Winnability + Friendly Incumbent Are Key Ingredients
Cover Story - November 2007
By Ken Ortolon
Which one of your children do you like best? The Texas Medical Association Political Action Committee (TEXPAC) had to answer a question something like that in 1998 when Greenville family physician Robert Deuell, MD, challenged long-time Democratic incumbent state Sen. David Cain. TEXPAC had to decide which one was its favorite - a fellow physician and TMA member, or a veteran lawmaker who was a staunch supporter of organized medicine on important issues.
The physicians who decided which candidate TEXPAC would throw its influence and money behind never questioned whether Dr. Deuell would be a good senator, but felt they had to stand behind their "friendly incumbent" rule. Thus, TEXPAC stuck with Senator Cain and he won. It made the same choice in 2002, even though redistricting had tilted the district in the Republicans' favor. Dr. Deuell came out on top in that election and was reelected in 2006, this time with TEXPAC's endorsement.
"Bob Deuell, as you can imagine, is a strong supporter of Texas medicine, but at the time he ran against David Cain, and David Cain had been a good supporter of medicine on insurance reform and Medicaid reform," said Dallas dermatologist Dan McCoy, MD, former chair of TEXPAC's Board of Directors and Candidate Evaluation Committee.
Senator Deuell says he has an excellent relationship with TEXPAC and TMA today and says the friendly incumbent rule has merit.
Sometimes TEXPAC's choice can have membership ramifications. That's what happened in 1986 when Judith Zaffirini (D-Laredo) challenged veteran Republican state Rep. Benny Bock, of New Braunfels, for a state Senate seat. Some physicians in the district were angry that TEXPAC took the pragmatic approach and endorsed Zaffirini because she was the likely winner. Some of them dropped out of TEXPAC.
"The doctors in New Braunfels really liked Benny Bock," said Sheldon Gross, MD, of San Antonio, a former TEXPAC Board of Directors chair. "At that time, no one really knew much about Judith Zaffirini. What we did know is there was no way a Republican was going to win that district."
The gamble paid off. Senator Zaffirini is still in the Senate, where she has become a champion for medicine on public health, Medicaid, and many other issues.
Over its 40-year history, TEXPAC frequently has had to make some hard decisions on candidate endorsements, particularly when the state leaders disagree with local physicians over the best candidate, or, as in the Deuell-Cain election, a TMA physician member opposes an incumbent who has supported medicine's issues.
TEXPAC leaders acknowledge that members will never agree 100 percent on every endorsement, but they are committed to making sure plenty of grassroots physician input goes into every decision.
And, both TEXPAC leaders and its political consultants say the organization has one of the most thorough candidate vetting processes of any political action committee in Austin. And that has led to a long-term success rate of more than 90 percent in getting its endorsed candidates elected.
Measuring the Candidates
TEXPAC has decisions to make again as voters go to the polls a year from now. Historically, it has based endorsements on three key factors: local physician input, the candidate's "winnability," and the candidate's stance on priority issues that impact physicians' ability to practice medicine. His or her long-term relationship with organized medicine - the "friendly incumbent" rule - is factored in as well.
"TEXPAC has always chosen to look at local physician input as the first step in the process," said current evaluation committee Chair Susan Strate, MD, of Wichita Falls. She says the committee not only seeks input from local county medical society leaders and legislative committees, but also from individual physicians active in the legislative process. The committee also seeks a recommendation from the TEXPAC district chair representing that area.
Next, TEXPAC confers with its Democratic and Republican political consultants. "Our ability to operate successfully as a nonpartisan PAC, on behalf of our patients and our physician colleagues, requires us to rely on advice from well-respected advisors who are knowledgeable of the electoral dynamics," said TEXPAC Chair Manuel Acosta, MD, of El Paso.
Then, the evaluation committee meets with each candidate to gauge his or her support for medicine's issues.
In fact, TEXPAC's political consultants say the organization is one of the few political action committees that meets face-to-face with candidates and also provides briefing documents to help educate candidates on medicine's key issues.
"I deal with a lot of other organizations and associations and their PACs," said Democratic consultant Kelly Fero, "and nobody is as thorough as TEXPAC about getting information into the hands of lawmakers and candidates."
David Reynolds, TMA director of political education, says those briefing documents help bring candidates up to speed on complicated health care issues.
"If you're talking to a candidate who is a banker or a farmer, they're not going to know a lot about health care," Mr. Reynolds said. "So you give them that document and then let them think about the questions you might ask, help them work through the issues."
Dr. Strate says the candidate meetings and the briefing documents are a critical part of the endorsement process.
"It really gives us a good chance to look at the candidates in terms of their stances on the issues," Dr. Strate said. "It allows physicians at the local level to lay a solid foundation for a relationship with a legislator and establishes appropriate expectations of how we can work cooperatively on health care issues."
