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How you—and ACP—can catalyze political change

From the July/August 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

By William A. Reynolds, FACP

In analyzing the College's goal of universal health insurance, we need to examine its role as an effective agent for change.

ACP has a very active Health and Public Policy Committee, which is chaired by Regent Whitney W. Addington, FACP. This committee formulates the College's health policy, usually in the form of position papers that are reviewed by the Board of Governors and approved by the Board of Regents. Our Washington staff, headed by Howard B. Shapiro, PhD, serves as the liaison between ACP, the federal administration and Congress, and is an effective and valuable resource.

Unlike many special interest groups, the College does not have a political action committee (PAC). The laws and other rulings that govern tax-exempt, educational and scientific organizations (known as "501(c)(3)" corporations) are generally interpreted as prohibiting PACs. The assumption is that charitable work and public education are inconsistent with partisan political activity.

Under IRS rules, ACP cannot financially contribute to political campaigns, although we can spend money to educate the public and our membership on health policy issues of a political nature. Our Governors and other chapter representatives visit Washington every spring for an event we call Leadership Day on Capitol Hill, advocating ACP positions in meetings with their senators and representatives. Some ACP Governors remain in contact with their representatives throughout the year.

As I described in last month's column, in my interviews with a number of members of Congress, I asked how ACP could more effectively influence our elected representatives on legislative topics important to internists and to the College. All agreed that establishing a personal relationship is key. All suggested that physicians use every opportunity to visit their representatives in person, that they write to express their opinions and they arrange face-to-face meetings with legislators on their home turf. All said that visiting elected officials in their local office has a greater impact than visiting them in their Washington office, where visits are almost always squeezed into a hectic schedule. They also suggested that physicians get acquainted with their legislators' staff person in charge of health affairs who can help provide access to the politician.

Making contacts

Those of us from less populous states have much easier telephone and personal access to our senators and representatives. No matter where you're from, however, contacting your representative's health policy staff is easier. Establish a working relationship with that person. Make a telephone call on any important issue, and do not give up after one call. Two, three or more follow-up calls to track what's happening on a given issue really will get your legislator's attention, since it is rare that anyone takes the time and trouble to follow up. Don't worry about being a nuisance; as Sen. Max Baucus (D-Mont.) told me, "that's what we get paid for." A follow-up letter is also useful.

Does a personal campaign contribution make a difference? My interviews with congressmen convinced me the short answer is "yes." Although most indicated that they often don't know if a constituent who is writing, calling or visiting is a contributor, the staff knows, and your access is through the staff. Campaign contributions are essential for election and are clearly appreciated. One thing I noted during my interviews is that physicians have an advantage because of the respect accorded them by society. Thus, they have some extra clout with their elected legislator. You will only increase your access and influence by making a contribution. I was assured that the contribution does not have to be a large; $200 is a significant amount. The legal limit is $1,000.

For the greatest impact, members need to get to know their newly elected legislators early on. The same advice applies to new initiatives or bills in Congress. Having input while they are being formulated and debated in subcommittees is essential. Once a bill gets to the floor for a vote, it is nearly impossible to reshape it or to change your legislator's vote.

Do not expect everyone on the Hill to know or recognize ACP. However, those involved in health care issues do know us and respect us for our integrity and positions.

Should we have a PAC?

Some of our members and Governors have argued that the College should change its status to 501(c)(6), the designation for trade associations, which would enable us to have a PAC and to lobby with much less restriction. The AMA and ASIM are both 501(c)(6) tax-exempt organizations with PACs, as are many other medical specialty organizations.

One misconception about the role of PACs, however, is that they provide a large amount of money to influence or buy votes. In fact, smaller PACs typically provide only $500 to $1,000 contributions to politicians in the name of a member from that state. PAC money serves mainly to provide recognition and access for that member, not the organization. It is the health care organizations with large PACs that gain political clout for the organization as well as access for members and lobbyists by giving larger amounts of money.

ACP has not been philosophically inclined to operate in this way. At the recent Annual Session, the Board of Governors declined to support a resolution favoring the creation of a PAC by the College. As a 501(c)(3) organization, we enjoy a significant profile on the Hill and are frequently invited to testify before congressional committees and provide input and information for federal agencies such as HCFA. We are known for advocating for issues on their merits and public good without regard to a political agenda. We also avoid the conflict of supporting a candidate who may hold positions that are different from the College's legislative agenda.

While we may not be interested in creating a PAC, I feel strongly that our leaders and members need to exercise the tremendous potential we have as individuals to influence our local elected officials. This is how democracy should work, and we should not focus only on the national level, particularly since much of the action in health care reform will take place at the state level. If we really care about health care reform, the profession and providing the best care for our patients, we must take up the call to action as individuals and as an organization.

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