New Legislative Advocacy for AHECs 2004 - National AHEC...

© 2004 Charles G. Huntington

Legislative Advocacy for

AHECs

Charles G. Huntington, PA, MPH Associate Director Connecticut AHEC Program 263 Farmington Avenue, MC 2928 Farmington, CT 06030-2928 (860) 679-7968 (860) 679-1101 (fax) [email protected]

© 2004 Charles G. Huntington 1

TABLE OF CONTENTS

Introduction......................................................................................................................... 2

PART ONE – The Basics of Legislative Advocacy

Why Do This? ..................................................................................................................... 3

How a Bill Becomes Law ................................................................................................... 7

Understanding the Needs of Legislators ........................................................................... 12

Message Making ............................................................................................................... 14

Position Papers – What They Are and How to Use Them................................................ 17

Letter Writing.................................................................................................................... 20

Meeting with Your Legislator........................................................................................... 23

Mastering the Media ......................................................................................................... 26

Legislative Coalitions are Powerful.................................................................................. 28

Hosting a Visit to Your Office or Facility ........................................................................ 31

Forming a Health Advisory Committee............................................................................ 33

Persistence Pays ................................................................................................................ 35

PART TWO – Getting Involved in Political Campaigns

Entering the Fray............................................................................................................... 37

Volunteering...................................................................................................................... 40

Fund Raising / Political Giving......................................................................................... 42

Issue Forums ..................................................................................................................... 46

Candidate Coffee............................................................................................................... 49

Getting Staff Members Involved....................................................................................... 51

PART THREE – Lobbying by 501(c)(3) Organizations

Lobbying by 501(c)(3) Organizations............................................................................... 52


The punishment of wise men who refuse to take part in the affairs of government is to live under the government of unwise men. (Plato)

INTRODUCTION This handbook shows you, an AHEC staff or board member, how to influence state, local, and national legislative processes. It provides you with step-by-step instructions, and it lets you to determine the extent of your involvement by offering a broad range of options. Every member of the AHEC family, from the concerned independent voter to the most highly partisan political junkie will find useful information within these covers; it doesn't matter what your party affiliation or political persuasion. Your only risk in having received this material is in failing to use it. In doing so you cede the political process to others, many of whom surely have interests different from your own. The material in this handbook is based on two over riding concepts: Strategic thinking and Building relationships.

The ability of AHECs to achieve their goals, like it or not, is tied to our having supportive legislation. Influencing positive AHEC legislation is a strategy that we must employ if we are to achieve our goals related to health professions’ education, minority and disadvantaged recruitment, continuing education, improving the quality of primary and preventive care, and eliminating health disparities. Successfully implementing a legislative strategy is predicated on building and maintaining productive relationships with local, state and federal legislators. There is no substitute. Part One provides you with background material that is relevant regardless of the level of political activity in which you choose to engage. It is the basic "stuff” of advocacy, and it will help you to understand your audience and to hone your message. It is material worthy of your periodic review, certainly before you launch into any new activity. Part Two presents you with the "how-to's" of a broad range activities related to political campaigns. Some are simple and short-term, and some are highly complex and require a long-term commitment. Part Three briefly summarizes the law dealing with lobbying by 501(c)(3) organizations.


WHY DO THIS? Most AHEC programs and centers are dependent on state and federal funds. Government funding requires, first, that the AHEC program be authorized, that is, exist in statute, and, second, that funds be allocated to the program through the appropriations process. Authorizing legislation: Defines the program, Usually expires after 3 – 5 years, and May specify a ceiling on annual funding.

Appropriations legislation: Allocates funding on a year-to-year basis, Usually is good for one or two years, and May occasionally contain policy directives.

Both state and federal legislatures assign bills to various committees for initial consideration. AHEC legislation is usually taken up by committees with jurisdiction over health or education issues. Most often, different committees consider authorization and appropriations. Because legislatures tend to follow the recommendations of the committees on bills that have gone through committee consideration, most legislative advocacy efforts are focused on the members of the relevant committees. This doesn’t mean that legislators who do not sit on one of the committees of jurisdiction are not important. Ultimately, all bills must come before the full legislature. But, for reasons of economy of effort, legislative advocacy efforts tend to be focused on those committees that consider legislation important to AHECs. Legislative advocacy is important because every form of government, from the local health department to the Congress of the United States, takes actions that either directly or indirectly affect the health of your community. As more and more responsibility devolves from the federal government to the states and local levels, you will have an even greater chance to affect the decisions of elected officials. It is important for you to consider your role in legislative advocacy not simply because AHECs depend on state and federal funding. Three concurrent trends make your involvement in legislative advocacy more important than ever. Federal spending for domestic programs has not kept pace with the growth in the

economy or the growth in AHEC programs. As a result, we are being asked to do more with less.

