Physicians, Alliance Members Jump Into Politics
Cover Story – November 2012
By Amy Lynn Sorrel
Tex Med. 2012;108(11):14-22.
Being a family physician in a town of 11,000, J.D. Sheffield, DO, knows firsthand how his Gatesville patients and their families increasingly struggle to afford medications and rising health insurance premiums and copayments. As chief of staff at Coryell Memorial Hospital, he gets to peer into the books and sees similar financial strains. And having practiced in the rural town for nearly two decades and having helped run his medical clinic, he understands the weight small businesses bear when he sees them reluctantly dropping health insurance coverage for their workers.
To ease some of his patients' burdens, Dr. Sheffield has distributed medication samples, partnered patients with pharmaceutical assistance programs, and used sliding fee schedules.
"But when I didn't see anything else we could do at the local level, I felt the best position to help them would be in a legislative seat in Austin," he said. "My patients' situation motivated me to run."
Some of his top goals are making health care coverage more affordable across the board and recruiting more physicians to small towns like his, where medical offices and hospitals are often among the larger employers in the community.
The Republican nominee for the District 59 House seat on Nov. 6, Dr. Sheffield stands among an unprecedented number of physicians and TMA Alliance candidates who ran or are still running for office in the 2012 elections. After unseating several incumbents unfriendly to organized medicine's legislative agenda, in some cases following drawn-out, hotly-contested July runoffs, representatives from the house of medicine are poised to fill as many as eight seats in the Texas House and Senate combined – a first – and keep one seat in the U.S. Congress.
Those battles were accompanied in some cases by an unparalleled surge in grassroots activism by the Texas Medical Association Political Action Committee (TEXPAC), TMA's political advocacy arm; the TMA Alliance, the volunteer force behind the association; and local medical communities, whose members campaigned by foot, by phone, and by mail for their colleague candidates.
Over the past decade, Texas doctors have increasingly sought elected office, according to TEXPAC leaders. Before this election, however, no more than three or four physician or alliance members ran for or held seats in the state legislature at one time. The once-in-a-decade redistricting process, coupled with the debates over federal health system reform, is partially responsible for this peak in physician candidacies.
Even more, perhaps, is a growing awareness among doctors that if they're not helping drive the health policy decisions that directly impact medicine, someone else will take the wheel, says Houston emergency physician Arlo Weltge, MD, chair of TEXPAC's Membership Committee.
"Government plays an increasingly broad role in the day-to-day lives of patients and physicians. In Texas, Medicaid spending makes up the largest portion of the state budget, and second to that is education. So when two-thirds of the budget goes to health care and education, it depends on professionals and leaders in those areas to step up and engage in the process."
The Patient Protection and Affordable Care Act (PPACA) played a role because so much of its implementation depends on what transpires in the state legislatures, and "what happens with PPACA is going to profoundly affect physicians and patients in Texas," added Joe Todd, MD, a Fort Worth orthopedic surgeon and TEXPAC board chair.
Meanwhile, the redistricting process reshuffled a number of legislative seats and opened up many new opportunities for change. The redrawn maps prompted some lawmakers to retire, pushed others into different districts or created new ones, and gave some sitting lawmakers the chance to trade a House position for one in the Senate.
The shake-up created unique opportunities for several fresh physician faces to jump into the races and for medicine to continue to prime the pipeline with candidates who can educate lawmakers on key health policy issues and communicate medicine's agenda.
"The more new faces we have active, the more we have to build on into the future," said Corpus Christi ophthalmologist Jerry Hunsaker, MD, who chairs TEXPAC's Candidate Evaluation Committee.
Neurosurgeon Greg Bonnen, MD (R-Friendswood), is one of those newcomers. He's seeking an open seat in the general election for House District 24 in Galveston County.
As a solo practitioner, a faculty member at The University of Texas Medical Branch at Galveston, and a cofounder of Houston Physicians' Hospital, a specialty hospital in Webster, Dr. Bonnen has participated in the health care arena from nearly every capacity imaginable, from physician to purchaser to facility-owner, and from private practice to academics.
"There's no question that not only in our communities and on the campaign trail, but also in the legislature, doctors have the ability to effectively articulate and explain some complex issues that those with different backgrounds may not as quickly be able to diagnose," he said. Despite the high count of medical candidates in this election, he said, "compared with the number of attorneys or insurance agents or other professions running for office, we don't have enough doctors doing the same."
