As the nation sat around the breakfast table the morning after Election Day in 2010, many were shocked at the robust Republican wave of victory. A mere two years after Democrats were given a clear mandate in the 2008 elections—
overwhelming control of the U.S. House of Representatives, a filibuster-proof majority in the Senate, and President Obama in the White House—even the most seasoned Beltway insiders underestimated just how frustrated Americans had grown. In the opinion of some voters, President Obama and the Democratic supermajority in Congress had neglected the ailing economy and instead forged ahead with a contentious health care reform package, Wall Street bailouts, and cap and trade legislation, all of which led to a dramatic shift in public opinion and a good night for Republicans. Despite Democrats outspending Republicans, often by large margins, the Grand Old Party (GOP) captured the House with a net gain of 63 seats and narrowed the power gap in the Senate, leaving the Democrats with only a six-seat advantage.
At that time, Republicans were brimming with confidence heading toward 2012 and the presidential election year. It was almost a foregone conclusion the GOP would take control of the Senate, with Democrats defending 23 seats, many of which were particularly vulnerable, compared with Republicans’ 10. Furthermore, with the Republican sweep of state offices in 2010, the redistricting process was often conducted in a manner that would greatly strengthen Republican prospects in a majority of districts nationwide.
Early in the election cycle, other factors, such as what many Americans perceived as slow job growth and a persistently sluggish economy, indicated Republican gains would once again prove substantial. Furthermore, the U.S. Supreme Court ruling in Citizens United v. Federal Election Commission reversed two major restrictions on campaign spending—the first on corporate spending to explicitly support or oppose political candidates and the other on direct campaign spending by corporations and unions.1 Popular belief held that the reversal of these two spending bans would further bolster Republican chances. Though ultimately incorrect, these changes to campaign finance law unquestionably served to facilitate unprecedented levels of election spending.
Campaign spending on the rise
The official numbers for total dollars spent were unavailable at press time, but estimates just before the election from the Center for Responsive Politics, a leading research group concerning money in politics, put the final spending at more than $6 billion. It was projected that the President and challenger Mitt Romney spent approximately $2.6 billion, the House races totaled nearly $1.1 billion, and the Senate candidates spent around $743 million. Meanwhile, due to the Citizens United Supreme Court ruling, spending by outside groups tipped the scales with total spending by traditional political action committees (PACs) through independent expenditures and super-PACs spending reaching $1 billion.2
As Election Day drew near and the voters, particularly in battleground states, endured seemingly endless political ads, contentious debates, and candidates whose own words ultimately ensured their electoral demise, the high expectations for the GOP failed to materialize. When the dust settled and all the votes were counted—in some instances, recounted—the dynamics in Washington, DC, remained unchanged. President Obama was reelected, Republicans maintained control of the House, and the Democrats retained their status as majority party in the Senate.
David Wasserman, the House editor for The Cook Political Report known for his encyclopedic knowledge and shrewd analysis of congressional races, asserted that “the last three election cycles have been ‘wave elections’ where one party has seen tremendous gains on election night.”3 However, he came to view 2012 as more of a whirlpool, stating, “There’s a lot of churning around and a lot of change that’s not going to work exclusively in one’s side’s favor.”3
Democrats held the Senate with a 55–45 edge, thanks in large part to polarizing Republican primaries that eliminated more moderate or “mainstream” candidates, putting forth nominees who faced insurmountable difficulties in connecting with general election voters. Sen. John Cornyn (R-TX), Chairman of the National Republican Senatorial Committee, “suggested several of the losing GOP Senate candidates beat themselves, either through controversial comments or poorly run campaigns, rather than being outmaneuvered by Democratic opponents.”4 In the House, Democrats’ performance was better than initially forecast, though falling short of Minority Leader Nancy Pelosi’s (D-CA) prediction that the Democrats would gain the 25 seats needed to take back the House with a net gain of eight seats, bringing the balance of power to 234 Republicans to 201 Democrats.4
Washington insiders and average Americans were left to ponder what $6 billion got them. Reid Wilson, editor-in-chief for the National Journal Hotline, described it as a “Democratic president hindered by a painfully slow economic recovery, a dysfunctional Senate controlled by a Democratic majority that cannot advance his agenda, and a Republican House determined to reverse course, all three institutions plotting against each other, unable and—more importantly—unwilling to forge a consensus.”5 Despite the historic levels of spending and the initial favorable condition for Republicans, significant change was simply not in the cards.