Measuring the candidate's winnability factor, or what Dr. Strate calls analyzing the "hard, cold numbers," is the next step in the process.
Republican consultant Bryan Eppstein says winnability is a critical factor that sometimes outweighs a candidate's overall stance on medicine's issues.
While a political action committee might not want to endorse a candidate who will support its positions only two out of 10 times, that group might strongly consider someone who will vote with it 40 or 50 percent of the time over someone who might be stronger on the issues but has little chance of victory, Mr. Eppstein says.
"TEXPAC certainly doesn't want to get in bed with our political enemies, but many times it's not that easy a decision," he said. "Rarely does TEXPAC get the chance to endorse someone who is 100 percent with them. No other PAC has that luxury, either."
The final element in TEXPAC decisions is the friendly incumbent rule. Dr. Acosta says TEXPAC must demonstrate loyalty to those elected officials who have supported medicine's issues in the past.
"It's important that everybody knows we will support a friendly incumbent," Dr. Acosta said. "It's extremely important to continue to show the elected officials that we support them."
When it comes to politics, Austin is a very small town, says Dr. Gross. If TEXPAC turned its back on a friendly incumbent, it could lose its credibility among other elected officials who might decide TEXPAC could not be counted upon to support those who had previously supported medicine's issues, he says.
Nixon's the One
Winnability and the friendly incumbent rule butted heads again in 2006, when TEXPAC endorsed state Rep. Joe Nixon (R-Houston) in a four-person Republican primary to fill a state Senate seat vacated by Sen. Jon Lindsay (R-Houston).
Representative Nixon had authored the landmark TMA-backed medical liability reforms in 2003 and enjoyed tremendous physician support. But the polls showed he badly trailed Houston talk radio personality Dan Patrick, the eventual winner, and state Rep. Peggy Hamric (R-Houston).
"We had a great passion for Joe Nixon because he had been the author of the tort reform bill and had taken a lot of heat for carrying that bill," Mr. Eppstein said. "And yet, this was really not a campaign where Joe Nixon was being assaulted by trial lawyer opponents. TEXPAC, in the end, stayed with Joe Nixon even though he ended up coming in a very, very distant third."
Another case where emotion may have outweighed winnability was the governor's race in 2002. Gov. Rick Perry's veto of the TMA-backed prompt payment bill incited considerable physician support for Democratic challenger Tony Sanchez, Dr. Acosta says. After a very heated discussion, TEXPAC endorsed Mr. Sanchez, even though the polls showed Governor Perry likely would win.
"I think emotion took the forefront and objectivity took the back seat because people were upset over Perry's veto of prompt pay," Mr. Eppstein said. He added that the race was never close and that Mr. Sanchez lost by 21 points.
Dr. Acosta says TEXPAC and TMA also have worked hard to mend fences with Governor Perry, whom TEXPAC endorsed in 2006. The governor since has backed TMA on major issues such as tort reform, even going to the TMA building to sign the medical liability reform legislation into law and speaking at the 2006 TMA Fall Conference.
"Politics don't advance the ball when it comes to public service," Governor Perry said. "I support initiatives that make our state a better place for Texans to live, work, and raise a family. When the policies are good, so are the politics."
No political organization ever achieves 100-percent success, and being on the losing end of a campaign can have negative consequences. Mr. Eppstein says TEXPAC has paid a price in some instances for backing the wrong candidate. In others, it has worked hard to build a relationship with officeholders it didn't initially endorse.
A case in point is Sen. Jane Nelson (R-Lewisville), whom TEXPAC did not support in her first race in 1992.
"TEXPAC did not endorse Jane Nelson, and she is perhaps the single most prolific legislator on medical legislation of the last decade," Mr. Eppstein said. He also noted that though TEXPAC endorsed Senator Nelson's opponent in 1992, physicians formed a strong independent committee to back her and played a key role in her victory.
Examining the Process
Despite an occasional misstep, TEXPAC has had overwhelming success in its political endorsements. Still, the organization is willing to look at its processes to make sure it is making the best decisions for organized medicine.
Dr. Strate says TEXPAC has updated its operating rules to maximize local physician input in the endorsement process.
"We really took a critical look at how we could strengthen the process, improve communication, improve accountability, and increase the input that we get from a variety of sources when we evaluate candidates," she said.
Those operating rules now include a job description for local district chairs that emphasizes communication at the grassroots level, Dr. Strate says.
"Those district chairs work to recruit TEXPAC members and work to solicit local input," she said. "And they try to keep the local physicians informed about what TEXPAC is doing and why we make the decisions we do."
TEXPAC also is examining how it applies the winnability standard and the friendly incumbent rule. TEXPAC leaders and political consultants held a lengthy discussion of those issues at a TMA Board of Trustees meeting in August.
