As Senate Finance Committee negotiators put the last touches on their long-awaited bill, health care stakeholders are intensifying their lobbying push in a last-ditch effort to influence the panel’s result.

Associations and companies huddled with their outside consultants last week after President Barack Obama’s joint address to Congress, trying to game out their next steps.

Health care groups are lobbying aggressively on specific parts of the package, rather than a full-out assault to kill the legislation.

“It’s go time,— one outside lobbyist said. “You are going to see some people pushing very hard in support of a bill.—

But as the process has become more insular, it has been harder for outside groups to exert influence at the Finance Committee level.

“It’s going to be hard to change a lot, frankly,— one Democratic health care lobbyist said.

Insurers, medical device makers and laboratories are all facing proposed excise taxes, and they have the difficult predicament of needing key moderate Senators to go to the mat for them — a Senator who agrees to make his vote contingent on taking out a particular tax, for example.

“If you’re trying to influence the product at this point, you need a vote,— the veteran health care consultant said.

Senators such as Olympia Snowe (R-Maine), Blanche Lincoln (D-Ark.), Ben Nelson (D-Neb.) and Mary Landrieu (D-La.) are considered to be pivotal votes in the debate.

“You’re going to see a lot of people activating companies back home— to reach out to those Senators, the consultant added. “We’re in hand-to-hand combat phase, and if you don’t have grass roots and grass tops already activated, then it’s probably too late. You’re really at the point where you have to have CEOs calling Members of Congress.—

Another lobbyist with a list of health care clients said the Finance Committee is no longer holding many meetings with industry groups.

“There are a handful of swing Democratic Senators, and there’s a grasping at straws about how do we get an audience with someone who can say, ‘My vote is contingent on this,’— the lobbyist said.

This lobbyist added that his clients are considering last-minute fly-ins as well as issue advertising. The U.S. Chamber of Commerce, for instance, is flying in 60 CEOs of midsized companies today and Tuesday to discuss health care, among other issues.

“Some of these interest groups have been playing nicely, quietly,— this lobbyist said. “I think you may start to see some re-evaluating their passivity. They’re going to be saying, ‘It’s time for us to make noise because we are on the chopping block.’—

The insurance industry and physicians are by far the most outspoken critics of the Democratic package. After getting hammered by the White House, nobody expects the insurers to support the Senate package.

The insurance industry in particular is still “evaluating— how to move forward, according to one outside consultant. “At the moment, they are keeping their powder dry.—

Robert Zirkelbach, spokesman for the insurers’ chief lobby group, America’s Health Insurance Plans, said his group has several fronts that it is focusing on, including proposed new taxes on high-cost plans and on insurance companies.

“These new taxes are only going to make coverage less affordable and won’t put our health care system on a sustainable path,— Zirkelbach said. “This is the opposite of what health care reform is supposed to accomplish.—

AHIP also is opposed to cuts to the Medicare Advantage program for seniors.

On all fronts, Zirkelbach said his group has activated its grass-roots networks. On Tuesday, the group is holding a press conference “to release a new report showing the higher quality of care seniors in Medicare Advantage plans receive compared to traditional Medicare,— according to a press advisory of the event.

Zirkelbach said it is still too early to say what type of advertising and messaging AHIP might engage in. “We’re waiting,— he said. “We’re still focused on what we can do to advance health care reform.—

But he added: “We have significant concerns with some of the proposals that have been advanced. So we’re talking to policymakers about the negative impact these proposals will have on the constituents they represent, particularly new taxes and cuts to Medicare Advantage.—

Several lobbyists for insurance companies said they don’t expect AHIP or individuals to mount a public offensive against health care reform.

“Their play is to make this as painful as possible while never supporting it,— one health care lobbyist said about the insurers.

While physicians groups were buoyed by Obama’s nod to include medical malpractice as part of the overall health care discussion, they are still lobbying against several provisions in the bill.

Doctors are one of the few constituencies that have supported the House’s legislation over the Senate’s.

“This is bigger than just physician payments,— said Shawn Martin of the American Osteopathic Association. “There’s an overall goal and objective that we are trying to move along.—

The insurers, medical device companies and clinical labs are also pushing back aggressively against the excise tax that is a part of the package that Finance Chairman Max Baucus (D-Mont.) released last week.

Clinical labs are facing a tax that would raise $750 million annually to help pay for the health care bill. Similarly, the medical device industry is facing a $4 billion annual fee.

AdvaMed, which represents the medical device industry, has said that its members would not only be hit by the fee but would also be affected by the tax on clinical labs.

Other groups are also pushing hard.

“Our accelerator will remain pinned,— AARP spokesman Andrew Nannis said.

The seniors’ lobby group is pressing ahead with its ads, mailers, media outreach and Hill lobbying to secure health care reform this session.

Similarly, the Pharmaceutical Research and Manufacturers of America is moving ahead with its aggressive pro-health care reform lobbying push. PhRMA, which has spent tens of millions on a national advertising campaign, was the first outside group to cut a deal with the Finance Committee.

“We’re trying to make as many people across the country aware of the importance of comprehensive health care reform,— PhRMA’s Ken Johnson said.