The stage is already being set for the 2014 mid-term elections, and if history continues to repeat itself, the Republican Party may have some advantages, despite an intra-party identity crisis. According to Mr. Wasserman, “A president’s party typically loses a large number of seats in the midterm cycle of the president’s second term; the most obvious recent example is the 2006 Democratic wave, when House Democrats gained 30 seats and the majority”—a phenomenon known as the six-year itch.6 Conditions in the Senate lean in favor of the Republicans once again, with seven fewer seats to defend (13 to Democrats’ 20), especially if they are able to seize better control of candidate recruitment. Furthermore, in 12 of the 13 states Republicans will be defending, Mitt Romney won all but Maine—in contrast to seats the Democrats must retain, seven of which are in states Governor Romney won. Those factors, combined with potential retirements and resignations, once again present Democrats with a significant challenge to maintain Leader Harry Reid’s control of the Senate.6
The very real concern exists that with a similar partisan breakdown in the House, Senate, and Executive, the potential for the status-quo gridlock in Washington remains disturbingly high. With surgeons now facing nearly 30 percent cuts due to the flawed sustainable growth rate formula used to calculated physician payment, an additional 2 percent in cuts due to sequestration, potential cuts to graduate medical education, continued long-term inaction on any meaningful medical liability reform, and so on—continued inaction by policymakers serves as a very real threat to the access and quality of care for surgical patients, and a true impairment to the practice of surgery.
The ACSPA-SurgeonsPAC (the American College of Surgeons Professional Association’s political action committee) supported 93 candidates for the House of Representatives (79 total) and Senate (14 total) in the 2012 congressional elections, with an overall success rate of 92 percent. The disbursement ratio for individual candidate PAC contributions was 60 percent to Republicans and 40 percent to Democrats. Inclusive of party committees and other leadership PACs, the ACSPA-SurgeonsPAC disbursed $745,500—58 percent went to Republicans, 42 percent to Democrats. (A complete list of contributions can be found at www.surgeonspac.org, which is accessible to Members and Fellows of the College.)
As in years past, the shifting control of Congress helps to determine the overall disbursement strategy and party breakdown reflected in ACSPA-SurgeonsPAC spending. Due to the inert nature of the 112th Congress, to be careful stewards of PAC dollars, the 2012 elections saw a sharp decline (27 percent since the 2010 election cycle) in total ACSPA-SurgeonsPAC spending. However, the PAC was able to support several promising newly elected members of Congress, and was also able to help in many close races where incumbent champions for surgery on Capitol Hill were in danger of losing their seats.
It is critical that the ACSPA-SurgeonsPAC remain empowered to affect the course of future elections and work to elect the best possible advocates for surgery and the surgical patient. Additionally, individual surgeons must become advocates and build the relationships necessary to spur action in Congress. There are many ways surgeons can get involved and help to elect members of Congress who understand the critical role that surgeons play in the U.S. health care system, including the following:
- Visit the ACSPA-SurgeonsPAC website at www.surgeonspac.org for more information on how to get involved with the ACSPA-SurgeonsPAC and for disbursement lists of candidates the PAC has supported. The ACSPA-SurgeonsPAC is surgery’s most potent tool in shaping the make-up of Congress and exerting the profession of surgery’s political clout. The ACSPA-SurgeonsPAC provides the access and relationships critical to ensuring that surgeons’ unique expertise and perspectives are considered when health policy decisions are made in Washington.
- Many members of Congress and candidates set up health care advisory boards composed of physicians and other experts to help guide policy decisions. Volunteer to serve on one of these panels or, more generally, on a candidate’s campaign.
- Attend the 2013 Leadership Conference and Advocacy Summit in Washington, DC, April 13–16, to learn about issues that affect surgeons, engage decision makers, and directly advocate for your patients and practice. (Learn more and register by visiting www.facs.org/ahp/summit/index.html.)
Surgeons may also work with the College’s Washington Office staff to:
- Set up in-district delivery of ACSPA-SurgeonsPAC checks (a great way for physicians to get to know their member of Congress or candidate and/or to help cultivate the existing relationship).
- Schedule a time for the member of Congress or candidate to tour the physician’s office and learn more about issues facing surgery and how Congress directly affects the physician’s practice and patients.
- Host an in-district fundraiser for fellow surgeons and the greater physician community, benefiting the candidate in the physician’s district.
Individual relationships with members of Congress and their staff are critical to the success of surgery’s advocacy efforts on Capitol Hill. There is no better time to cultivate these vital contacts than when a member or candidate needs your help. To learn more, or to get involved, contact ACSPA-SurgeonsPAC staff at 202-672-1512 or email@example.com.
- McElroy L. Supreme Court of the United States blog. Citizens United v. FEC in plain English. Available at: www.scotusblog.com/2010/01/citizens-united-v-fec-in-plain-english/. Access December 19, 2012.
- Center for Responsive Politics. 2012 election spending will reach $6 billion, Center for Responsive Politics predicts. Available at: www.opensecrets.org/news/2012/10/2012-election-spending-will-reach-6.html. Accessed December 11, 2012.
- Kaiser A. Political pundit predicts Obama win. The Chicago Maroon. Available at: http://chicagomaroon.com/2012/10/16/political-pundit-predicts-obama-win/. Accessed December 11, 2012.
- John Cornyn on Senate races: GOP bungled it.
- Politico.com. Available at: www.politico.com/news/stories/1112/83893_Page2.html#ixzz2EIpS5PDa. Accessed December 10, 2012.
- Wilson R. No easy status quo. National Journal Magazine. Available at: www.nationaljournal.com/columns/on-the-trail/an-uneasy-status-quo-20121105. Accessed December 11, 2012.
- The Cook Political Report. Available at: http://cookpolitical.com/story/5156. Accessed December 10, 2012.