By Fredreka Schouten and John Fritze, USA TODAY

WASHINGTON — Hospitals, coal miners and clinical labs are among the special interests that have won exemptions from taxes and other cost-cutting measures in a health care plan crafted by the Senate Finance Committee.

The landmark legislation, which could face a committee vote this week, comes after months of negotiations over how to provide coverage to millions of uninsured Americans.

It also has faced intense scrutiny from groups that would be affected by its changes. The health care industry has spent more than $263 million to lobby Congress during the first six months of this year — more than any other sector, according to the non-partisan Center for Responsive Politics.

"The health care lobbying interests are cutting deals ... on whatever affects their fiefdom," said Steve Ellis, vice president of Taxpayers for Common Sense, a non-partisan watchdog group.

Erin Shields, a spokeswoman for committee Chairman Max Baucus, D-Mont., said the bill is crafted for families, small businesses and seniors. "Every decision Sen. Baucus makes about this bill, he makes for them — no matter what any industry or any special interest wants," she said.

Still, hospitals secured a 10-year exemption from cost-cutting recommendations that would be made by an independent federal commission charged with controlling spending in the government's Medicare program.

Richard Coorsh of the Federation of American Hospitals said the group reached agreement with the Obama administration to forgo $155 billion in government reimbursements over a decade to help pay for the plan. "This reflects that the Senate Finance Committee and the White House understand the degree of that sacrifice," he said.

The hospital pact, however, has drawn the ire of doctors' groups, who would be subject to commission recommendations. Michael Maves, CEO of the American Medical Association, called the provision a "serious inequity" in a letter to Baucus last month.

Other changes:

• Coal miners, firefighters and others in jobs deemed high-risk are more likely than others with high-cost insurance policies to avoid a new tax. Under the bill, a 40% tax would apply to family policies that cost more than $21,000. Under a measure by Sen. Jay Rockefeller, D-W.Va, the threshold would be $5,000 higher for those in high-risk jobs, such as mining, law enforcement and construction.

Rockefeller said coal miners in his state need more expensive coverage because their jobs lead to serious illnesses. "I absolutely had to take care of them," he said in a statement.

• A $750 million annual tax on clinical labs such as Quest Diagnostics was dropped after trade groups, including the American Clinical Laboratory Association, objected.

The tax was included in a draft of the bill released Sept. 16 but was removed six days later. Now, the bill calls for a five-year reduction in Medicare payments — a change that would affect smaller labs that work with seniors more than large labs, said Mark Birenbaum of the National Independent Laboratory Association, which represents small labs. Alan Mertz, president of the American Clinical Laboratory Association, argued that the new provision would be better than the tax for labs of all sizes.

• Doctors who perform medical imaging tests such as MRIs in their offices would face less severe cuts under the bill than proposed by President Obama. Those cuts would be phased in over five years.

At issue is how much doctors should be reimbursed by Medicare for the tests. Obama and House Democrats said the in-house MRIs are fraught with the potential for abuse and are ripe for cuts to help free up money for other Medicare spending.

The industry, including the Access to Medical Imaging Coalition, has said that the cuts would have made it difficult for rural doctors to afford scanning equipment. "This is a dramatic improvement," said Tim Trysla, a lobbyist with the coalition.

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