Enhancing surgical advocacy at the state level: The Day at the State Capitol grant program in action

In 2010, the American College of Surgeons (ACS) started a new program to increase the number of chapters that host lobby day programs at their state capitols. The Board of Regents approved a proposal that the Board of Governors and more than 27 chapters endorsed, which would provide $50,000 in grants over a two-year period for state chapters to organize lobby days during the 2011 and 2012 legislative sessions, with renewal in 2013 and 2014. Chapters were eligible to receive up to $5,000, but would be required to match that grant with one dollar for every two dollars received.

The level of interest from state chapters regarding the grant program was high and demonstrated a pent-up demand to increase their state-level advocacy efforts. For the first year of the program, 10 state chapters were awarded grants for the 2011 legislative session, including Alabama, Connecticut, Florida, Georgia, Indiana, Massachusetts, New York, Northern California, Ohio, and Virginia. In 2012, the second year of the program, the level of participation grew to include 16 states and 17 ACS chapters. The chapters that were awarded grants for the 2012 lobby day program were Alabama, Northern California, Connecticut, Florida, Georgia, Illinois (both the Metropolitan Chicago Chapter and Illinois Chapter), Indiana, Kansas, Maine, Massachusetts, Michigan, North Carolina, Ohio, Oregon, Tennessee, and Virginia. At press time, all of the chapters had completed their Day at the State Capitol programs except for Maine, Michigan, and North Carolina.

Following is a summary of the Day at the State Capitol programs held in 2012, including the various approaches for hosting lobby day events, and highlights of some of the important legislation and bills that were discussed with state legislators.

Alabama Chapter lobby day (March 8)

The Alabama Chapter held their lobby day with a core group of leaders from the chapter. Collective meetings with state senators and representatives were held and a number of important and complex issues facing the state were discussed. The surgeons offered their expertise and perspectives on the severe budget crisis and impending cuts to state programs, concerns over workforce shortage and counties without immediate access to surgeons, trauma funding and trauma system development, scope-of-practice expansion, and insufficient funding for public, not-for-profit safety net hospitals. Mark Jackson, the director of legislative affairs and a registered lobbyist with the Medical Association of the State of Alabama, participated and helped organize these meetings with legislators. In addition, ACS State Affairs staff presented an overview of state policy and state legislative affairs at the College.

California Chapter lobby day (April 17)

The Northern California Chapter held its lobby day in conjunction with the California Medical Association’s (CMA) Legislative Day. The CMA arranged some insightful briefings and invited excellent speakers to help the chapter leadership prepare for their legislative visits. While meeting with legislative leaders, discussion centered on a prostate exam bill (A.B. 1621) intended to address a flaw in the existing statute. Under the law, a physician and surgeon examining a patient’s prostate gland during a physical examination were required to provide the patient with specified information if certain conditions were present. A.B. 1621 provided an exemption to this requirement in a trauma/emergency care setting.

The bill was introduced by Assemblywoman Linda Halderman, MD, FACS, and sponsored by the Northern California Chapter. Lobbying efforts for this bill extended beyond the lobby day and turned out to be very successful, as the bill passed and was signed into law by the governor on July 10. (For additional information on the Northern California Chapter Day at the State Capitol, refer to the report by John Garry, MD, FACS, and John Maa, MD, FACS.)

Connecticut Chapter lobby day (March 13-14)

The Connecticut Chapter held their event along with the Connecticut State Medical Society’s Doctor’s Day. This was a two-part event with a dinner sponsored by the chapter on March 13, which included a briefing on advocacy. The following day’s event featured many knowledgeable speakers, including strategic and influential members of the legislature, and Gov. Dannel Malloy. The 20 attending Fellows took the opportunity to discuss with legislators their opposition to the proposed changes to the certificate of merit law in Senate Bill 243. This bill would have revised and removed enacted provisions concerning certificates of merit in medical malpractice actions. This bill did die in the Senate upon adjournment of session.

Florida Chapter lobby day (January 30)

Representatives from the Florida Chapter and the Florida Committee on Trauma headed to Tallahassee January 30 to host their second Day at the State Capitol. The event kicked off with a cocktail reception that provided the opportunity for several ACS members and a number of legislators to have meaningful interactions. The following day, meeting attendees were briefed by the chapter’s lobbyist and then addressed by the former Florida Surgeon General, Frank Farmer, MD.  The legislative appointments focused on a number of issues, including a high school student athlete concussion bill that was passed during the legislative session and the restructuring of the Department of Public Health and the Trauma Division.

Georgia Chapter lobby day (February 2)

The Georgia Chapter lobby day event included a breakfast orientation and briefing session that provided important information about planned meetings with legislative leaders. Issues discussed included working to reinstate funding for state employee health insurance coverage for bariatric surgery, as well as a discussion of the state’s need for the Uniform Emergency Volunteer Health Practitioners Act. As a result, a senator and representative offered to introduce this legislation in the 2013 session. Surgeons also “worked the line,” which means they pulled representatives out of the chamber during general session in order to briefly meet with them. The attendees were given recognition by the chair of the House Health Committee on the floor of the House and then treated to a private meeting with Gov. Nathan Deal (R).

Metro Chicago and Illinois Chapter lobby day (April 25)

A small group of surgeons from the Illinois Chapter and Metro Chicago Chapter held a collaborative effort in their first lobby day program this spring. Following a breakfast briefing on budget issues and effective advocacy strategies, the group met with a number of representatives and senators. Although no specific bills were identified for lobbying, attendees recognized the importance of traveling to Springfield to meet with their representatives and continuing to build a rapport with them and create a strong working relationship.