Domestic programs of all kinds have fallen into disfavor. Both democratic and republican legislators view the role of government in our society from a more conservative perspective. Domestic programs such as the AHEC Program are a tough sell.


Changes in our authorizing legislation have put us in the position of competing with other programs for the same dollars. Advocates for other programs are not shy in suggesting that AHEC dollars would be better spent elsewhere.

The net effect of these three trends is that we are experiencing more competition for fewer dollars and must make our case to a Congress that is less willing to hear any of it. Members of Congress and members of state legislatures support the programs they feel are of the greatest value to their constituents, and they cannot know the value of AHECs relative to other programs unless members of the AHEC community tell them. AHEC staff members, AHEC board members, and people who benefit from AHEC services are best able to articulate why spending tax dollars on AHECs makes good sense. No one else is going to tell the AHEC story for us, but it is an absolute certainty that advocates for other competing programs will be making a compelling case as to why their programs should be funded instead. Changing markets. As a member of the AHEC family you are well aware of the changes in health care. Not only is there large-scale change, but the pace of change is increasing. More and more people are without health insurance, and fewer and fewer providers are available to serve the needs of vulnerable populations. Amidst all the activity, how can your voice be heard by those who are responsible for establishing our state and nation’s health policies? Moreover, health care has become increasingly competitive. Whereas doctors and hospitals used to make most of the decisions affecting health care delivery, now insurance executives and health plan administrators do. Change is never easy, and change is inevitable. It is only reasonable for you to wonder, "What kind of change am I in for?" Although often lost amid the turmoil, in some ways the health care market is evolving along the lines that AHECs have espoused for decades: more community-based, more culturally sensitive, more preventive, more comprehensive, and more continuous. Important segments of the market have come to value the perspective that AHECs have to offer, even though at this moment in time you may not feel that way. For AHECs there is much opportunity in the changing health care delivery system. Inevitably, change creates winners and losers. Dollars for federal and state programs are perennially tight, and competition for those dollars is ever more fierce. Frequently lost in the shuffle are the most vulnerable populations who are least able to advocate for their own needs. Not surprisingly, those interests who feel most threatened by changes in the health care system are mobilizing aggressively to protect their interests. As Americans, we believe in free and competitive markets. Free markets have made us the strongest and most powerful nation on earth. We eschew market regulation unless it is


absolutely necessary, and when it is necessary, we impose only the minimum burden of regulation necessary to simulate competition. Whether or not health care can be distributed appropriately within a competitive market and with what burden of regulation remains a subject of much good-faith debate. But, it is the nature of competitive markets that some participants will do better and some will fare less well. Despite the swelling ranks of those doing less well, at least as measured by the loss of health insurance, the advocates of a competitive health care market have won the day. Political reality. While legislators frequently seek to pass laws that are "right," being right does not guarantee success in the legislative process. In any case, "rightness" is in the eye of the beholder. As often as rightness, the legislative process is driven by the political realities facing legislators. The art of successful advocacy often boils down to figuring out what those realities are and then marshaling the resources necessary to make the process work in your favor. Few people engage in the political process without feeling that their idealism has been violated. But, as a nation, we have been well served by our political processes, and few of us would voluntarily agree to be governed under a different system. We are a nation of competing interests, and, somehow, through all the messiness, those interests get balanced out. As a general matter, those who commit themselves to the process are the ones whose interests are brought to bear. As a member of the AHEC family you are right, but being right does not guarantee that the legislative process will always treat AHECs well. If you are convinced of the virtue of what you do everyday, then it is incumbent on you to do whatever it takes to persuade your legislators of the merits of your case. Others with entirely different ideas about how taxpayer dollars ought to be spent think that they are right too, and they are applying every tool in their arsenal to ensure that their version of right prevails. You're the health care expert. Legislators are rarely health care professionals. They are not in a position to understand health care needs at the community level or to know the best way to train and recruit health care providers. As a member of the AHEC family you are. Legislators need your advice. Legislators take advice from those who will give it. If you don't give it; they won't get it, or they will get it from someone else. Getting involved in the legislative process is about delivering a message. Getting involved means learning how to make your message the most compelling message your legislator hears. You may think that being a dedicated member of the AHEC family and serving diligently your community is enough. Such things should be recognized for their intrinsic value. You are right, they should be, but that well-deserved recognition simply does not occur automatically. Doing the right thing in your AHEC, as important as that is, doesn't mean that your legislator will know what you do or that it is right. You have to tell him or her. And, you can be a very effective communicator of your message. All you have to do is learn the rules that are in this handbook and apply them.


