Philadelphia Medicine Spring 2020 - 27

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ADVOCACY

The Little Guy Who Gets
Legislation Passed
By: Larry Light

egislative battles come in all shapes and sizes, and with widely
varying levels of intensity. In the advocacy world, physicians
and physician organizations are significant players. They
engage regularly, and often successfully, on a broad scope of issues.
State and national physician organizations bring significant resources
to bear in a lobbying campaign and the participation of specialty
organizations only increases their clout. Their image as clinicians
wearing white coats and concerned about their patients helps
tremendously. Consequently, other stakeholders such as insurers,
hospitals, trial lawyers, labor unions and patent-oriented groups
take notice, as does the news media.
When the issue is a high-profile conflict between two relative
giants and their allies, the politics can be especially volatile. Tort
reform is an example because it means that physicians, hospitals,
insurers, corporations and defense attorneys will square off against
plaintiff trial lawyers, labor unions and groups representing injured
patients. In Pennsylvania, tort reform issues have been so fiercely
debated that a "moratorium" is sometimes imposed by legislators
who are weary of being caught in the middle.
A successful lobbying strategy for physician advocates can be
convincing legislators to kill or meaningfully amend legislation that
they oppose. Arguing that the proposal would have a negative effect
on the practice of medicine and quality of health care being delivered
to patients can be convincing. But realistically, no advocacy group
wins every legislative battle. In many cases, physician groups find
that they are at a serious disadvantage against the most powerful
lobbying force in the advocacy world - the "little guy."

Like beauty, good or bad legislation is in the eye of the beholder.
Capitol hill veterans know that the "little guy" can negate their best
efforts to oppose even the most egregious "bad" legislation. From
the physician perspective three state laws, all opposed by physicians,
demonstrate the impact of the "little guy."
A law repealing the mandatory motorcycle helmet law, Act
10, was passed in 2003. The proposal wasn't new. Emergency
physicians, PAMED and other specialty groups had successfully
opposed the repeal for years. Repeal advocates, primarily motorcycle
riders, combined an aggressive grassroots advocacy campaign with
an argument based on protecting personal freedoms, to win passage
of the law.

Motorcycle enthusiasts attended countless political events, met
with legislators in their districts, rallied in Harrisburg and participated in numerous community projects. They became a powerful
political force, with a focus on a single issue, and they carried the
day. Subsequent studies revealing increases in motorcycle fatalities
have meant little.
The MOM (Medicare Overcharge Measure) issue brought
another uphill battle for physicians. It proved politically impossible
to effectively oppose a ban on balance billing Medicare patients.
House Bill 700 was designed to protect the "little guy" and as Act
81 of 1990, it still does. The votes in the House and the Senate were
overwhelming (140-61 and 44-6 respectively) and the most often
heard comment from legislative "friends" was that the senior citizen
was a constituent that they did not want to offend.
A more recent example is Act 112 of 2018. House Bill 1884 was
introduced because a constituent patient did not receive a timely
report of test results. The new law requires that testing entities notify
patients directly that test results have been sent to their physician
when the medical imaging test results are determined to have a
significant abnormality. Three legislators in the House and Senate
voted against the bill, despite aggressive opposition and reasoned
arguments from physicians.
The legislative process does present opportunities to soften unpalatable language with physician friendly amendments. The patient
test reporting law was changed significantly between introduction
and final passage. Legislation in later years modified the motorcycle
helmet law repeal. That process represents a political compromise
and some measure of success that should not be discounted.
Fortunately, physicians can also find themselves, sometimes
surprisingly, in the role of the "little guy." Legislative battles against
health insurers present allow physicians to argue that their patients
deserve the best clinical care, regardless of oppressive insurance
policies meant to maximize insurer profits. When pitted against
pharmaceutical companies, physicians have another opportunity
to claim the "little guy" advantage.
Physicians generally have a broad legislative agenda and when
they encounter the "little guy", "bad" legislation is often the result. *
Larry Light is the retired director of communication for the Pennsylvania
Medical Society.
Spring 2020 : Philadelphia Medicine 27

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Philadelphia Medicine Spring 2020

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