TEXPAC Restructures to Squash Medicine's Enemies and Stay "United in Protecting Patients"

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Cover Story — September 2014

Tex Med. 2014;110(9):18-24.

By Amy Lynn Sorrel
Associate Editor

When a competitive March primary election knocked out one of El Paso's longtime medicine-friendly House representatives, local physicians like Gilberto Handal, MD, decided to "take the bull by the horns" as the race for the House District 76 seat headed into a late May runoff.

In one corner stood a former Texas House member with a poor track record of supporting the house of medicine and working with fellow lawmakers. From the other corner, Dr. Handal and the El Paso County Medical Society heard a different story. 

After interviewing Democratic newcomer Cesar Blanco for possible endorsement by the Texas Medical Association Political Action Committee (TEXPAC), TMA's political advocacy arm, they agreed: The former chief of staff to U.S. Rep. Pete Gallego (D-Texas) not only had experience and success working with Democratic and Republican peers, but also had an open ear toward medicine's issues.

"He worked with the Texas Legislature. He's been able to negotiate for El Paso and compromise when it's needed. We talked to him about physicians being the leaders of the [health care] team, and he understands the differences in nurse practitioner training. And he is willing to listen to any argument and make reasonable, knowledgeable decisions," said Dr. Handal, an infectious disease specialist. "That's what it took for us to understand he was the right person for the delegation of El Paso."

El Paso County Medical Society submitted its endorsement recommendation to TEXPAC's Candidate Evaluation Committee, which supported the move, as did the full TEXPAC Board of Directors. Come May 27, Mr. Blanco won his party's nomination with TEXPAC's support and nearly 70 percent of the vote. 

"We [physicians] really made a difference," Dr. Handal said. "To me, it's almost unprofessional if we are not defending the profession," in the political realm, he says. "We can't be reactive, and politics is a way to be proactive."

With government playing an increasingly broad role in physicians' and patients' day-to-day lives, the medical profession needs to be involved more than ever, says TEXPAC Board Chair Jerry Hunsaker, MD. That involvement is critical not only to the PAC's success as a political entity but also to physicians' success in caring for their patients. 

"Political participation is crucial to providing good patient care," the Corpus Christi ophthalmologist said. 

Guerilla Warfare

In an increasingly difficult political environment, TEXPAC leaders say the organization is poised to get even tougher with changes that ensure medicine's voice rings in the Texas Legislature and that good health policy — not partisan politics — prevails. The impending departure of Gov. Rick Perry, combined with big turnover at the Capitol and in statewide offices, made this year's primary election season one of the most significant Texas has seen in the past 20 years. And big spending by anti-medicine groups made for some contentious races. 

"The political environment is getting more competitive. There are more players. And it's getting more expensive. TEXPAC has a good track record, but we've got room to improve," said Waco otolaryngologist Brad Holland, MD. 

The TEXPAC membership chair also heads the organization's restructuring committee. "We don't want to be a Republican PAC or organization. We don't want to be a Democratic PAC or organization. We want to be the Party of Medicine. But to do that, we need more of our practicing physicians — those out in the trenches feeling the pain of all that's brought down on them — we need more of those doctors involved. And we need to do better than the 11 percent of TMA member physicians involved."

TEXPAC emerged strong, winning most of the 2014 primary and runoff races in which it endorsed candidates and preserving key seats held by physician and TMA Alliance (the association's volunteer force) members. Rep. J.D. Sheffield, DO (R-Gatesville), and Sen. Donna Campbell, MD (R-New Braunfels), each overcame three-way primary races in their districts to win their party nominations without a runoff. 

The TMA Alliance's Rep. Susan King (R-Abilene) also took her primary race with nearly 70 percent of the vote. A surge of grassroots activism by TEXPAC and the alliance accompanied those battles.

But the significant loss of some pro-medicine candidates and long-standing office-holders — most notably, family physician Sen. Robert Deuell, MD (R-Greenville) — means physicians cannot let down their guard, Dr. Holland warns. 