Self-determination. As a member of the AHEC family involved in the legislative process you are helping to ensure that elected officials make the right decisions about health care. In getting involved, you put yourself in a prominent position to influence your legislative environment -- from your city council to your statehouse; from Congress to the White House -- and the public policies under which you live. Few people make the effort to engage in the political process to this degree. Because of your efforts, your elected representative will recognize you as a valuable contributor, as someone with valuable expertise, and as someone who can be trusted. Your representative and senators will listen when you speak; they will seek your advice on important and controversial matters. You will be welcome in their offices. Their success will depend on you. And our success in protecting AHECs’ core beliefs about health care also depends upon you. This is an important responsibility that you are undertaking, not dissimilar from the one you undertook when you entered the AHEC world. As an AHEC staff member or a member of an AHEC board, you assumed responsibility for improving the health and wellbeing of your community. In becoming politically active, you are taking an additional step in executing that same responsibility. Because the decisions that Congress and state legislatures make have such a powerful effect on health care delivery, the latter (political activity) is really just a direct extension of the former (your role in the AHEC movement). The political activities that you are undertaking will ensure that you and your colleagues can continue to serve the needs of your community. You are doing this to maximize your contribution to the health and wellbeing of your community. The role of professional lobbyists. Since many state and national professional organizations employ professional lobbyists to represent their interests before Congress and state legislatures, you may wonder why it is important for you to get involved directly in politics. The fact is that the nature of lobbying has changed. Sunshine laws and aggressive press reporters make the back room deals of the past much more difficult to pull off. Moreover, advances in the use of electronic communications and the increased use of polling have made it much easier to organize large "grassroots" efforts around specific issues. While professional lobbyists continue to play an important role in representing various interests, legislators have always been, and will continue to be, most persuaded by their constituents -- the people who have the power to put them in office and keep them there. Legislators want to know what the voters think. There are two kinds of voter messages that politicians receive. The first is a volume response; i.e., lots of mail on a particular subject. The second is advice from personal and trusted friends. This handbook tells you how to engage in the latter. You are the constituent, you are the voter, and you are a member of the AHEC family. Your opinion counts. Lobbyists have an important function in providing information and in organizing constituent pressure (a volume response), but they can't do it all. There is no substitute for your direct involvement.


HOW A BILL BECOMES LAW You do not need to have a detailed knowledge of legislative process in order to be successful in your legislative advocacy efforts. However, a general familiarity with the steps by which a bill becomes a law will help you understand the rationale and timing of the advocacy process. In this section you will find a description of how a bill becomes law in the U.S. Congress. The process in state legislatures is similar.1 But first, here are the key points that you need to understand about the process. Only a handful of bills are ever enacted into law Each bill goes through a complex process that contains many decision points. The failure to clear any one of these decision points means the bill is dead for that legislative session. Approximately 10,000 bills are introduced into every two-year session of Congress, but only a couple of hundred become law. Advocacy efforts are timed to coincide with key legislative decision points Although the overall process can be quite complex, each bill is subjected to a few key decision points such as subcommittee and committee consideration, legislative hearings, and conference committee consideration. Advocacy efforts are targeted toward influencing the right decision at these key decision points. Each bill is assigned to be considered by a committee with specific jurisdiction In the U.S. Congress AHEC legislation is considered initially by the legislative committees that have specific jurisdiction over health matters. If a bill fails to be reported out of a committee, it is dead. But if a bill is reported favorably by a committee, it has a good chance of becoming law. A table of the key health committees in the Congress appears below. Legislative advocacy efforts are targeted on the members of the key health committees Because committee consideration of a bill is so crucial to its ultimate success, advocacy efforts are focused on the members of the key health committees. Lists of committee members are readily available through the Web site of every legislative body. If this relatively small group of legislators can be convinced to support a bill, its chances of passage are markedly improved. A long-term perspective is an essential asset Legislative dockets are very crowded, and competition for the attention of legislators is keen. Not infrequently, it takes one or two legislative sessions for a bill to enter to consciousness of the legislators. Patience, persistence, and realistic expectations about the number of years that it takes to get a bill passed are essential assets in legislative advocacy.

