Health care reform negotiations have put a chill into the once-cozy relationship between key medical industry stakeholders and some Republicans on Capitol Hill.

GOPers are complaining that those industries that could be hardest hit by Democrats’ reform proposals have not done enough to engage well-funded arsenals because they are desperate to stay at the table while a health care package is being crafted.

Hospitals, pharmaceutical companies, insurers and doctors are not taking an aggressive enough approach against Democrats’ plans, some Republicans and even fellow business lobbyists say.

“Getting into bed with the Democrats now isn’t going to change their mind in the morning,— said one Senate GOP leadership aide. “Their longtime policy goals are more in line with Republicans, so it seems they are being very short-sighted.—

Another Senate GOP leadership aide said that some segments of the business community have been slow to wake up to the economic realities of the Democrats’ proposals. “It’s as if at first they thought they were guests at the dinner party only to arrive and find themselves on the menu,— this aide said. “The House bill brought to light just how bad this legislation would be to the economy and their bottom lines.—

A senior House GOP aide griped that insurers and other key industry stakeholders have been “missing in action— when it comes to defending their own industry.

Capitol Hill and lobbying sources said health care industry groups have been successfully silenced so far by Democrats, especially Senate Finance Chairman Max Baucus (Mont.), but they also predict that the groups will step up their messaging against reform bills in the House and one reported out of the Senate Health, Education, Labor and Pensions Committee.

“The major stakeholders have been, more or less, bought off so they can stay engaged in the process,— one Republican health lobbyist said. “The second thing, they do honestly support certain reforms. I don’t think they want to kill it.—

One health care consultant said Members expected to see a realignment with business interests that focused more on the party currently in power.

“I think people on and off the Hill understood that this was inevitable,— this consultant said. “What they underestimated was the degree to which probably the Finance Committee, in particular, was able to coerce silence from stakeholders.—

This strategy of keeping stakeholders publicly quiet while maintaining a dialogue for ongoing negotiations privately has become the new model for Congressional/downtown relations. “The role of the stakeholder has really changed,— this consultant added.

From the Republican side, this consultant said, there’s a certain amount of “irritation about, Why would we defend you when you won’t defend yourself?’—

Not so, one in-house health care lobbyist says.

“No one’s in bed with the Democrats,— the lobbyist said. “People are engaging with the majority like anybody would.—

This lobbyist noted that Republicans such as Finance ranking member Chuck Grassley (Iowa) and HELP ranking member Mike Enzi (Wyo.) are as important as most Democrats.

“Where I think there have been some strains is where some Republicans very much want to kill health care reform, and I don’t think there’s an interest at the industry level to kill health care reform at this point.—

This lobbyist added that the “health care industry is not making deals because they’re cozying up to Democrats. Unlike in 1993-94, the industry is engaging because the industry supports getting something done. PhARMA, hospitals, insurers, nobody believes that it’s good business to continue with the status quo.—

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said his organization wants a bipartisan, comprehensive health care reform package.

“We are working with people on both sides of the aisle in both the House and Senate,— he said. “We think we need to accomplish reform, but we have also expressed our strong opposition to a government-run plan and the impact it would have on the coverage people have and currently like.—

One health care consultant, like several others, stressed that lobbyists are maintaining ties and keeping GOPers apprised when it comes to most reform issues.

“They are trying behind the scenes to keep relationships with Republicans,— said another health industry lobbyist.

And perhaps the health industry lobbyists will be calling on those connections sooner rather than later. Lobbyists working on health care reform say they expect at least some of the quiet stakeholders to ratchet up the noise level in the next two weeks and over the August recess.

“You’ve got some pretty bad bills out there in the House and from Senate HELP,— one health care lobbyist said. “There are a certain amount of stakeholders who will be doing things a bit differently in August. Even if you’ve upset Republicans, you’re having some conversations right now with them about what you’re going to be doing in August.—

National Retail Federation Vice President Neil Trautwein said his group and some Hill GOPers have similar concerns over health industry groups that have inked deals with Democrats already.

“Frankly, there’s a lot of shared frustration over groups that have hastened to try to cut deals that may or may not hold water over the long run,— said Trautwein, who is his organization’s point person on health reform. “Absolutely, I really think those have lent a certain degree of momentum to some of the wrong bills at the wrong time. We’re still strongly supportive of reform, but at least two out of the three alternatives on the table are severely flawed,— he said.

“And the fact that some of these groups might try to carve out a deal I think is vastly premature. Speaking for NRF, we’re absolutely not pleased by it,— Trautwein added.

Trautwein said the House bill and the one reported out by the Senate HELP Committee would severely hurt retailers.

“We’re frustrated with Congress for getting health care reform so wrong so far,— he said. “The only semibright light is the Senate Finance Committee. We’re still hoping to get something reasonable out of them.—

Trautwein predicts that as the reform bills further take shape, some of the health industry stakeholders will come back into the opposition fold, and “the broad coalitions we’ve seen in the past— will reappear.

David M. Drucker contributed to this report.