TEXPAC leaders say the conservative group Empower Texans and Texas Right to Life ganged up on Senator Deuell for defending medicine on end-of-life issues. (See "Difficult Choices," February 2013 Texas Medicine, pages 35-38.)  Their candidate ousted the three-term veteran lawmaker by a mere 300 votes. The affront by Empower Texans and other anti-medicine camps with deep pockets also contributed to losses for TEXPAC candidates in key statewide races for lieutenant governor and attorney general, among other contests. 

"There are organizations in our state that are putting TMA and TEXPAC in the crosshairs. Those groups have millions of dollars behind them, and for us to be able to compete on a statewide level, we need more help, we need more members, and we need more dollars," Dr. Holland said. 

In some of the Senate and statewide races, for example — including Senator Deuell's — medicine's opponents outspent TEXPAC 10 to 1, PAC Director Clayton Stewart adds. 

TEXPAC did well in the House races and still has six physician and alliance friends in the Texas Legislature, including veterans Sen. Charles Schwertner, MD (R-Georgetown), Rep. John Zerwas, MD (R-Simonton), and second-term Rep. Greg Bonnen, MD (R-Friendswood). Their seats are uncontested.

The organization also helped score some key primary wins for nonphysician candidates who, with local physician backing, prevailed over some of medicine's opponents, Mr. Stewart notes. For example, TEXPAC helped carry a new friend of medicine, businessman Will Metcalf, to victory over Empower Texans and Texas Right to Life attacks in the Republican primary runoff for House District 16 in Montgomery County.

But losses in the Senate in particular show "the battle has gone from trench warfare to guerilla warfare," Mr. Stewart said, adding that even despite their victories, Representatives Sheffield and King faced tough sledding from well-financed anti-medicine forces. The political cycle "lays the groundwork for the legislative session, and when we lose our friends, physicians are putting their practices at risk," Mr. Stewart added.

Dr. Hunsaker adds that in addition to the usual, well-defined anti-medicine suspects like trial lawyers looking to tear down tort reform and allied health professionals seeking scope-of-practice expansions, some of medicine's latest foes are more subtle. That makes local physician involvement all the more crucial to dispelling myths about medicine's agenda, he says. 

Vaccines, for example, are known cost-effective, disease-preventing treatments. "But right now we are in a unique situation in that we have some groups that ardently oppose anything medicine wants to do if it involves spending, even if it's spending wisely for the benefit of Texans," Dr. Hunsaker said. 

A Bigger, Better PAC

To counterattack, TEXPAC leaders are revamping the organization to go out and battle on behalf of physicians. That boost includes changes that open up more avenues for physicians to get involved politically, locally, and financially. 

The plan starts with enlarging TEXPAC's voting board and ramping up overall membership to include more physicians of all political stripes from across the state; improving the candidate endorsement process; and building the war chest and grassroots preparation needed to carry out medicine's agenda. 

With the restructuring, Dr. Holland says, TEXPAC's mission to stay "united in protecting patients" stands on firmer ground. "TEXPAC will be a different organization. It will be a better organization. It will be more inclusive and involve physicians more than it ever has before. But our mission and our scope has to be bigger because our opponents are growing, and we are challenged at every turn. And if we don't improve and build and grow, we are going to fall behind and lose more and more of these political battles." 

To achieve that growth, the organization aims to roughly double the size of the voting board. TEXPAC's current board has 44 voting members: one for each of Texas' 31 Senate districts, plus votes from the alliance, the resident and medical student sections, and TEXPAC's internal committees. The new board would include two members from each Senate district and increase alliance, resident, and student votes.  

Fourth-year osteopathic medical student Blair Cushing remembers scanning the TEXPAC roster at a board meeting a year or so ago and noticing not a single medical student on the list. "I looked at my classmates and said, 'We need to sign up.'" 

The Texas College of Osteopathic Medicine student did just that. Ms. Cushing, the former student representative to TMA's Board of Trustees, also sees more of her classmates donning their TEXPAC badges at the TMA Medical Student Section meetings she attends. The medical student and resident slots on the TEXPAC Board are full, too, and the restructuring contemplates expanding the medical student representation from one position for the entire TMA Medical Student Section to nine: one for each medical school in Texas. 

