In Washington, momentum may be building to repeal an important funding source for the Affordable Care Act – a 2.3 percent sales tax on an array of medical devices – everything from surgical gloves to artificial joints.

The industry has raised an army to battle the provision on Capitol Hill and spent more than $200 million since 2008 on the effort.

The manufacturers’ campaign is just the latest example of why it’s hard to reform an industry that’s crying out for change.