Legislative Affairs Feature -- May 2002
By Ken Ortolon
In 1988, a little red card started a conservative revolution on the Texas Supreme Court and cemented the reputation of organized medicine as a force to be reckoned with in Texas electoral politics.
"A Clean Slate for '88" -- an extensive grassroots campaign to elect conservative judges to the state's highest civil bench -- was a high watermark for the Texas Medical Association Political Action Committee (TEXPAC). This year, TEXPAC is celebrating another high point in its history -- its 40th anniversary.
TEXPAC's leaders from throughout its four-decade history, as well as Austin politicos who have watched it grow, say the organization has evolved from humble beginnings into one of the most successful grassroots political movements in the state.
"I've seen it evolve from what at the time was a group just trying to prove its worth," said San Antonio child neurologist Sheldon Gross, MD, who chaired TEXPAC's Board of Directors in the mid-1990s. "It has evolved into what I think is the most important state [medical] PAC in the country and one of a very small handful of PACs in Austin that are at the top of the pyramid in terms of political influence."
TEXPAC was founded by a handful of physicians and the late TMA General Counsel Philip R. Overton in 1962, when the concept of political action committees was fairly new. Writing in his book Inside Medical Washington, Standing Up for Doctors' Rights in the Nation's Capital , the late James H. Sammons, MD, says Texas physicians had only an "informal group" that got involved in electoral politics before TEXPAC.
"We sat around the table and talked about the need to raise money to support political candidates," wrote Dr. Sammons, a former TMA president and executive vice president of the American Medical Association. "The way to do that in those days was to reach in your pocket and simply put your pro rata share into the pot. And that's what we did."
A PAC Is Born
But in the early 1960s the political stakes were getting larger for medicine. In 1961, the AMA Political Action Committee (AMPAC) was created, partly in response to physicians' fears about creation of the Medicare program. AMA, according to Dr. Sammons, decided to step up its level of political involvement because physicians feared the government was making promises to the elderly that it couldn't keep.
"The political atmosphere nationally was fueled by a small but dedicated cadre of social activists who were then and still are blatantly intent on nationalizing the entirety of health care delivery," said Kemp thoracic surgeon Milton V. Davis, MD, a former TMA president and early AMPAC board member.
Dr. Davis says his job as an AMPAC board member was to actively encourage state medical societies to create their own political action committees.
But TEXPAC's successes were slow in coming. Initially, physicians were reluctant to get involved in the political arena.
"Only a few physicians initially believed either that there was a need or that we could or should actively participate," Dr. Davis said.
Former TMA Executive Vice President Robert G. Mickey, who served as TEXPAC director from 1967 to 1976, says TEXPAC raised only about $20,000 the year he started with the organization.
One of his first efforts was to enlist the aid of county medical societies in recruiting members. Despite some initial reluctance, Mr. Mickey convinced the Dallas County Medical Society to place a voluntary TEXPAC dues check-off on its membership application. Dues at the time were $30 per year. Harris County Medical Society soon followed suit.
"Within maybe a year, we had 13 of the 20 largest county medical societies signed on," Mr. Mickey said. "So the money began to come in. We doubled the money in the next year, then doubled it again." By the mid-1970s, annual contributions were approaching $400,000.
With the growing political war chest, TEXPAC's successes began to grow. But Houston ophthalmologist Alan C. Baum, MD, a former TMA president who chaired TEXPAC in 1990-91, says the organization was not having much impact in influencing health care policy.
"We succeeded because we tended to support incumbents," he said. "But we didn't affect change. We rarely stepped out on a limb to do something that would make a difference."
Putting Down Grassroots
That, however, began to change in the late 1970s as organized medicine began to learn that political success involved more than writing a check. One of the first significant changes came in the early 1970s when the TMA Board of Trustees appointed two TMA Alliance members to serve on the TEXPAC board. The alliance, then known as the Women's Auxiliary to the Texas Medical Association, soon proved its worth in grassroots electoral politics.
According to Celebrating Our Diamond Jubilee, 1918-1993, written by Helen Alexander, Elizabeth Nixon, and Frances Hatfield, a major turning point occurred in the mid 1970s when alliance members from San Antonio were asked to talk with a local legislator -- a trial lawyer -- about health care issues. San Antonio general surgeon Everett Bratcher, MD, and his wife, June, volunteered to visit the lawmaker but were snubbed, the authors wrote.