Ms. Cushing's activism in TEXPAC, TMA's First Tuesdays at the Capitol, and local events has since earned her valuable face time with Tarrant County lawmakers, even those who differ from her political beliefs. Those events turned into an opportunity to talk about the ongoing need for more graduate medical education funding to keep aspiring doctors like her in Texas. 

"I developed personal relationships with my representative and representatives from around the county and even their staff members. And during session, every time I went into their offices, even unannounced, I always had an audience," Ms. Cushing said. "They remembered me. They were supportive. And immediately, every one of those representatives said, 'We don't know about this issue, and we need your help to understand it.'"

Candidates for Medicine

The more members engage in building and maintaining relationships with local lawmakers and candidates and the more politically diverse TEXPAC's membership, the better medicine's issues are understood, Dr. Holland says. 

That understanding is key to the PAC's political endorsements, a process the restructuring committee also aims to revitalize.

"We are looking at redoing the way we gauge support, the way we grade and rank our friends and foes, and how we make decisions as to whom to endorse and not endorse," Dr. Holland said. "Physicians have scientific minds. We like to deal in the objective, not the subjective, and we have ways of looking at who truly are our friends and using hard data to do so."

Foremost, TEXPAC gears the endorsement process around recommendations that come directly from physician members and county medical societies that know or work closely with candidates on medicine's issues, says Candidate Evaluation Committee Chair Arlo Weltge, MD, a Houston emergency physician. Other top factors include candidates' support for medicine's goals; their background and experience, for example, if they work in medicine or have family who do; and their potential to win. (See "TEXPAC 101: Candidate Endorsement.")

But Dr. Weltge stresses physicians should engage with every candidate for two reasons: "One, we can't control every election. So the candidate we endorse won't always get elected, and we need to have a relationship with those who do end up in office. Two, even the ones who lose, for the most part, aren't going away. They will be around exerting their influence. So the more we educate candidates long term, the better our issues are understood."

The former scenario recently played out when TEXPAC's endorsed candidate Rep. Dan Branch (R-Dallas) lost the Republican bid for attorney general in a crowded primary election. 

But the relationship Dallas pediatric cardiologist Lee Ann Pearse, MD, and other physicians from Collin and Dallas counties developed over the years with Mr. Branch's rival and victor, state Sen. Ken Paxton (R-McKinney), kept open the lines of communication with the winner heading into the November general election. 

It was the local doctors' vote of confidence in Senator Paxton and his willingness to work with TMA and TEXPAC that ultimately led to the board's decision to back him in the general election, Dr. Hunsaker says. 

Dr. Pearse admits she preferred that TEXPAC back Senator Paxton at the outset, and although both candidates had strong ties to medicine, she remained vocal about her choice. 

"But the bottom line is, having those individual relationships can give another side of the story you don't see in a campaign," she said. "It's critically important for all voices to be heard, and TEXPAC is working hard to reflect the voices of every area, not just Austin. But to do that, physicians have to get involved at the local level and say something."

More recently, medicine's voice and influence have resounded to such a level that candidates now knock on TEXPAC's door looking to work with TMA and earn PAC endorsement, Dr. Weltge adds. Last December, candidates in the statewide attorney general and comptroller races eagerly sought TMA's invitation to speak to members at TMA's Winter Conference held in February. 

"The fact that candidates are seeking us out early on and looking for our endorsement is a huge win, partly because we [physicians] represent an important piece of society and partly because we [TEXPAC] have been very effective," Dr. Weltge said.

Local Action

TEXPAC's revitalization plan also means the organization will be reaching out to on-the-ground physicians and county medical societies with grassroots membership drives, updates from the Capitol, and specifics on how to mobilize locally. (See "TEXPAC Will Come to You.")

San Angelo oncologist David Cummings, MD, signed on just two years ago when he realized the mountain of changes the Affordable Care Act brought to his doorstep. He since stepped up to fill an open vice chair slot on the board for his district and helped spur his county society to become more active — another TEXPAC goal. The PAC and the county medical society worked together to host a roundtable with a local representative, vet candidates for possible endorsement — and more importantly, Dr. Cummings says — arm physicians with the educational tools they need to participate in the legislative process itself.

