the debate.

Richard Kirsch of Health Care for America Now, a coalition of unions and non-profits supporting public insurance, said he is "extraordinarily worried" about the lobbying by those opposed to a public plan. "The other side is going to be out-spending us inside the Beltway," he said.

Outside Washington, an alliance of groups that support public insurance, including Kirsch's, vowed to spend $82 million on community organizing and advertising this year. Some have spent more on lobbying, too. The Service Employees International Union, for instance, increased spending 46% to $690,131, lobbying reports show.

All health sectors spent $149 million on lobbying this year, a 10% jump, according to CQ MoneyLine, a non-partisan website. Overall spending on lobbying is down 2.6% this year, according to the site.

Health lobbying

Lobbying expenses increased 41% for 20 large insurance and drug companies in the first quarter of this year compared with the same period last year.

See the graph here.