Why It Matters

Why It Matters

The Greater New York Hospital Association’s $540,000 Q3 2025 in-house lobbying spend reflects existential threats to hospital finances. GNYHA is a longstanding player with over two decades of federal advocacy—420 disclosures totaling $44.4 million—and maintains consistent spending patterns rather than escalating investments.

The current landscape presents unprecedented challenges: catastrophic Medicaid DSH payment cuts took effect October 2025, while site-neutral payment reform bills advance in Congress. GNYHA has publicly endorsed the Save Our Safety Net Hospitals Act to prevent $300 million in annual New York hospital cuts.
Proposed legislation like the Same Care, Lower Cost Act and Preventing Hospital Overbilling of Medicare Act would further reduce hospital revenues by equalizing Medicare payments across settings.

By the Numbers

The Greater New York Hospital Association Inc. reported $540,000 in lobbying expenditures for Q3 2025 through its in-house operations. This represents a continuation of GNYHA’s massive advocacy footprint: over two decades of federal lobbying, 420 total disclosures, and $44.4 million in cumulative spending. The bulk of that investment, $33.02 million across 77 disclosures, has flowed to in-house operations rather than external firms.

GNYHA supplements its internal team by retaining external specialists. Long-standing partners include Card & Associates LLC ($2.2 million since 2014), Alston & Bird LLP ($1.69 million, 2009-2020), and Tonio Burgos & Associates Inc. ($620,000 since 2016). In total, GNYHA has engaged 18 different lobbying firms over its history.

The organization’s in-house team composition is not detailed in available disclosures, limiting analysis of specific member backgrounds or congressional experience.

The Agenda

The Greater New York Hospital Association is actively lobbying to protect hospital funding streams threatened by federal cuts and payment reform proposals. The organization has publicly endorsed the Save Our Safety Net Hospitals Act, which aims to prevent nearly $300 million in annual cuts to New York hospitals by reforming Medicaid DSH calculations. GNYHA is simultaneously opposing multiple site-neutral payment proposals, including the Same Care, Lower Cost Act and H.R.3023, which would reduce hospital revenues by expanding Medicare payment equalization.

The organization continues advocating for increased Graduate Medical Education funding and broader healthcare reimbursement protections for its member hospitals.

Broader Context

Healthcare policy is currently undergoing seismic shifts that directly threaten GNYHA’s member hospitals. Medicaid DSH payment reductions of $8 billion took effect on October 1, 2025, after being delayed for over a decade.

New York is disproportionately affected by these cuts. Following the cuts, New York State announced it would lose $7.5 billion in annual federal funding to its Essential Plan, forcing termination of coverage for 450,000 New Yorkers and increasing uncompensated care burdens on hospitals.

More broadly, sweeping healthcare cuts under H.R.1 will reduce federal spending by over $1 trillion and increase the uninsured by 10 million. Work requirements will force millions off Medicaid, while state-directed payments to hospitals will be capped at Medicare rates, cutting payments to expansion-state hospitals.

Meanwhile, site-neutral payment reform remains a persistent congressional priority. Rep. Tim Kennedy (D-NY) introduced the Same Care, Lower Cost Act, arguing it could save Medicare $157 billion over ten years by equalizing payments across settings. These legislative threats directly motivated GNYHA’s sustained Q3 2025 lobbying investment.

Between The Lines

The industry faces significant headwinds from multiple legislative proposals targeting hospital revenue streams. S.1629 – Same Care, Lower Cost Act and companion bills like H.R.3023 – Preventing Hospital Overbilling of Medicare Act would implement site-neutral payment policies that GNYHA has historically opposed. Concurrently, Sens. Maggie Hassan (D-NH) and Roger Marshall (R-KS) are pushing the Fair Billing Act targeting facility fees at off-campus locations.

On the defensive front, GNYHA finds key allies in the New York delegation. Sen. Kirsten Gillibrand and Rep. Jim Banks introduced the Save Our Safety Net Hospitals Act to prevent nearly $300 million in annual DSH cuts to New York hospitals. Sen. Chuck Schumer announced the Protecting Health Care And Lowering Costs Act to combat projected Medicaid coverage losses for tens of thousands of New Yorkers. Graduate medical education also remains active, with the House Judiciary Subcommittee hearing on "The Match Monopoly" highlighting physician shortage challenges and structural residency system problems. Additionally, a House Ways and Means hearing on "Medicare Advantage: Past Lessons, Present Insights, Future Opportunities" addressed provider complaints about administrative burdens and prior authorization delays from MA plans.

Competitive Landscape

GNYHA operates within a crowded and competitive hospital advocacy ecosystem, with numerous healthcare systems and hospital associations pursuing overlapping legislative agendas. NewYork-Presbyterian Hospital and UPMC (University of Pittsburgh Medical Center) actively lobby on nearly identical priorities: opposing site-neutral payment cuts, protecting Medicaid DSH funding, and advancing graduate medical education (GME) expansion. Mass General Brigham Inc. pursues similar strategies, while state-level associations like the Hospital and Healthsystem Association of Pennsylvania reinforce unified industry messaging on federal payment and reimbursement issues. This consolidated advocacy front—amplified by the American Hospital Association’s broader efforts—creates a powerful lobbying force around healthcare financing. However, site-neutral payment reform faces increasingly serious congressional momentum. Rep. Tim Kennedy (D-NY) introduced the Same Care, Lower Cost Act, while Sens. Maggie Hassan (D-NH) and Roger Marshall (R-KS) introduced the Fair Billing Act. Multiple site-neutral proposals—including the Preventing Hospital Overbilling of Medicare Act and the SMART Health Care Act—demonstrate sustained bipartisan pressure to limit hospital outpatient department payments, creating a direct competitive threat to GNYHA members’ revenue streams.

The Bottom Line

Greater New York Hospital Association Inc. spent $540,000 on in-house lobbying in Q3 2025, maintaining its consistent advocacy presence. The organization faces significant threats from proposed site-neutral payment reforms and Medicaid funding cuts. GNYHA is actively supporting legislative efforts like the Save Our Safety Net Hospitals Act to protect hospital funding. Its advocacy aligns with priorities championed by New York’s congressional delegation, particularly Senators Chuck Schumer and Kirsten Gillibrand.