Seven Tips for Effecting Legislative Change
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Getting involved in state and local politics is another way you can care for your patients and community.
Fam Pract Manag. 2001 Apr;8(4):35-38.
Why should you and I – busy family physicians – get involved in politics? Our patients need us to, that's why. Who better than family physicians understands the complexities of providing health care to patients of all ages? Who better can share patients' personal stories about how health care affects their lives? Who better can help shape future health care legislation? Despite our hectic schedules, there is a lot we can do to make our voices heard. A strong political affiliation isn't required, nor is a major time commitment. Here are seven tips for getting more involved at the state and local levels:
Because family physicians work with patients of all ages, their expertise on health-care issues is particularly valuable to legislators.
Getting involved in state and local politics requires a basic understanding of the legislative process, but not necessarily much time.
Writing your legislator, serving on legislative task forces and testifying on an issue during committee hearings are just some of the ways you can get more involved.
1. Get to know your local legislators
Take advantage of opportunities to introduce yourself to your legislator when he or she is campaigning, fund-raising or holding a “town meeting.” Find out about his or her interests and goals for your community. When I was at another residency program, a local legislator expressed an interest in medical education, so we began inviting him to our residency graduation. He attended every year, giving us the opportunity to discuss medical education issues and meet the new physicians who would be practicing in our state.
2. Increase your political awareness
If you need to brush up on politics in your state, log on to the Internet. Most state legislative offices maintain Web sites. The AAFP's legislative action center, “Speak Out,” (www.aafp.org/family) provides links to state legislative sites and tracks current legislation of interest to family physicians and their patients.
3. Offer your opinion
Share your views with your legislators. Some legislators consider receiving comments from as few as a dozen constituents an overwhelming response to an issue. Writing and sending a letter takes very little time. [See “Getting a word in” for tips on effective communication.] Most local and state legislators have e-mail addresses. Mine check their messages daily when the legislature isn't in session. In fact, I often get a response within 24 hours. Response time is slower when the legislature is in session, but e-mail and fax are still the best ways of delivering your message. If you call, you'll probably end up speaking to an aide who you'll have to rely on to relay your message.
Most legislators have a group of physicians they consult with regularly on health-related issues. If this interests you, call the legislator's office and offer to be a resource. It's been my experience that legislators welcome expert input on health care issues.
GETTING A WORD IN
The following suggestions, adapted from “Speak Out,” the AAFP's legislative action center (http://www.aafp.org/advocacy/involved/grassroots.html), will help you maximize your effectiveness when corresponding with legislators.
Writing letters or e-mails:
Make it personal. An individually written letter, rather than a form letter, will make a better impression on your legislator. Legislators will respond to their constituents, so be sure to include your name and full address, including ZIP code.
Be specific. Your purpose should be stated in the first paragraph. If your letter pertains to a specific piece of legislation, be sure to identify it by its full name and number, e.g., House bill (HB):_________, Senate bill (SB):_________.
State your position. Explain why you support or oppose this particular issue. Keep in mind that local examples concerning the impact of this legislation are very powerful. Be courteous and to the point, keeping your letter focused on one issue.
Ask for a response. Indicate to your legislator that you would appreciate a reply that includes his or her position on the issue.
Find out when your state's legislature is in session. Most state legislatures are only in session part of the year. The National Conference of State Legislatures publishes a calendar of legislative regular sessions (available at www.ncsl.org/calendar/). If your state's legislature is out of session, it may be more effective to send your letter to your legislator's district office. To locate the names and addresses of your state's legislators, go to www.senate.gov/general/contact_information/senators_cfm.cfm and simply click on your state.
Address your legislator properly. Begin your salutation with “Dear Senator [last name]” or “Dear Representative [last name].” Always address the envelope with “The Honorable [full name of legislator].”
Follow up. The AAFP's legislative action center also tracks legislative votes. If you agree or disagree with your legislator's vote, take the time to let him or her know.
You can locate the telephone numbers of your state legislators through the AAFP's legislative action center.
Identify yourself. State your name and the organization that you represent or the town where you live.
State your position. For example, say, “I am calling to support/oppose HB_______/SB _______.” Elaborate on only one or two points. Too much information may confuse your message. Ask about the legislator's position on the issue. If you are asked to supply information about the issue, do so as soon as possible.
Don't assume that your legislator is already an expert on the issue. Be prepared to educate him or her, using local or personal examples in your explanation.
If the legislator isn't available. Telephone calls to state legislators' offices are often taken by a staff member. Ask to speak to the legislator or to the aide who handles the issue you would like to comment on. If he or she isn't available, you can also leave a message. Take down the name and title of whomever you speak with and ask that the legislator send you a written response.
Be courteous. Thank the person who took your phone call for his or her time and consideration.
4. Oppose or support proposed legislation
You can use the Internet to follow legislation in most states as it goes through committee and floor votes. And you can make a critical difference by commenting on proposed legislation during this stage. For example, several years ago, a physician in my state of Virginia failed to report a case of Hepatitis A to the local health department. Several other patients became infected as a result. Shortly after this incident, a bill was introduced in the legislature requiring physicians to report all infections, including upper-respiratory infections, to patients' employers. Can you imagine how much time we would have spent on the phone during flu season if this bill had passed?