Other rookies include ophthalmologist/emergency room physician Donna Campbell, MD (R-New Braunfels), who is competing in the general election for the District 25 Senate seat after ousting incumbent Sen. Jeff Wentworth. Alliance member Sonal Bhuchar (R-Sugar Land), wife of TMA member Subodh K. Bhuchar MD, lost in her bid for the House District 26 seat in a crowded Republican primary, after serving as president of her local school board.
Similarly, Susan Todd (R-Fort Worth), a former president of both the TMA and AMA alliances and wife of TEXPAC Chair Dr. Todd, was bested in her inaugural race for the District 97 House seat in Tarrant County. Pediatrician Mark Shelton, MD, vacated that seat when he opted to run for the Senate seat in District 10. Ms. Todd hoped to preserve another medicine-friendly face in Dr. Shelton's spot. She does not plan to run again. Nevertheless, the loss came with a silver lining.
Thanks to the grassroots efforts of the alliance and TEXPAC, Ms. Todd's district had a record voter turnout from the medical community in the May 29 primary, with roughly 50 percent of physicians and their spouses in the community casting their votes. That was despite a low overall turnout of only 11 percent of eligible voters in Tarrant County.
"Having been a novice at this and never run before, the support of TEXPAC and the alliance made me more credible up front, and we certainly got the attention of the medical community, which can only help in the future," Ms. Todd said. "When the alliance and TEXPAC get involved, they make a bigger difference than I think they realize."
Good Ol' Fashioned Grassroots Action
The record turnout was the result of some serious grassroots activism by both physician and alliance members who traveled to Tarrant County from all over the state to block-walk on behalf of Ms. Todd, another first. Even a downpour of rain during a Saturday morning event in February didn't keep away a group of University of North Texas Health Science Center osteopathic students, who could have been sleeping instead, Ms. Todd says.
One of those physician volunteers, pediatrician and allergist Robert J. Rogers, MD, of Fort Worth, block-walked nearly every weekend in support of Ms. Todd and hit the phone banks hard, working lists of local physicians to get them out to vote.
"For anybody who says physicians don't vote – that certainly was not true in our district," said Dr. Rogers, who also chairs the Tarrant County Medical Society Medical Legislation Committee.
Block-walking in the community gave him the chance to interact with local residents, too, where he found that many, while generally interested in the health care issues of the day, "didn't have a clue as to what was really going on, and how big of a problem Medicaid funding and the number of uninsured are in Texas," he said. "It was good to talk with people about that so when they are reading the paper and trying to pay attention and decide whom they vote for, they will rank health care as one of their important issues."
Five years ago, Dr. Rogers would have described himself as a "typical" doctor, frustrated with Medicaid's poor payments and administrative hassles, but lacking a comprehensive view of the program's statewide impact. That was until he started working on these campaigns.
"The more physicians like me who really have no interest in running, but get involved in these elections, I can't help but believe it's going to make us more successful in the legislature as we go into the future," he said. "There's no way to learn without just doing it, and we doctors should be out there supporting those candidates who are shouldering the burden for all of us."
TEXPAC members, including physicians, alliance members, residents, and students, were instrumental not only in helping candidates get exposure, but also in spurring them on to win their primary and runoff races.
A first-ever TEXPAC-sponsored "meet the candidates" tele-town hall event held in March mobilized more than 2,000 TMA and alliance members in a virtual question-and-answer session with Dr. Bonnen, Ms. Todd, Ms. Bhuchar, and Republican state Rep. Charles Schwertner, MD, an orthopedic surgeon from Georgetown who left his Central Texas House seat to run for an open seat in Senate District 5.
TEXPAC's financial and grassroots support provided Dr. Bonnen with extra helping hands as he and other volunteers knocked on 44,000 doors in 11 months of campaigning in the primaries. A December 2011 U.S. Supreme Court ruling that blocked Texas' use of the state's initially redrawn redistricting map pushed the March 6 primary to May 29, and Dr. Bonnen's marathon race ended in a runoff that he ultimately won on July 31, also with record voter turnout in Galveston County.