"There is an ongoing debate in TEXPAC about whether there should be a blanket friendly incumbent rule or whether it should be more strategic, with each race taken more on its own merit," said Mr. Fero. "I think the latter argument is winning out recently because there is a feeling that, at least in some cases, the automatic friendly incumbent rule that leads to an endorsement and a contribution does not necessarily get the attention of lawmakers who aren't the strongest friends of medicine."
Dr. McCoy has his own ideas about how TEXPAC's endorsement process might change.
"We need to look at our decision-making process in the backdrop of a very partisan legislature, one that is really polarized along party lines," he said, "and decide if that process works as well as it used to, particularly in regard to how we lobby and endorse members in the leadership."
Dr. McCoy says TEXPAC may need to take a stronger look at actual voting records rather than just an elected official's past relationship with organized medicine or with his or her local physicians.
Finally, Darren Whitehurst, director of the TMA Division of Public Affairs, says physicians must remember that no elected official will support you 100 percent of the time. The goal, he says, is to ensure that organized medicine builds positive relationships with legislators and has reasonable access to argue its positions.
"To increase the likelihood of having legislators who support medicine's issues, we have to constantly work on improving grassroots interaction with them. Legislators need to understand that we are trying to help their local physicians provide health care services for their constituents."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.
TEXPAC Endorses Dr. Shelton in House Race
The Texas Medical Association Political Action Committee (TEXPAC) has endorsed Fort Worth pediatric infectious disease specialist Mark Shelton, MD, in a Nov. 6 special election for state representative.
Dr. Shelton is one of seven candidates vying for the House District 97 seat left vacant by the resignation of state Rep. Anna Mowery (R-Fort Worth), who stepped down on Aug. 31. TEXPAC endorsed him after receiving strong support from both the Tarrant County Medical Society and TCMS Alliance. Key specialty society political action committees also support him.
Dr. Shelton is medical director of infectious diseases at Cook Children's Medical Center in Fort Worth. He is an active member of TMA, Tarrant CMS, and TEXPAC. He currently serves on the TMA Council on Scientific Affairs.
Because it is a special election, there will be no primary. The seven candidates (one Democrat and six Republicans) are on one ballot. If no one receives 50 percent of the vote, the two top vote getters will face each other in a runoff in December.
Other candidates include Fort Worth attorney Dan Barrett, a Democrat, and Republicans Craig Goldman, of Fort Worth, an independent insurance agent; Fort Worth school board member Chris Hatch; Jeff Humber, of Benbrook, director of business development for outreach health services for a Texas-based home health care company; former state Rep. Bob Leonard, of Fort Worth; and Benbrook City Councilman James Scholl.
Get in the Race: Join TEXPAC!
Do you feel that political decisions are made in Austin or Washington, DC, without your input? If so, you don't have to stand idly by and allow your frustrations to build. Why not make a difference in the political process by joining the Texas Medical Association Political Action Committee (TEXPAC)?
In 2008, Texans will head to the polls to elect state and federal candidates who will wield tremendous power over the fate of medicine. TEXPAC will be there, front and center, advocating on behalf of Texas patients and their physicians, helping to elect proven friends of organized medicine.
"TEXPAC really is the vehicle TMA uses to change health care policy in Austin," said Wichita Falls pathologist Susan Strate, MD, chair of the TEXPAC Candidate Evaluation Committee.
Among legislative victories scored in the Texas Legislature this year was a historic 25-percent increase in Medicaid payments to physicians for children's care and a 10-percent increase for adult services; the safeguarding of the 2003 medical liability reforms; and rescinding of most of the 2003 cuts made in eligibility for the Children's Health Insurance Program, providing health insurance for 120,000 additional children.
"There is no question that organized medicine works," said TEXPAC Board of Directors Chair Manuel Acosta, MD. "Some people were very skeptical that we could change the liability situation. We were able to change it because physicians got together and got involved."
If you want to get involved, contact TEXPAC at (800) 880-1300, ext. 1361, or visit the Web site at www.TEXPAC.org.
Contributions to Texas Medical Association Political Action Committee (TEXPAC), Texas Medical Association PAC-Statewide (TEXPAC-Statewide), and American Medical Association PAC (AMPAC) are not deductible as charitable contributions for federal income tax purposes.
Voluntary political contributions to TEXPAC are shared with AMPAC. Contributions are not limited to any suggested amount. Neither TMA nor AMA will favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions to TEXPAC and AMPAC are subject to Federal Election Commission regulations. Federal election law prohibits TMA from soliciting donations from persons who are not in its solicitable class (e.g., TMA members and their families). All donations received from persons who are not in TMA's solicitable class will be returned.
All articles in Texas Medicine that mention Texas Medical Association's stance on state legislation are defined as "legislative advertising," according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine : Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.
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