1 A description of the legislative process in your state can be found on the Web site of your state legislature.


Authorization versus appropriations When the U.S. Congress creates a new health program, it first adopts authorizing legislation, which establishes the program in law, defines its purposes and how it is to operate, and may set a ceiling on the amount of money that can be spent on that program. Authorizing legislation usually specifies a period of time, usually three to five years, after which the program must be re-authorized if it to continue to exist. Congress has a separate process for funding programs called appropriations. Most health programs are called discretionary programs and must be funded by Congress on a year-to-year basis. There are separate committees for dealing with authorization and appropriations matters. Discretionary versus mandatory spending Another important distinction is between discretionary and mandatory spending. Mandatory spending occurs whenever a person qualifies for some federal benefit such as Medicare or Social Security. These programs are broadly referred to as entitlement programs. Mandatory spending is not subject to the annual appropriations process. Congress exercises a degree of control over mandatory spending by modifying an entitlement program’s benefit or the criteria by which a person becomes entitled to the benefit. Discretionary programs are subject to the annual appropriations process. Without an annual appropriation of funds, no spending would occur under discretionary programs. Military spending and a broad range of public health service programs are discretionary programs. Over time, a greater and greater proportion of federal spending has shifted to mandatory programs, which now occupy approximately two-thirds of the federal budget. How a bill becomes a law in the U.S. Congress A diagram of the legislative process used in the U.S. Congress is shown on page 11. Anyone may draft a bill; however, only members of Congress can introduce legislation, and by doing so become the sponsor(s). The legislative process begins when a bill is numbered, (H.R. signifies a House bill and S. a Senate bill), referred to a committee, and printed by the Government Printing Office. The following are the steps of legislative procedure: Referral Committee: With few exceptions, bills are referred to standing committees in the

House or Senate according to the topic of the bill and the jurisdiction of the committee. Committee Action: When a bill reaches a committee, it is placed on the committee's

calendar. A bill can be referred to a subcommittee or considered by the committee as a whole. It is at this point that a bill is examined carefully, and its chances for passage are markedly influenced. If the committee decides not to act on a bill, it is the equivalent of killing it.

Subcommittee Review: Often, bills are referred to a subcommittee for study and hearings.

Hearings provide the opportunity to put on the record the views of the executive branch, experts, other public officials, supporters, and opponents of the legislation.


Mark Up: When the hearings are completed, the subcommittee may meet to "mark up"

the bill, that is, make changes and amendments prior to recommending the bill to the full committee. If a subcommittee votes not to report legislation to the full committee, the bill dies.

Committee Action to Report a Bill: After receiving a subcommittee's report on a bill, the

full committee can conduct further study and hearings, it can vote on the subcommittee's recommendations and any proposed amendments, or it can do nothing. When the full committee votes affirmatively on recommendation to the House or Senate, the procedure is called "ordering a bill reported."

Publication of a Written Report: After a committee votes to have a bill reported, the

committee chairman instructs staff to prepare a written report on the bill. This report describes the intent and scope of the legislation, impact on existing laws and programs, position of the executive branch, and views of dissenting members of the committee.

Schedule Floor Action: After a bill is reported back to the chamber where it originated, it

is placed in chronological order on the calendar. Debate: When a bill reaches the floor of the House or Senate, rules and procedures

governing the debate on the legislation are determined. The specific rules of debate adopted for a bill can significantly influence the bill’s chances of passage.

Voting: After the debate and the approval of any amendments, the bill is passed or

defeated by the members voting. Referral to Other Chamber: When a bill is passed by the House or Senate it is referred to

the other chamber where it usually follows the same route through committee and floor action. This chamber may approve the bill as received, reject it, ignore it, or change it. Often the same or similar bills are introduced into both the House and Senate and follow roughly parallel courses through both chambers.

