Medical stakeholders, who shelled out millions of dollars to lobby on the contentious health care bill, are keeping their wallets open as they try to boost candidates they hope will either promote or gut the new law.

So far this election cycle, the health sector has shelled out more than $40 million in campaign contributions, with the largest share, $23.8 million, going to Democrats, according to a CQ MoneyLine analysis.

Some groups indicated they may alter their giving as the election approaches, and it appears likely that the Republicans will be in charge next year.

But for now, many of the health care law’s most ardent supporters, including hospital groups, the American Medical Association and drug companies, are donating heavily to Democrats who backed the changes.

On the other side, the donations of health insurance companies, which helped lead the fight against the health overhaul, are tilted toward GOP candidates who opposed the measure. Medical specialists such as orthopedic surgeons who also found fault with the overhaul are betting much of their campaign money on Republicans.

“We are giving to those folks who agree with us,” said Peter Mandell, who chairs the council on advocacy for the American Academy of Orthopaedic Surgeons. “More Republicans than Democrats align with our position.”

So far in this election cycle, the orthopaedic surgeons’ political action committee has given $518,000 to Republican candidates and $358,000 to Democrats. In the 2008 election cycle, before the health care debate heated up, the group’s giving was almost equally split between the two parties.

By contrast, the American Medical Association, which threw its prestige behind the Democrats’ health care plan, has so far given about 55 percent of its PAC contributions to the majority party. That is about the same ratio as in the 2008 election cycle but far higher than the 2006 election season, when the group gave Democrats 29 percent of its contributions.

The medical association’s PAC states that it takes into account recommendations from state chapters, incumbent voting records and the competitiveness of races.

Shifting Political Winds

The AMA also appears to be attuned to the changing political climate and the likelihood that Republicans will make major gains in November.

In April, a month after Congress approved the health care measure, AMA’s PAC contributed to the campaigns of Speaker Nancy Pelosi (D-Calif.) and Majority Leader Steny Hoyer (D-Md.), who pushed the legislation through.

However, on the last day of August, as speculation grew about the likelihood of Republicans gaining control of the House, the medical association donated $5,000 to House Minority Leader John Boehner (R-Ohio), who is in line to become Speaker if his party prevails.

Other groups say they likely will adjust their giving as the elections near.

The American Hospital Association has so far given a lopsided 70 percent of its contributions to Democrats, a major turnaround from 2006, when Republicans received more than half of the group’s contributions.

But Mark Seklecki, the AHA’s vice president for political affairs, suggested that by November the gap between Democratic and Republican candidates won’t be so wide.

“The election season is not over yet,” he said. “The numbers will change a little bit. It will moderate somewhat and be more reflective of what has happened.”

Though the hospital association was a strong proponent of the health care overhaul, Seklecki said the group looks at Members’ records on a range of issues. He added that Democrats have been getting more money from the association in part because “there are just more of them” in Congress.

But the greater number of Democrats on Capitol Hill hasn’t influenced some major players in the health insurance industry, which was particularly critical of the health care reform bill.

America’s Health Insurance Plans, which lobbies for the industry, has so far given $121,000, or 60 percent, of its contributions to Republican candidates. That is a reversal from 2008 when the trade group gave a majority of its money to Democrats.

AHIP also contributed $79,000 to Republican leadership PACs, compared with $15,000 to Democrats’ leadership coffers. The insurance group donated to the leadership PACs of Boehner and House Minority Whip Eric Cantor (Va.) as well as other rising GOP stars, including Reps. Paul Ryan (Wis.) and Dave Camp (Mich.), who is in line to head the Ways and Means Committee should his party win control of the House.

An AHIP spokesman did not respond to several phone calls seeking comment.

Making Its Point

One of the most active political participants in the health insurance industry has been Indiana-based Wellpoint Inc., which has given $392,000 to Republicans and $145,000 to Democrats so far this cycle.

The company also has contributed more than $1 million in largely unrestricted funds to 527 groups — all of them with GOP affiliations, including the National Governors Association.

Wellpoint President Angela Braly contributed this year to GOP Senatorial candidates including Rep. Roy Blunt (Mo.) and Kelly Ayotte in New Hampshire. She also donated to the PAC of Senate Minority Leader Mitch McConnell (R-Ky.).

In May, Braly sharply criticized President Barack Obama for suggesting that her company dropped coverage for women with breast cancer. A Wellpoint spokesman did not respond to inquiries about the company’s political giving.

Among the most active proponents of the health care plan have been the drug companies, which early on reached a deal with the White House to back the bill.

This election cycle, the drug companies have shelled out $3.9 million to Democratic candidates and $3.2 million to Republicans. Several of the largest drug companies also favor Democrats in their giving, including Amgen, Eli Lilly and Co., Merck & Co. Inc. and Pfizer Inc.

The Pharmaceutical Research and Manufacturers of America, the drug company’s trade group, has given $75,000 to Democrats so far in this election cycle, compared with $32,000 to Republicans.

In recent election cycles, PhRMA has reversed its traditional pattern of giving to Republicans. In the 2006 cycle, the group gave only 21 percent to Democrats. By 2008, Democrats received 56 percent of PhRMA’s money.

“We don’t look at party affiliation but rather at the record of elected officials on both sides of the aisle who have supported policies that align with our important mission of helping patients win their battle against disease,” said Wes Metheny, PhRMA’s senior vice president. “We seek to be relevant, in a bipartisan way.”