The evening the bill was posted on the Web site for the Virginia General Assembly, I sent a fax to the chair of the appropriate committee that suggested modifications that addressed the concerns of the bill's sponsors, but didn't require physicians to notify every employer about every head cold.
The bill was amended at the committee's first meeting. The moral of the story? Physician input on health-related issues can effectively reduce the number of corrections or amendments that a bill may require and help speed its progress through the system.
Perhaps the best way to affect proposed legislation is to testify before the committee hearing the bill. Public input is frequently allowed and always appreciated. If you're interested, talk to a committee member about having your name placed on the docket. Be forewarned: Testifying before a committee can be time-consuming and frustrating. Committees often work on a large number of bills at once and may postpone your testimony with little prior notice.
5. Get new legislation introduced
Any citizen or organization can draft a bill, but in most states, they can't introduce the bill to the legislature without a sponsor. A great way to find a sponsor is to meet with your local representatives before the legislative session begins and ask for their help. Prepare yourself for the meeting. Have information at hand to show the pros and cons of the issue and why your proposal would benefit the constituency. State medical societies have been an excellent resource for equipping me with the research and reports I need.
It is also helpful to write a draft outline of the legislation and present that to your representative. To get an idea about how to draft a proposal, look online at current legislation or previous legislative resolutions. Or ask for guidance from a lobbyist for your state medical society or a politically active member of your state AAFP chapter. As long as the draft makes your point, you don't need to worry about wordsmithing. The legislator or legislative attorneys will make the necessary revisions.
Another way to get legislation introduced is to send a resolution to your state chapter of the AAFP or any other medical society where you're a member. These organizations usually have lobbyists or staff members with contacts in the legislature and can help you get your proposal introduced. For example, a local family physician introduced a resolution to the Virginia Academy of Family Physicians to suspend the annual $250 assessment on physicians that endows the state's neurological birth injury fund while the fund was actuarially sound. The legislation was adopted during the next General Assembly session and since then, Virginia physicians haven't had to pay into the fund.
Once a bill is introduced, it must follow the legislative process, which varies from state to state. To be successful, it must have broad, preferably bipartisan support. It also never hurts to have a committee chair co-sponsor a bill. One of the easiest ways to obtain co-sponsors is to present a copy of the bill to the legislator in person or to send a copy with a letter attached asking the legislator to co-sponsor it.
If the legislation is a health care bill, it will fare better if you can demonstrate support from your state's medical society, health department or specialty medical organizations and consumer groups. Enlisting support may be as easy as making a phone call or sending an e-mail to an organization's president or a medical school dean. You may be asked to meet with a group's board of directors to make a brief presentation.
When the bill reaches committee hearings, it's important to have someone (you!) present to answer legislators' questions, explain technical medical language or offer testimony to enhance the bill's chances of passing. Providing a concise fact sheet to committee members that states your position and the people and organizations supporting it can also be useful.
LEGISLATIVE DO'S AND DON'TS
Avoid medical jargon.
Be factual and concise, giving examples when appropriate.
Know the pros and cons of the issue.
Personalize your communication.
Be a patient advocate.
Meet with your local legislators when possible; hopefully, before an issue comes up.
Be a good listener.
Learn the legislative process.
Always answer legislators' questions or requests for more information accurately and promptly. Be truthful if you don't know the answer.
Be willing to testify on issues that are important to you and your patients.
Threaten or make demands.
Be dictatorial, especially if you don't have a thorough knowledge of the issue.
Use form letters.
Come across as self-serving.
Be impatient. The legislative process can be time-consuming.
6. Serve on a task force
Some state legislatures have study committees and task force meetings between legislative sessions. The work these groups do often results in legislative recommendations for the upcoming session. Many medical organizations send representatives to participate in these study groups. If you have a strong interest or expertise on a current health-related issue, ask the organization(s) you're affiliated with to send you. Your participation won't require a lot of your time. Often these groups meet only once or twice.
7. Ask for state funding
As with any legislative bill or resolution, introducing a budget amendment to get state funding for a project requires a legislative sponsor. The ideal sponsor would be a member of the appropriations or finance committee. Competition is fierce where state dollars are concerned and these committee members have a great deal of influence on how the money will be spent. Getting to know them can prove to be invaluable. Bipartisan support is also helpful, as are concise, correct fact sheets and competent testimony demonstrating the need for funding during committee hearings. Following the budget amendments as a constituent can be difficult as not every state posts its budget amendments online.
Your legislature works for you
It is important for us as physicians to share our expertise with legislators as it relates to health care policy and our patients. All you need to effectively advocate for your patients and your profession is a basic understanding of the legislative process and a will to do so. Physicians have made a difference in our state governments. You can make a difference. Your patients and community will be glad you did.
Dr. Hofford is associate director of the Carilion Family Medicine Residency in Roanoke, Va., and associate professor at the University of Virginia, Charlottesville. He is also a past president of the Virginia Academy of Family Physicians. He would like to thank Cynthia M. Hofford, ART, for her helpful editorial suggestions.
Copyright © 2001 by the American Academy of Family Physicians.
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