Conference Committee Action: If only minor changes are made to a bill by the other

chamber, it is common for the legislation to go directly to the President for signature. However, when the actions of the other chamber significantly alter the bill, a conference committee is formed to reconcile the differences between the House and Senate versions. If the conferees are unable to reach agreement, the legislation dies. If agreement is reached, a conference report is prepared describing the committee members' recommendations for changes. Both the House and Senate must approve the conference report.

Final Action: After a bill has been approved by both the House and Senate in identical

form, it is sent to the President. If the President approves of the legislation, he or she signs it and it becomes law. Or, if the President can take no action for ten days while Congress is in session, the bill automatically becomes law. If the President opposes the


bill, it can be vetoed, or if the President takes no action after the Congress has adjourned, the legislation dies by a mechanism known as a “pocket veto.”

Overriding a Veto: If the President vetoes a bill, Congress may attempt to override the

veto. This requires a two-thirds roll call vote of the members who are present in sufficient numbers for a quorum.

The Federal Legislative Process

Federal budget process Unlike most bills, the federal budget is a must-pass piece of legislation. It follows a somewhat different path through Congress than other bills. Because of its must-pass nature, legislators often attempt to attach their legislative priorities to the budget bill. Much of what Congress accomplishes from year to year is done in the context of the budget. For that reason, legislative advocacy efforts are also dictated by the budget process.

Bill introduced by member of Congress

Bill referred to a

standing committee

Bill referred to subcommittee for study and

hearings

Committee mark-up

Committee reports bill

Floor action

scheduled

Rules of debate

established

Vote occurs

Referral to the other chamber

Committee consideration

Vote in the other

chamber

Differences reconciled in conference committee

Reconciled bill voted upon in

each chamber

Bill sent to President

President signs or

vetoes the bill

Congress over-rides or sustains

veto


Federal Budget Process

Important committees As noted above, only certain committees have jurisdiction over health legislation. Legislative advocacy efforts are generally targeted on the members of these key committees. In the U.S. House of Representatives, the subcommittees tend to take the lead in considering bills, while in the U.S. Senate, most of the action occurs at the full committee level.

House of Representatives Senate Ways and Mean Committee Subcommittee on Health

Commerce Committee Subcommittee on Health and the

Environment Appropriations Committee Subcommittee on Labor, HHS, and

Education

Finance Committee Health, Education, Labor And Pensions Committee Appropriations Committee Subcommittee on Labor, HHS, and

Education

President's budget sent to Congress

(early February)

Committees complete budget review

Budget Resolution Adopted

(April 15)

Appropriations Committees

allocate funds within budget

targets

Budget Reconciliation

Omnibus Budget

Reconciliaion Act

(October 1)

Other committees

report changes

necessary to achieve budget targets


UNDERSTANDING THE NEEDS OF LEGISLATORS A key element in positioning yourself to influence the legislative process is understanding the needs of legislators and doing whatever you can to meet those needs. It's really very simple; you try to meet their needs, and later, when the time is right, they will try to meet yours. Candidates first. The first and most important thing that you must understand is that legislators are always candidates. Except perhaps for U.S. Senators, who have six-year terms, elected officials are almost always running for office. An essential screen through which a legislator will put every issue before deciding on his or her position is the impact that position will have on the chances for re-election. What's in a name? Candidates for elected office need first-and-foremost to achieve solid name recognition in their districts. Promoting name recognition involves everything from yard placards and bumper stickers to slick expensive infomercials. Because of the high cost of advertising, candidates seek as many opportunities as possible to generate free publicity through the news media (earned media). This is where you come in. Several sections of this handbook show you how to stage news events that will attract the media and generate free publicity. Keeping the news angle in mind is something about which you will be reminded throughout this handbook. Building the platform. Beyond name recognition, candidates need to distinguish themselves through their individual campaign messages, which collectively make up a platform. Each candidate seeks to be identified with a few clear, broad campaign themes, or "planks," that resonate with voters. Most people don't care very much about politics, so candidates attempt to communicate in a way that connects with voters regarding things they do care about. Most often this means connecting at an emotional level. Politicians know that people will vote for someone they believe cares about the same things that they care about. But, how does a politician know what the voters care about? Not infrequently they use poll results, but more often they rely on their own constituents who take the time to share their concerns. Because you know that your candidate needs to develop messages that resonate with constituents, you can communicate your issues in a way that literally gives the politician the message he or she needs. There are a number of things that you can do to help meet the candidate's need for an identifiable campaign platform. First, you can encourage the candidate to include a health care plank. Second, you can advise the candidate on what his or her health care plank ought to be. Third, you can arrange events at which the candidate promotes his or her health plank and