In the 1976 election, Ms. Bratcher and others in the local medical community recruited Republican businessman George Pierce to run against the incumbent. Despite their inexperience at running a political campaign, the TEXPAC-backed candidate came within 1,000 votes of winning. Two years later, the group backed Mr. Pierce again, and with a considerable amount of grassroots campaigning by alliance members, he won.
Since then, the alliance has been a major contributor to TEXPAC's success. "TEXPAC's reliance on the alliance is significant," said current TEXPAC Chair Robert T. Gunby Jr., MD, an obstetrician-gynecologist in Dallas.
With the willingness of both physicians and alliance members to pitch in on grassroots campaigns, TEXPAC has become much more than merely a source of campaign funds, Dr. Gunby says.
"TEXPAC is so much more than just a check to a candidate," he said. "TEXPAC is a political grassroots movement. We don't ask physicians and alliance members to give to TEXPAC, we ask them to join TEXPAC, and that's a considerably different verb."
This grassroots advocacy has turned TEXPAC into one of the most respected political action committees in Austin. And its political successes have been many. Among those, a handful stand out as particularly important.
In 1986, TEXPAC backed Democrat Judith Zaffirini, of Laredo, against Republican State Rep. Bennie Bock, of New Braunfels, for an open state Senate seat despite vocal opposition from physicians from Representative Bock's House district.
"It was a very, very difficult fight in the endorsement process," said Austin political consultant George Shipley, PhD. "There were a number of doctors who dropped out of TMA because of it. But they went ahead and endorsed her, gave her $30,000, and, in my judgment, provided her with the margin of victory."
Since then, Senator Zaffirini has been a staunch advocate of medicine, chairing the Senate Health and Human Services Committee for several sessions. In 2001, she authored the Medicaid reform bill that provided physicians with their first substantial fee update in nearly a decade.
Another important race came in 1991, when Waco oral-surgeon-turned-lawyer David Sibley, a Republican, was battling Rep. Betty Denton (D-Waco) and others in a special election to fill a vacant Senate seat. Representative Denton led the balloting, but the TEXPAC-endorsed Sibley earned a spot in the runoff.
TEXPAC again weighed in, financing a get-out-the-vote campaign in areas of Dallas and Ellis counties where Sibley had considerable support.
"Our mission was to increase the voter turnout from the first balloting," said Fort Worth political consultant Bryan Eppstein, who ran TEXPAC's campaign. Since the election occurred at the height of the Persian Gulf War, Mr. Eppstein bought two miles of yellow ribbon and had it cut into six-inch strips. Then campaign workers mailed the strips or handed them out door to door, along with cards urging voters to support the men and women in the armed forces by exercising their right to vote.
"It's probably the single most successful get-out-the-vote program in the history of Texas politics," Mr. Eppstein said. "We increased balloting by 300 percent from the first election to the runoff."
Again, the new senator became a fast friend of medicine, sponsoring much of what became a landmark package of patients' rights bills enacted in 1997.
Building a Better Court
There have been countless other victories for TEXPAC over the years, but Mr. Mickey says the Texas Supreme Court races in 1988 were TEXPAC's "shining moment."
The 1987 session of the Texas Legislature had ended in frustration for physicians. A package of constitutional amendments to provide some tort relief was pulled down late in the session without a vote.
"We saw it as futile," Dr. Baum said. "We didn't feel like anything we did in 1987 would make any difference until something could be done about the state Supreme Court."
Dominated by the plaintiff's bar and considered highly activist, the court had a reputation for legislating from the bench. In 1977, physicians worked hard to advocate for major medical malpractice reforms only to see large portions of the new law thrown out by the court.
What's worse, charges of corruption were rampant. In 1987 the court was the subject of a highly critical exposé by the CBS newsmagazine "60 Minutes." The reported entitled "Is Justice for Sale?" was an open indictment of Texas' system of electing judges.
It was in that atmosphere that TEXPAC contemplated wading into the court races. And it was a chance remark at a meeting of TEXPAC leaders, TMA lobbyists, and members of the Jefferson County Medical Society that produced the spark for TEXPAC's most successful campaign.
"The room was crowded with doctors," said Kim Ross, TMA vice president for public policy. "I told them that what had to happen next was a change in the composition of the Supreme Court, that we had an opportunity to elect several new judges. And a doctor at the back of the room said, 'Well, don't send me a bunch of biographical and judicial information. Just give me a little card with the right name on it that I can give to my patients.'"
