Are you at the table or on the menu?

It is a reality that the practice of gastroenterology and medicine in general is subject to the public policy decisions made by Congress. The high importance that medical societies like AGA place on advocacy speaks to the impact that legislative and regulatory decisions have on clinical practices. The old adage “if you’re not at the table, you’re on the menu” gets to the heart of why it is so critically important for gastroenterologists to engage in political advocacy. As a profession, GIs have a choice: sit on the sideline as decisions are being made or have a seat at the table when health policy decisions are being made on Capitol Hill.

AGA is committed to representing the interest of gastroenterologists in Congress and is active in the political process in many ways. AGA, like many other medical and specialty medicine societies, has dedicated staff who represent the professional interests of GIs in both the legislative process and in the regulatory space. However, government actions and activities have become so important to the health care delivery system that the responsibility for legislative effectiveness must reside, in part, with all gastroenterologists — not just with the public policy professionals in AGA.

“Government can do something to help you, or government can do something to hurt you — but government is going to do something” -Hubert Humphrey

It is up to gastroenterologists to step up and provide our perspective on the impact of legislation, regulation and encroachment on both our practices and our patients. It is up to us — the members of the association — to provide the personal stories and the impact on the issues we care about. If we don’t speak up for ourselves, no one will do it for us.

We can do that in many ways. We can go to the Hill during our legislative fly-in. We can send action alerts. We can meet with legislators when they are home for in-district breaks. Another important avenue for us to build relationships with candidates — before they even step foot in Congress — is through our AGA’s political action committee: AGA PAC.

What is AGA PAC? And why should GIs care about political engagement?

Politics help shape public policy. It determines who gets elected, who is the most effective in Washington and who has political visibility. In turn, public policy affects our priorities, which include easing administrative burdens such as prior authorization and step therapy, funding biomedical research, protecting fair reimbursements for GI services, reforming self-referral laws, and most importantly, ensuring patient access to high-quality GI care.

Political activity allows us to elect supporters of our specialty, participate in the legislative process, raise the visibility of GI and have a seat at the table when health policy decisions are being made. In short, political action is no longer a luxury, but rather a necessity for our specialty.

So, how exactly do AGA members engage in political activity?

Corporations and associations like AGA are prohibited by law from contributing their organizations’ funds to federal candidates. They are, however, legally able to raise voluntary funds from their employees or members of the sponsoring organization in a separate fund, called a Separated Segregated Fund (SSF), or what is most commonly known as a political action committee (PAC).

The courts consider contributions freedom of political speech and association PACs like AGA PAC are an avenue through which members are able to exercise their right to participate in the political process and have their collective voice heard. Only gastroenterologists who are AGA members are legally permitted to contribute to AGA PAC, which is the only political action committee solely dedicated to representing the interests of gastroenterology on Capitol Hill.

AGA PAC is our specialty’s only formal vehicle for political involvement. AGA PAC is our voice in Washington.

GIs are among the least politically active physician groups.

Exit polls following the 2018 midterm election showed that health care was the most important issue to voters, and recent polling shows that health care continues to be voters’ top issue. Even with the high visibility of health care in our public discourse and the impact that legislative and regulatory actions can have on our patients and profession, GIs remain among the least politically engaged physician organizations (see Graphic 1).

A misperception or limited understanding of the role that PACs play in our political process was found to be one of the barriers to engagement. The rise of Super PACs and the subsequent rise of political spending and the conflation of Super PACs with traditional PACs in our public discourse further complicates the effort.

 

Contrary to common belief, connected PACs like AGA PAC represent the most transparent money in the campaign finance system.

Following the 2010 Supreme Court Citizens United rule, which gave rise to Super PACs and brought unprecedented levels of political spending into our election system, the role of traditional PACs has been subject to misinformation and misperceptions (see Graphic 2). The Supreme Court found that prohibiting certain types of political speech by corporations violated the First Amendment and ruled that individual and corporate spending on advertising that is not coordinated with candidates in a federal election cannot be limited (known as “independent expenditures”). Contrarily, traditional PACs like AGA PAC are heavily regulated and are subject to strict financial limits and reporting requirements.

One of the most important distinctions is that only traditional PACs are allowed to directly contribute to a candidate’s campaign, with the primary goal of electing candidates who understand our industry and policy goals, whereas Super PACs may not. Only traditional PACs are legally able to coordinate directly with the candidates they support. This is important because, through our PAC, we can educate candidates, including incumbents who are seeking re-election, on the issues that are important to us.

The power of the collective

Through AGA PAC, GIs are able to leverage our collective political power to affect change by helping elect legislators who will best represent our profession once in Congress. Although every contribution is important to the candidate’s campaign, PAC contributions have a greater impact because candidates know the money comes from a broad base of contributors, many of whom are constituents from back home. With individual contributions, candidates may not know why you supported them or which issues matter to you. When a PAC makes a contribution, it sends a strong, collective message that contributors share the interests of their association or industry. There is strength in numbers.

“The whole is greater than the sum of its parts” -Aristotle

There are more than 4,000 connected PACs in the U.S. and more than 40 medical specialty PACs. There is no shortage in competition for political visibility. However, we simply will not be on a legislator’s radar screen without a political presence in Washington. While there is no absolute guarantee that a PAC will help secure legislative victories, the lack of a PAC would put AGA in a deficit situation in terms of gaining the attention of lawmakers and ensuring a fair hearing on our issues.

The benefits of political engagement far outweigh the cost of disengagement. Through AGA PAC, AGA members are afforded the opportunity to get involved in the democratic process and make an impact on issues that affect our patients. It is our vehicle to stand as one voice, as the voice for gastroenterologists, and be heard in public policy debates and in the decision-making process.

For better or for worse, we are dependent on the whims of Congress. Gastroenterologists need to step up and be heard on Capitol Hill. Participation in advocacy and in AGA PAC is key. The stronger our PAC, the stronger our voice.

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