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WASHINGTON PERSPECTIVE

How is the College working to influence the 2000 elections?

From the February 2000 ACP–ASIM Observer, copyright 2000 by the American College of Physicians–American Society of Internal Medicine.

By Robert B. Doherty

Months ago, the College's Board of Regents made a commitment to put health care for the uninsured at the center of the 2000 elections. The Board then put its money where its mouth is and voted to spend almost $1 million to support the College's Decision 2000 campaign for universal coverage.

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How is that money being spent? And is it doing any good? Although the final votes in the presidential and congressional races are still months away, Decision 2000 is beginning to have an impact.

Our message

Americans have a reputation of responding with compassion and commitment to diseases that affect relatively small groups, yet they have tolerated a situation where 44 million Americans are without health insurance coverage. Why? One answer can be found in opinion polls, which suggest that most Americans believe that good medical care is available to even those who have no health insurance.

One of the Decision 2000 campaign's goals is to counteract that perception. Using the tag line, "No Health Insurance? It's Enough to Make You Sick," the campaign is trying to educate policy-makers, candidates running for office and the public that a lack of health insurance is not just an inconvenience, but a matter of life and death. By showing that people without health insurance face a greater risk of illness or even premature death, ACP–ASIM hopes to persuade elected leaders to view the problem with the same sense of urgency as risk factors such as smoking or drunk driving.

The campaign is using a variety of tactics to get its message out. The College has released research and studies to document the impact of being uninsured on health. We have used news conferences, editorials and paid advertising to get the word out through the media. And we have launched grassroots activities to get the message directly from voters to the candidates.

Research and media activities

The linchpin of ACP–ASIM's campaign is the paper we released at a Nov. 30 press conference. The paper summarized the results of more than 130 studies demonstrating that a lack of insurance is a risk factor by itself, even when other variables are taken into account. The paper received widespread news coverage, including reports in the Washington Post and the Wall Street Journal, as well as coverage on radio and television programs that reach millions of potential voters.

We are planning future studies that will more thoroughly examine how a lack of insurance affects specific population groups, including Latinos and women—two groups that will be key voting blocs in the 2000 elections.

Before and after we released our research paper, the College placed advertisements in the Washington Post and Roll Call (a Capitol Hill newspaper), each with the "No Health Insurance? It's Enough to Make You Sick" tag line. The College also ran full page advertisements with the same theme in the Manchester Union-Leader, New Hampshire's largest newspaper, during the weeks preceding the nation's first presidential primary. This was the first time that the College had ever allocated resources to promoting our agenda in a presidential primary state. We have plans to launch similar ads in other primary states.

Whitney W. Addington, FACP, the College's President and spokesperson for the Decision 2000 campaign, has met with reporters from newspapers and radio and television stations throughout the country, providing yet another means for us to get the word out to voters and candidates.

Grassroots activities

Finally, ACP–ASIM has been using its grassroots network of state chapter leaders, key congressional contacts and individual members to help voters deliver the message directly to candidates. We provided College members with a petition in the November issue of ACP–ASIM Observer calling on all candidates to commit themselves to making solutions to the uninsured problem a top priority. The results of the petition, which was co-sponsored with the Catholic Health Association, will be tabulated and provided to the news media and presidential candidates later this year.

We've also worked with our chapter Governors to develop editorials supporting the campaign's themes for local newspapers. We will soon be placing a voter's guide on ACP–ASIM Online to help internists—and other interested voters—ask the "right" questions of presidential and congressional candidates about their positions on the uninsured.

Results

Is all of this effort having any impact? The early verdict is yes.

Three of the four candidates for president—Sen. John McCain, Vice President Al Gore and former Sen. Bill Bradley—have issued statements of support for the College's research findings. The campaigns of both Mr. Bradley and Vice President Gore have released detailed proposals to expand coverage. And while the issue has not yet become a major theme of the Republican candidates, that is likely to change as we move closer to the general election.

Polls show that access to insurance is among the most important issues for voters. An increasing number of organizations representing consumers, physicians, and other health professionals have endorsed the Decision 2000 campaign message.

When the Decision 2000 campaign was launched last summer, there was nowhere near the level of attention being paid to the issue by the candidates, the electorate or other organizations. While it would be presumptuous to claim that all of the interest in the uninsured is due to the Decision 2000 campaign, there is no doubt that the College's message has been heard by the leading presidential candidates—and by those who advise them. One of the campaign's early contributions to the debate has been to provide the candidates with a new way of looking at the uninsured, as a public health issue rather than simply an economic issue.

The campaign's full effect won't be known until after the elections, and perhaps even more importantly, when the new president and Congress take office next year. But it is not too early to conclude that Decision 2000 has led many, including those running for the nation's highest office, to view ACP–ASIM as the leading physician organization in promoting solutions to the problems of the uninsured. By enhancing the College's overall credibility and stature, Decision 2000 will benefit ACP–ASIM not only in our advocacy efforts on behalf of the uninsured, but on other issues of importance to internists and their patients.

Robert B. Doherty is ACP–ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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