"We had no option but to campaign all out, not knowing when it was going to end. And TEXPAC's help definitely made a difference, helping us run a first-class campaign," he said. "The turnout was spectacular, and that was definitely related to our grassroots activities."
Dr. Sheffield said his inexperience was a drawback when he first campaigned unsuccessfully two years ago in a tough race with a 12-year incumbent. This time, TEXPAC's support helped him organize and pull through to victory.
When the primary election was extended another three months, Dr. Sheffield's campaign budget also got stretched to the limit. Heading into the runoff, TEXPAC stepped in with significant financial boost, "and we could not have made it through July without that support," Dr. Sheffield said.
Most of the physicians in House District 59 got behind Dr. Sheffield in his second run for the House. Some of those doctors promenaded alongside him and his patients in local town parades, donning campaign signs and fluorescent green T-shirts beneath the Texas summer sun.
"When physicians in a district start calling us about a candidate, that's when TEXPAC starts to get involved and get excited," Dr. Todd said, adding that candidates endorsed by TEXPAC are committed to working with local physicians and TMA to address the needs of all Texans.
Knowing this election cycle presented a great opportunity with redistricting, TEXPAC Director David Reynolds said the organization, the largest bipartisan medical PAC in the state, spent significant resources to ensure medicine's voice resounds.
"To be successful in the 140-day session, we must be fully engaged the other 590 days of the biennial political cycle. That takes finances and elbow grease to help get the best candidates from all political stripes elected to serve, so we can have physicians available in the legislature at critical times to ensure the views of all practicing doctors are taken into consideration," he said.
TEXPAC also helped score some key primary wins for nonphysician candidates who, with local physician backing, ousted some opponents unfriendly to medicine's agenda, Mr. Reynolds says.
Bennett Ratliffe (R-Coppell) toppled four other candidates in the Republican primary contest for the House District 115 seat, ultimately defeating in a runoff an optometrist who spent more than three-quarters of a million dollars. Ninety percent of the loser's campaign funds came from optometrists. Christopher Paddie (R-Marshall) unseated an incumbent with a long antimedicine record for the House District 9 seat. In both contests, the local physician communities were committed to defend against potential scope-of-practice infringements.
Meanwhile, several veteran physician and alliance members in the legislature are well-positioned to continue building strong relationships with other elected officials and provide leadership in navigating the evolving health care landscape, Dr. Todd says.
Those unopposed veterans include Sen. Bob Deuell, MD (R-Greenville), a family physician who is vice-chair of the Senate Health and Human Services Committee and sits on the state Medicaid Reform Waiver Legislative Oversight Committee, along with House Rep. John M. Zerwas, MD (R-Simonton), who won reelection in District 28. Dr. Zerwas, an anesthesiologist, also sits on the House Public Health and Appropriation Committees with Rep. Susan King (R-Abilene), wife of TMA Board Trustee Austin King, MD, and an alliance member who won her race outright as well. Representative Schwertner is expected to win the open Senate seat in District 5. Drs. Shelton and Schwertner also sat on the House Appropriations Committee. U.S. House Rep. Michael Burgess, MD, an obstetrician-gynecologist and long-time TMA ally, is in a contested congressional race for his North Texas seat.
These figures will be "in a position of great importance to the institutional memory going forward, transferring that knowledge to the newcomers, and helping to train them up," Dr. Todd said.
TEXPAC has high hopes for success on Nov. 6. Nearly all of the physician and alliance candidates are expected to win their contests, if they haven't already, especially after they came out on top this far amid crowded fields, entrenched incumbents, and rugged runoffs.
Dr. Shelton's tightly contested District 10 Senate race against incumbent Sen. Wendy Davis (D-Fort Worth) will be one to watch and, if successful, could for the first time put four physicians in the Senate.
"Winning the primary election very strongly predicts who is going to win the general election, and that's why it was critical in some races for us to get engaged early on in the process," TEXPAC's Dr. Weltge said.
Regardless of who wins, he added, "our task and goal is to make sure that all elected legislators are educated on the implications of the medical issues they are presented with and that they all understand the importance of good health policy."
Amy Lynn Sorrel can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
TEXPAC Endorsements for Nov. 6
The Texas Medical Association Political Action Committee had endorsed these candidates in the Nov. 6 election at press time.
