Industry stakeholders that have spent the past year working overtime to influence almost every aspect of the massive health care reform bill are now struggling to put their imprint on a final product that likely will be shaped by the arcane budget reconciliation process.

Lobbyists said that reconciliation does not lend itself well to outside pressure because rules limit the substance of the bill to issues directly tied to the budget. Furthermore, they say now that President Barack Obama has outlined what he wants to see in the measure, there is less leeway for input from industry groups.

“The majority of issues in play are unlobbyable at this point,” said Andy Rosenberg, a principal in the firm Thorn Run Partners. Rosenberg said that K Streeters can still provide valuable advice to clients by explaining what is happening with the legislation on Capitol Hill and “helping them handicap the likely outcomes.”

Democrats are charting a two-pronged approach to pushing health care reform over the finish line. The strategy calls for the House to vote on the health care measure already approved by the Senate. Then the chamber would take up a reconciliation measure that would include some of the changes that lawmakers and the White House want to see made to the Senate bill. The Senate would take up the reconciliation measure, which requires only a simple majority to pass.

The Senate Parliamentarian would be the referee in deciding which provisions in the reconciliation bill meet the budget-related requirements. Since Republicans are expected to raise numerous objections to the bill, Ralph Neas, president of the National Coalition on Health Care, predicted the Democratic leadership would be judicious in the crafting of the measure.

“I think it will be as narrowly constructed reconciliation bill as possible,” he said. “I think there will be a significant limitation on the range of debating points.”

One longtime health care lobbyist predicted that for K Street the debate over reconciliation will “be more of a viewer spectacle than an interactive game. A lot of lobbyists around town have morphed into reporters.”

The lobbyist said that most of the lobbying will likely take the form of grass-roots campaigns back in lawmakers’ districts.

But others disagree that little can be done to influence the reconciliation process. Well-prepared advocates can arm lawmakers with arguments on whether certain provisions either favored or opposed by their clients meet the reconciliation criteria, according to one health care lobbyist. Those talking points could indirectly sway the Parliamentarian, said the lobbyist, who added that it is not considered good form for K Street to directly try to influence the Parliamentarian.

“This is a different kind of lobbying. It is just more granular now,” the lobbyist said.

The rules governing reconciliation would likely preclude its dealing with a number of hot-button issues — perhaps the most contentious being abortion coverage.

Therefore, anti-abortion groups are spending much of their time focusing on convincing conservative Democrats to vote against the Senate bill when it comes up in the House.

Matthew Faraci, spokesman for Americans United for Life, said his group has been mobilizing its grass-roots supporters to urge 40 House lawmakers, who backed anti-abortion restrictions authored by Rep. Bart Stupak (D-Mich.) that were contained in the House bill, to oppose the Senate bill.

“The focus is on the House. That is where the action is,” Faraci said.

Other large groups also believe they need to stiffen the spines of wavering lawmakers.

Officials with the large senior citizens group AARP, which supports health overhaul legislation, said they have decided to re-engage in the health care debate after retreating for a brief period to give Obama a chance to hold bipartisan talks. However, after the meeting with Republicans at the White House resulted in no agreement, AARP is bolstering its grass-roots efforts to provide cover for lawmakers who are under attack back home.

“Are we just going to sit on the sidelines? No,” said David Sloane, senior vice president of government relations for AARP.

Sloane, however, said that AARP is not going to be launching the kind of major advertising campaign that was so prevalent in the health care debate last year.

“I don’t think advertising is the way to secure votes,” he said.

However, Sloane said that after a brief lull, media tracking services have found there has been an uptick in health care ads being aired back in lawmakers’ districts by other outside groups.

The U.S. Chamber of Commerce has underwritten millions of dollars of ads opposing the Democratic health care plan in the past year. But chamber spokeswoman Blair Latoff said the organization has not yet announced its next move. She said the business group, which opposed the changes outlined by Obama for health care reform, was waiting to see exactly what was included in the reconciliation bill.

But restaurant and retail industry groups are not waiting for the bill’s details to be released. Responding to intelligence they are picking up on Capitol Hill, those sectors have already launched campaigns to dissuade Democrats from inserting provisions in the reconciliation bill regarding health care coverage for part-time workers.

These groups support the Senate bill, which would only penalize employers for not providing health care coverage to full-time employees, which are defined as 29 hours a week or more. But Education and Labor Chairman George Miller (D-Calif.) is considering inserting provisions in the reconciliation measure that would make it harder for employers to reduce workers’ hours to avoid the penalty.

The National Restaurant Association recently blasted an action alert to its members urging them to contact their lawmakers to oppose Miller’s efforts.

“Please contact your representative and tell him or her to maintain the part-time worker exemption currently in the Senate-passed bill,” said the memo from Scott DeFife, the restaurant association’s executive vice president for policy and government affairs.

The Retail Industry Leaders Association is also opposing legislative attempts to change the Senate language. RILA spokesman Brian Dodge said his group was responding to rumors that Democrats would try to mandate that employers provide coverage for part-time workers.

“We’re anticipating the worst and acting on that,” he said. “This process does not lend itself to clarity.”

But Chip Kahn, president of the Federation of American Hospitals, said reconciliation is not a problem for groups like his that are generally supportive of the health care reform bills. He said his group will be convincing members to vote for the bill.

“People are just getting revved up,” Kahn said.