Coordinated Grassroots Approach Steers Medicine's Legislative Agenda
Legislative Affairs Feature -- March 2003
By Ken Ortolon
When the Texas Legislature convened on Jan. 14, Texas Medical Association members were there from the opening gavel, providing a visible presence for organized medicine and reminding lawmakers of the issues important to physicians and patients.
Fort Worth anesthesiologist Rex Hyer, MD, and his wife, Pat, were among several physicians and TMA Alliance members who spent that day at the Capitol visiting their lawmakers and watching the opening ceremonies. Even though there were no debates on medical liability reform and no committee hearings on Medicaid fees that first day, Dr. Hyer says it is critical to the success of medicine's issues that physicians take the time to become personally involved in the legislative process.
"It's one thing to visit with your state representative or state senator in his home office, but he doesn't really realize how important these issues are to our patients and our profession until we show up in the Capitol," Dr. Hyer said. "Involving the grassroots is primary. It's through our personal relationships and our personal interest that we influence legislation that we consider important."
But important as that personal contact with legislators is, it is only one element in a comprehensive lobbying strategy that has made TMA one of the most successful and influential organizations in Austin. By involving rank-and-file physicians from across Texas, the leadership of TMA, the various state specialty societies and county medical societies, and a team of TMA staff experts from the earliest policy debates through drafting and passage of legislation, TMA has built a reputation for true grassroots lobbying that few other organizations can rival.
Preparing the Agenda
TMA's preparations for the 78th Texas Legislature did not begin with the opening gavel. In fact, those preparations have been under way literally since the end of the 77th Legislature in May 2001. Waco internist Joe H. Cunningham, MD, chair of TMA's Council on Legislation, says dozens of physicians and virtually every staff department and division in the association were involved in developing TMA's legislative priorities for 2003.
"The thing that makes TMA an effective organization is that it is an organization with the full support of its members," he said. "We do better than other organizations because we are grassroots based. Physicians out in the communities who are practicing medicine and taking care of people see problems and become involved."
Dr. Cunningham says developing TMA's legislative platform begins with policy directives from the House of Delegates and Board of Trustees. But it also relies heavily on member input, such as data from TMA's biannual membership surveys. They provide critical information about the concerns and priorities of practicing physicians.
Once issues are identified, the Council on Legislation works closely with other councils and committees to vet issues and develop recommendations. Frequently, ad hoc committees of particular physician experts are created to provide advise on specific issues.
Wichita Falls pathologist Susan M. Strate, MD, chaired one such ad hoc committee that looked at patient safety issues during the interim and made recommendations on quality improvement, competency testing, and potential reform of the Texas State Board of Medical Examiners (TSBME). She says such committees play a key role in ensuring that TMA's legislative activities are physician driven.
"The issues that the Council on Legislation deals with are so numerous and so complex that the council needs to download responsibility for analyzing some of the issues to groups like ad hoc committees, which can bring certain areas of expertise to bear on the problems," Dr. Strate said. "For a given ad hoc committee, we can pull in experts on specific issues."
The patient safety committee, for example, included experts on quality improvement, representatives of the National Patient Safety Foundation, and physicians familiar with TSBME activities.
Those committees also can provide geographic and specialty representation to ensure that whatever recommendations are developed are workable for both rural and urban doctors, as well as those in various types of practice settings.
A Big Tent
Fort Worth surgeon Robert W. Sloane Jr., MD, immediate past chair of the Council on Legislation, says TMA also strives to make sure its legislative activities are as inclusive as possible.
"We are painfully open and inclusive," Dr. Sloane said. "We bring in every specialty society and every county medical society and seek their input and active support in the legislative process. Not every state has that kind of camaraderie where everybody stays inside the same tent."
Behind the physician effort, Dr. Cunningham says, are thousands of hours of staff time, not just from the Division of Public Affairs but also from other policy areas, such as socioeconomics, public health, and medical education.
"We pull all the resources of the association together when we have a legislative session," said TMA Executive Vice President Louis J. Goodman, PhD. "The lobbyists, of course, are the generals in charge; they're the field staff. But we bring in all the socioeconomic staff; we bring in legal, medical education, public health, science, and communications to support our legislative program. It goes as deep as the library to do research."
For example, TMA's Office of the General Counsel plays a key role in analyzing legislation and drafting bills and amendments.
"We've always been involved in supporting the line officers," said TMA General Counsel Donald P. Wilcox, JD. "There are a thousand bills that have been filed already. And there are hundreds of bills that we will be keeping track of closely. We divvy up the areas of expertise and interest to help track those bills, provide comments, write legislative amendments, and draft bills on all those issues."
Rich Johnson, director of TMA's Division of Medical Economics, says this approach to carrying out legislative activities has been developed and strengthened over the past decade. Because of staff changes that recently occurred in the TMA Division of Public Affairs, other TMA departments and divisions will play an even more critical role this year, taking on more of the actual lobbying in addition to their policy development and support roles.
"So, whereas in the past we may have been a little more compartmentalized, during this session we will see the integration of our policy staff into what we're doing in the legislative arena," said Mr. Johnson, who will be coordinating TMA's legislative activities this year with Mr. Wilcox.
TMA also has hired several consultants to assist in carrying out its 2003 legislative agenda. Those consultants include former Insurance Commissioner and Secretary of State Elton Bomer, former state Sen. David Sibley, former Health and Human Services Commissioner Don Gilbert, the Fort Worth political consulting firm The Eppstein Group, and veteran Austin lobbyist Mario Martinez.
Executing the Game Plan
The extensive planning and vetting of issues by physicians and TMA staff have led the association to adopt a legislative platform with four major planks -- medical liability reform (including caps on noneconomic damages), prompt payment reform, Medicaid funding and an increase in physician fees, and improvement of the state's childhood immunization rates and immunization tracking registry.
Dr. Cunningham says it is critically important to have physicians and TMA Alliance members involved in lobbying those issues this year. The $9.9 billion state budget shortfall projected by State Comptroller Carole Keeton Strayhorn in January will overshadow the entire session and make any victory on Medicaid funding and other issues difficult to achieve, he says.
"This year, it is more important than ever that we have a lot of doctor involvement," Dr. Cunningham said. "We need to have doctors working within the structure of TMA so that we have a unified message. A well-respected and admired constituent such as a local physician has much more influence with his or her local legislator than any number of lobbyists have.
"One of the great powers that TMA has is that the legislators know that their doctors are involved and their doctors care. And when they know that, then they're going to care about an issue, because doctors carry a tremendous amount of respect, they have a tremendous amount of influence, and they are tremendously important to the autonomy and well-being of the constituents who sent those legislators to Austin," said Dr. Cunningham.
"It's one thing to have a lobbyist walk into a lawmaker's office and give him information," added Dr. Hyer, "but if I walk into that office and he thinks, 'Rex took a day out of his work to come down here,' that's important to him."
Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.
For more information on current legislative issues, visit the "Legislative Issues" page on the TMA Web site.
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