Health care lobbyists representing insurers, drugmakers and a range of powerful industry interests are steeling themselves for a Senate chair immune to their usual charms — Bernie Sanders.

The Vermont independent is set to take over the Senate’s Health, Education, Labor and Pensions Committee next month. Leading the panel gives the Medicare-for-All proponent oversight authority over some of his policy priorities — drug pricing, workers’ rights and income inequality, and student and medical debt.

But Sanders’ well-chronicled antagonism toward lobbyists has some concerned they’ll be unable to blunt criticism of their clients’ profits or corporate executive salaries. They are anxious Sanders might seek to revive policies like importing drugs from Canada and other nations, an idea loathed by drugmakers.

Lobbyists also worry they’ll struggle to get traction on any push to make changes to a drug discount program involving pharmaceutical companies and hospitals or revisit association health plans after a Trump-era rule around them was voided.

“This will not be business as usual for K Street. It will be harder for companies to get in and make a case,” said Michaeleen Crowell, a lobbyist at lobbying and public affairs firm S-3 Group who served as Sanders’ chief of staff for more than five years. “The culture in the office is one where lobbyists are mistrusted, and they’re more likely to discount what they hear directly from companies.”

POLITICO spoke to more than a dozen lobbyists and lawyers about having Sanders at the helm of the HELP Committee, some of whom were granted anonymity to talk about the senator’s dynamic with K Street.

Multiple lobbyists representing health insurers, pharmaceutical companies, providers and health systems told POLITICO they’re going to have to “bank shot” their advocacy to get their messages across — lobbying other lawmakers on the committee and getting into the ears of progressive policymakers and left-leaning organizations.

“There are ways to get things passively on his radar if you know him well enough, if you know who he listens to or what he reads,” Crowell said.

Sanders’ office declined to respond to questions from POLITICO, including those about his relationship with lobbyists.

Lobbyists said another strategy could be working to insert favorable provisions into larger bills, lean on the panel’s House counterpart, the Energy and Commerce Committee, or go to Sen. Patty Murray (D-Wash.), who is stepping down as HELP Committee chair to head the Senate Appropriations Committee.

“It’s not status quo … we’re going to have to be creative with patient groups to get him to listen,” said a lobbyist with health system, health insurance and pharmaceutical clients granted anonymity to speak freely. “If I’m going to be completely honest, we’re still trying to figure out what we’re going to do.”

Sanders has talked about working to boost access to care, lower drug costs, expand the health care workforce and raise wages, and possibly reach across the aisle. Sanders is also expected to push the jurisdictional bounds of the committee, potentially taking on issues such as the health impacts of climate change.

K Street will likely watch how often Sanders collaborates with the committee’s incoming ranking member, Sen. Bill Cassidy (R-La.), as the two have a history of working across the aisle. Although some lobbyists have floated policies around drug pricing and surprise billing as a possibility for them to find agreement, it’s not entirely clear if they’ll end up on the same page.

“There’s a good chance the committee becomes a one-legged duck, swimming in circles,” said a Republican lobbyist and former HELP Committee staffer granted anonymity to speak freely.

But if the two end up aligning on some issues, that could be a liability for some industry clients on K Street.

Jeff Forbes, co-founder of lobbying and public affairs firm Forbes Tate, said Sanders has a history of bipartisanship, particularly while chairing the Senate Veterans Affairs Committee, and will work to get stuff done — “the question is going to be what, and at whose expense?”

“Does corporate America have to worry? Of course they do,” he added. “Between a populist Republican like Cassidy and a left-wing chairman like Sanders, they’ll have plenty of anti-corporate areas of mutual interest.”

With the Senate majority comes subpoena power, and it’s almost certain that health executives will be called to testify before the committee — a reputational risk for corporations.

“Subpoena authority is certainly something that gets people paying attention,” said Rafi Prober, co-head of the congressional investigations practice at Akin Gump Strauss Hauer & Feld.

And conditions are ripe for the HELP Committee to beef up its hearings schedule: The panel has only a few must-do items next session — reauthorizing both pandemic preparedness legislation known as PAHPA and an animal drug user fee bill — and Democratic priorities aren’t expected to move, given the GOP-controlled House. This gives Sanders the runway to dig into any issue he wants.

Most senior members of Congress have relationships with K Street because lobbyists had worked for — or closely with — them while serving as Capitol Hill aides, have donated to their campaigns or otherwise have become close with their staff.

Sanders, meanwhile, isn’t rubbing elbows with executives and lobbyists at fundraisers and doesn’t have a “kitchen cabinet” of donor-advisers he talks with about policy, Crowell and others said. He’s sworn off all money from political action committees — even ones run by other senators and members of Congress — to his Senate campaigns.

Further, most of his staffers have a mix of experience working for him, progressive campaigns and nonprofits and share the aversion to downtown corporate lobbyists.

“The prospects of a Sanders-led HELP committee are refreshing and exciting,” said Craig Holman, a lobbyist at Public Citizen who works on money-in-politics and ethics issues.

“The chairman will give everyone their due, including lobbyists representing the public’s interest, without being swayed by campaign cash,” he said. “Sanders’ new leadership position will help build some equity between the influence of the haves and have-nots, of which Public Citizen and other nonprofits more or less qualify as the latter.”

But one Democratic lobbyist who advocates before the HELP Committee, who was granted anonymity to speak candidly about the dynamic, said Sanders’ staff members rarely take people’s meetings.

“It’s hard to find a lobbyist [who] has had much success working with his staff. If the committee wants to be taken seriously on some very important issues, they’re going to need to be more open to talking with stakeholders — even ones [they] don’t like,” he said.

Not all lobbyists are so down on their prospects. Michael Strazzella, the leader of Buchanan Ingersoll & Rooney’s federal government relations practice, said he is optimistic about working with Sanders and his staff.

“He can be educated just like every other senator,” Strazzella said. “Influence is a strong word, to be honest, but I do believe that he is open to continuous education and understands the impact of new policies. … I don’t think he’s necessarily set in his ways about everything.”

Aside from his current staff, much of the dynamic with K Street will depend on who he brings in to work on the committee, several lobbyists told POLITICO.

Some hope it will be a departure from his traditional hiring patterns, but one lobbyist who has relationships with Sanders’ health care staff said he wants them to stick around.

“I just hope they stay because we at least know who we will be working with next year and can have conversations with them, » said the lobbyist, who was granted anonymity to speak about the relationship, in an email. « I worry about the staff changing some and not knowing any of the… players coming in and their approach to interacting with downtown. »

Ben Leonard contributed to this report.