Indiana Chapter lobby day (February 23)

The Indiana Chapter hosted its second Day at the State Capitol event after the conclusion of the chapter’s winter meeting. More than 25 surgeons gathered to listen to a number of presentations, including updates on the Affordable Care Act as well as a presentation titled How Surgeons Can Influence State Officials.

The keynote address was given by Indiana Rep. Cindy Noe (R), who was invited to participate after connecting with a constituent and ACS member at last year’s Day at the State Capitol. Meetings with legislators focused specifically on the proposed statewide smoking ban bill (H.B. 1149). The chapter’s lobbying efforts paid off when the smoking ban was signed into law during the 2012 legislative session.

Kansas Chapter lobby day (January 18)

The first lobby day program for the Kansas Chapter featured an informative program and agenda. The day started with a breakout session and included a presentation on state affairs resources, grassroots strategy, and legislative priorities from ACS State Affairs staff.

After an in-depth discussion, chapter members joined their primary care colleagues as part of the Kansas Academy of Family Physicians’ lobby day. The physicians were formally acknowledged during a House committee hearing on Medicaid reforms. A reception with legislators and staff concluded the event and allowed for additional conversations with state representatives and senators.

Massachusetts Chapter lobby day (June 27)

The first lobby day organized by this chapter resulted in a large turnout, with 61 chapter members attending. The agenda offered a wide variety of programs, including poster presentations, a simulation session that fulfilled continuing medical education credits, and a session on the ACS National Surgical Quality Improvement Program® and surgeons’ roles in improving health care quality while also reducing costs. The chapter created and presented the John Collin Warren Award to Senate President Therese Murray, acknowledging all of her work and collaboration with Massachusetts Fellows’ efforts in getting injury prevention legislation passed in the state. In addition to numerous visits with legislators, there was an impromptu visit from former Gov. Michael Dukakis (D), who was able to spend some time discussing national health care reform with attendees.

Ohio Chapter lobby day (March 13)

The Ohio Chapter and the Ohio Committee on Trauma hosted their second Day at the State Capitol in 2012. This year, the chapter’s program tested a new format, including dinner with key state legislators. A total of 20 chapter members and six legislators, including members of the House Health and Human Services Committee, discussed a number of legislative issues during the dinner, including breast reconstruction requirements, surgical technology practice, and reform in the state’s trauma system.

Oregon Chapter lobby day (February 12)

The Oregon legislature had a shortened budget schedule as they do every other session, and considering that legislators were looking only at budgetary issues, the focus of the lobby day centered on the state health care transformation legislation. This legislation would enact the Affordable Care Act mandates at the state level, establishing a state health insurance exchange program as well as medical liability reform. There was a dinner with speakers hosted by the chapter, including a lobbyist from the Oregon Medical Association, state Rep. Tim Freeman (R), and state Sen. Elizabeth Steiner (D). On February 13, the group covered grassroots advocacy and advocacy skills with State Affairs staff before the surgeons broke out to meet with their legislators. More than 20 legislative visits were held that day.

Tennessee Chapter lobby day (March 7)

The Tennessee Chapter held it first lobby day on March 7, 2012, during the Tennessee Medical Association’s Physicians Involved at the Tennessee’s Capitol Hill day. Five chapter members/officers were in attendance, who focused their conversations with legislators on the surgical quality improvement work being done through the Tennessee Surgical Quality Collaborative. Other important topics covered during the event included trauma funding, cancer care, rural access to general surgeons, scope of practice, and Medicaid funding. The surgeons in attendance also were able to attend a committee hearing addressing the new and emerging problem of the misuse of bath salts and other illicit drugs.

Virginia Chapter lobby day (February 15)

Earlier this year, surgeons gathered in Richmond to participate in the Virginia Chapter’s White Coats on Call event sponsored by the Medical Society of Virginia. Six surgeons attended the event and met with a dozen legislators during their time at the Capitol. When meeting with legislators, attendees stressed the importance of passing a number of important health care initiatives, including a definition of surgery bill (H.B. 266), legislation addressing nurse practitioner collaborations (H.B. 346), and support of the governor’s budget protecting Medicaid reimbursement rates for physicians.  Both the definition of surgery bill and the nurse practitioner collaborations bills were signed into law and demonstrate the success of this program and the effectiveness and importance of surgeons’ lobbying efforts.

Lobby day take-aways

The highly successful and diverse lobby day programs outlined in this article have increased the profile and reach of advocacy efforts by surgeons with their state legislatures. The following guidelines are key concepts to keep in mind when implementing a successful lobby day program:

  • States are often seen as incubators for new ideas, and ACS chapters have proven that to be true with a variety of successful lobby day models and events. One size does not fit all.
  • Building strong relationships with legislators takes time, and those chapters with a history of sponsoring lobby days and interacting with legislators are finding success in their advocacy efforts. Saying “hello” today over a cocktail at a reception can go a long way toward gaining sponsorship of a bill by a legislator.
  • Effective lobby days do not have to cost huge sums of money. Most of the lobby days described in this article likely cost $3,000-$5,000 overall—well within the budgets of most chapters.
  • Planning is already under way for the 2013 state legislative sessions, and many chapters have applied for lobby day grants for next year. Given the prevalence of health care issues and reforms at the state level, this will be a critical year for surgeons to be involved with advocacy efforts in their states.

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