Rep. Mark Shelton, MD (R-Fort Worth), District 12
Sen. Bob Deuell, MD (R-Greenville), District 2
Rep. Charles Schwertner, MD (R-Georgetown), District 5
Donna Campbell, MD (R-New Braunfels), District 25
Other Senate Endorsements
District 1: Sen. Kevin Eltife (R-Tyler)
District 6: Sen. Mario Gallegos (D-Houston)
District 7: Sen. Dan Patrick (R-Houston)
District 8: Rep. Ken Paxton (R-McKinney)
District 11: Rep. Larry Taylor (R-Friendswood)
District 15: Sen. John Whitmire (D-Houston)
District 19: Sen. Carlos Uresti (D-San Antonio)
District 20: Sen. Juan "Chuy" Hinojosa (D-McAllen)
District 21: Sen. Judith Zaffirini (D-Laredo)
District 23: Sen. Royce West (D-Dallas)
District 29: Sen. Jose Rodriguez (D-El Paso)
Texas House of Representatives
J.D. Sheffield, DO (R-Gatesville), District 59
James "Greg" Bonnen, MD (R-Friendswood), District 24
Rep. John M. Zerwas, MD (R-Simonton), District 28
Rep. Susan King (R-Abilene), TMA Alliance member, District 71
Other House Endorsements
District 8: Rep. Byron Cook (R-Corsicana)
District 12: Kyle Kacal (R-Bryan)
District 14: John Raney (R-Bryan)
District 17: Rep. Tim Kleinschmidt (R-Lexington)
District 23: Rep. Craig Eiland (D-Galveston)
District 26: Rick Miller (R-Fort Bend)
District 27: Rep. Ron Reynolds (D-Missouri City)
District 29: Ed Thompson (R-Pearland)
District 30: Rep. Geanie Morrison (R-Victoria)
District 31: Rep. Ryan Guillen (D-Rio Grande City)
District 34: Rep. Connie Scott (R-Corpus Christi)
District 39: Rep. Mando Martinez (D-Weslaco)
District 41: Bobby Guerra (D-Edinburg)
District 43: Rep. J.M. Lozano (R-Kingsville)
District 45: Rep. Jason Isaac (R-Dripping Springs)
District 48: Rep. Donna Howard (D-Austin)
District 47: Rep. Paul Workman (R-Austin)
District 54: Rep. Jimmie Don Aycock (R-Killeen)
District 62: Rep. Larry Phillips (R-Sherman)
District 64: Rep. Myra Crownover (R-Denton)
District 65: Ron Simmons (R-Carrollton)
District 74: Poncho Nevarez (D-Eagle Pass)
District 78: Rep. Dee Margo (R-El Paso)
District 87: Rep. Four Price (R-Amarillo)
District 99: Rep. Charlie Geren (R-Fort Worth)
District 102: Stefani Carter (R-Dallas)
District 105: Rep. Linda Harper-Brown (R-Irving)
District 114: Jason Villalba (R-Dallas)
District 115: Bennett Ratliff (R-Coppell)
District 118: Rep. Joe Farias (D-San Antonio)
District 119: Rep. Roland Gutierrez (D-San Antonio)
District 125: Justin Rodriguez (D-San Antonio)
District 127: Rep. Dan Huberty (R-Houston)
District 134: Rep. Sarah Davis (R-West University Place)
District 136: Tony Dale (R-Cedar Park)
District 137: Gene Wu (D-Houston)
District 139: Rep. Sylvester Turner (D-Houston)
District 141: Rep. Senfronia Thompson (D-Houston)
District 143: Rep. Ana Hernandez Luna (D-Houston)
District 144: Mary Ann Perez (D-Houston)
District 147: Rep. Garnet Coleman (D-Houston)
District 149: Rep. Hubert Vo (D-Houston)
U.S. House of Representatives
Rep. Michael Burgess, MD, (R-Lewisville), District 26
OtherU.S. House Endorsements
District 16: Beto O’Rourke (D-El Paso)
District 20: Joaquin Castro (D-San Antonio)
District 23: Quico Canseco (R-San Antonio)
District 25: Roger Williams (R-Weatherford)
District 34: Filemon Vela (D-Brownsville)
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