"Endorsements and trying to get the right people in office, of course, are important. But one of the biggest things TEXPAC can offer is education on how our government works, how a bill gets proposed, and how bills that are detrimental to medicine can get killed in committee if you have the right people in those elected positions," he said. "This means we [physicians] can intervene and have a voice in that process." 

TMA Alliance President Angela Donahue, of Fort Worth, says the volunteer force also has stepped up with TEXPAC representation from alliance members in every county who help galvanize grassroots campaigning by foot, by phone, and by mail. She agrees those efforts are becoming even more critical as races heat up. 

Ms. Donahue and the alliance legion block-walked and distributed push cards to physician offices and schools in support of pediatrician and former Rep. Mark Shelton, MD (R-Fort Worth), when he took another run at the open Senate District 10 seat after losing in 2012 to then-incumbent Sen. Wendy Davis, now the Democratic gubernatorial candidate. (TEXPAC has endorsed Republican gubernatorial candidate Attorney General Greg Abbott. Senator Davis did not ask TEXPAC for an endorsement.)

Ms. Donahue also spoke with patients and community members to dispel what she described as misrepresentations about medicine's platform spread by Dr. Shelton's opponent. "Unfortunately, the race didn't go the way we wanted, and when you have groups out there that are loud, it's hard to get people to understand this person is a friend of health care," she said.

But she's optimistic a stronger TEXPAC means medicine's voice can get even louder. 

Building the War Chest

TEXPAC leaders acknowledge politicking is not for every physician. Regardless, they emphasize every physician can help TEXPAC secure medicine's territory by participating financially. 

TEXPAC recently expanded the organization's contribution levels to create more opportunities for physician, student, and resident involvement. (See "Money Talks.") 

The organization also created a separate, state-only PAC fund to bolster medicine's influence. Previously, TEXPAC combined federal and state monies, which, by federal law, limited the organization in terms of the type and amount of money it could take in and dole out. 

Dr. Holland says having a distinct state-only fund means the PAC can accept larger donations and make larger donations at the state level, "which will open up lots of avenues for us to get involved and be a heavy hitter and accept donations that don't have to be capped or rolled over."

Whether physicians want to directly engage in the political process, "every TMA member ought to be making a contribution to represent medicine's interests," Dr. Weltge said. "If physicians are willing to spend the time and effort to meet a candidate and talk about our issues, those are efforts TEXPAC wants to support. It doesn't guarantee we will endorse that candidate. But we need every physician, regardless of political persuasion, speaking to medicine's issues and building those relationships. Then we will have candidates and legislators who are educated on our issues and friends who will listen for decades to come."

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.

SIDEBAR 

TEXPAC Will Come to You

Are you looking to strike up a conversation with your local lawmakers? Not sure how the legislative process works? Want to build support for a medicine-friendly candidate? 

TEXPAC has the resources and political know-how to get you going and can visit your county medical society to help. 

For more information, contact TEXPAC Director Clayton Stewart by phone at (800) 880-1300, ext. 1365, or (512) 370-1365; or by email

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SIDEBAR

Sept 14 TM Feature Sidebar

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 SIDEBAR

TEXPAC 101: Candidate Endorsement

Step 1: County Medical Society/Individual Physician/Physician Group
Interviews candidate based on his or her position on medicine's issues; votes to send recommendation to TEXPAC Candidate Evaluation Committee

Step 2: TEXPAC Candidate Evaluation Committee
Evaluates candidate recommendations; votes on whether to send recommendation to the full TEXPAC Board for final approval

Step 3: TEXPAC Executive Committee
Votes on how much funding should go to a recommended candidate should the TEXPAC Board support him or her

Step 4: TEXPAC Board
Votes on whether to endorse candidate recommendation

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The Texas Medical Association Political Action Committee (TEXPAC) is a bipartisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state levels. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional association (PAs) that would exceed federal contribution limits will be placed in the TEXPAC statewide account to support nonfederal political candidates. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions used for federal purposes are subject to the prohibitions and limitations of the Federal Election Campaign Act. 

Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for federal income tax purposes.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, call TEXPAC at (512) 370-1361.

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