Cleaning the Slate
From that, "A Clean Slate for '88" was born. By the next morning, the late Alex Short, then TEXPAC director, had produced a prototype of the slate card listing the names of the five TEXPAC-endorsed candidates in Supreme Court races. Three were Republicans and two were Democrats. A loose coalition of physicians, alliance members, business groups, and defense attorneys quickly was formed to distribute them. In all, 1.2 million slate cards were distributed through physicians' offices and in workplaces across the state.
"Everybody knows that for most people the judicial races are a bit of a mystery," said Dr. Baum. "We saw this as a way for physicians to at least signal to patients who they thought were the qualified candidates."
Dr. Gross says it was at that moment that "it really struck doctors how much influence we can have if we decide to exercise it. People respect their doctors. When a doctor hands a patient a slate card and says these are all good people who would do a great job, that goes a long, long way."
The slate cards were backed by a grassroots campaign that produced educational pieces that large corporations used to educate their employees and shareholders about the impact the court was having on the business climate of the state. Ad campaigns, billboards, and phone banking were thrown into the mix.
In the end, the Clean Slate campaign succeeded in electing four of the five endorsed candidates -- ousting one activist justice, re-electing two recently appointed conservatives against strong trial lawyer opposition, and winning one open seat.
Since then, TEXPAC's successes have continued. In 1998, it successfully backed Republican Supreme Court Justice John Cornyn for attorney general when virtually no other major political action committee would.
Dr. Gross says much of TEXPAC's success is attributable to its willingness to remain bipartisan.
"When you go into that room to make decisions as a TEXPAC board member, you leave all your party affiliations behind," Dr. Gross said. "What you look at are the candidate's voting record, his philosophies on tort reform, managed care, and Medicaid. You really should not care whether he's Republican or Democrat."
That sometimes makes for hard feelings. TEXPAC's recent decision to endorse Laredo businessman Tony Sanchez in the Democratic primary for governor was a case in point. During nearly an hour of heated discussion, many TEXPAC board members opposed the endorsement, preferring that TEXPAC stay out of the race altogether.
Dr. Shipley says that willingness to be controversial certainly has paid off for TEXPAC.
"TEXPAC has been a scrapper," he said. "It's been controversial, even with some doctors. But over the long haul it has put doctors at the table of power in the formation of health care policy by being willing to take risks."
Money Where Your Mouth Is
After 40 years of success, TEXPAC is continuing to look for new opportunities to influence electoral politics and health care policy. On the heels of its Supreme Court successes, the organization has now become involved in district and appellate court races.
But in spite of its success, TEXPAC leaders say recruiting new members is still their hardest task. Despite being one of the state's largest PACs in terms of fundraising, TEXPAC membership remains only about 20 percent of the total TMA membership.
"It's difficult for those of us who are involved and give it our heart to see other people shy away from it," said Carole Thompson, of San Antonio, one of the current alliance representatives on the TEXPAC board. "When you feel something's wrong with health care, you have to get involved. You can't just scream and be angry because you'll go nowhere."
Dr. Gunby says it's critical that more physicians and alliance members get involved if TEXPAC is going to keep up with its political foes.
"Many physicians think that politics is a dirty word," he said. "But that's how things get done. You have to participate or be swallowed up by other groups that are willing to participate."
Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.
Protect Your Patients and Profession -- Join TEXPAC!
The Texas Medical Association Political Action Committee (TEXPAC) has accomplished great things for medicine during its 40-year history. But TEXPAC could accomplish even more with the help of a larger percentage of Texas Medical Association and TMA Alliance members.
Currently, only about 20 percent of TMA members also participate in TEXPAC. Robert T. Gunby Jr., MD, chair of TEXPAC's Board of Directors, says it's vital that more physicians get involved in electoral politics.
"This is one of the most important things that organized medicine does to protect our patients and our profession," Dr. Gunby said. "It's through political involvement that medicine's goals are met."
Joining TEXPAC is easy. Regular membership is just $125 per year for TMA members and $100 for alliance members. Residents can join for just $40; medical students pay just $10 per year. Spouses of residents can join for $20, and medical student spouses can join for only $10.
If you're ready for a higher level of involvement, join the TEXPAC 300 Club for only $300 per year or the TEXPAC Capitol Club for $1,000. TEXPAC 300 Club members receive invitations to special 300 Club-only events, 500 frequent flyer miles, a TEXPAC 300 Club pin, and more. Capitol Club members get tickets to an annual VIP event, insider briefings with Texas officials, a gold Capitol Club pin, 1,000 frequent flyer miles, special recognition in Texas Medicine, and more.
You can join TEXPAC online at www.texpac.org or by calling (800) 880-1300, ext. 1361, 1362, or 1363.
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