obtains free media coverage. (As with name recognition, expensive media advertising is the main vehicle for communicating the platform message.)


All of these topics are covered later in this handbook. Getting the vote out. In a close election, voter turn out can make the difference between victory and defeat. Support is meaningless unless supporters vote. There are a variety of things that you can do to meet the candidates' need to get out the vote. Many of them are non-partisan in nature. (Regardless of the impact on election results, it is our collective civic duty to vote!) You can help increase voter participation by volunteering to register voters, by encouraging your colleagues, your employees, and your neighbors to vote, and by transporting individuals to and from the polls. This activity can be as simple as hanging a sign in your office urging people to register and vote, without regard to whom they actually vote for. Staying alive and avoiding risk. No matter what initially motivates a candidate to run for political office, it will all be for naught unless the candidate is elected. Staying in office means that a legislator must know the impact on the electorate of every decision that he or she makes. In fact, it is probably not too much of an exaggeration to say that impact on the electorate is the major factor driving most of the decisions that a legislator makes. Legislators are risk-averse. Most are loath to take a stand that can be used against them in an election, and they are reluctant to even consider taking a stand until they are able to assess with certainty the impact on voters of any particular bill. Assessing the impact on voters is not simply a matter of counting votes. It is more apt to mean avoiding the ire of active and vocal constituencies who are able to stir up voter sympathies. These two political imperatives, to get elected and to avoid risk, present you with tremendous opportunities. You are a constituent and a member of the community. You have your ear close to the ground. You know and can accurately communicate the diverse views within the health care community, and you can project with authority the impact of various legislative proposals on health care delivery. You provide the local perspective. You can prevent your legislator from stepping on a political land mine. Having said this, all legislators will occasionally take an unpopular but principled stand. Knowing that there are opinion leaders in the community will back them up is very important.


MESSAGE MAKING As a member of the AHEC family, you have a message to deliver, and you have a very limited opportunity to get it across. First, you need to get your audience's attention and then you need to communicate it in a clear and concise manner. This is not necessarily difficult to do, but it requires a little forethought and planning on your part. The right message delivered at the right time and through the right channel makes for effective communication. Failing to coordinate the message and its delivery with the audience wastes time and effort. You will need to invest a little of both in order to be recognized and heard. Your message must be important enough to be heard over the barrage of information competing for the legislator’s attention every day. And, your message must vie with those taking competing views, who may have greater resources with which to craft and deliver their own perspectives. As a member of the AHEC family, you have probably learned to write and speak in an professional or academic language, a language that is highly intellectual. In some ways you have learned to keep emotion out of your language. However, the language of politics is designed to reach people on an emotional level. Even though politicians may fully appreciate the intellectual merits of your argument, what you are trying to communicate must connect at the gut level. In order to communicate effectively, you don't need to change what you believe or value, you just need to be sensitive to your audience and how you express your message. Below are some guidelines on creating a persuasive message and communicating it. Know your audience. Before you can be persuasive, you must know to whom you are talking. Do a little background research. Candidate biographies are available on legislative and campaign websites. If your AHEC program or academic health center employs a lobbyist, he or she can provide you with extensive information on state and federal legislators. Interspersing your conversation with bits of personal (but not too personal!) information can help make a connection. It is essential that you know the candidate's past record related to the issue that you bring. You can find this out through press reports, press releases, previous conversations, speeches, voting records, or word-of-mouth (confirm!). Again, your program’s lobbyist can assist you with voting records. Know your topic. It may seem self-evident, but don't ever assume that you can just "wing-it" in a conversation with a legislator. Make sure your facts are straight and supportable, and know both sides of the issue. If you don't know the answer to a question, say so and offer to get it.


While it is important for you be viewed as a political supporter, as someone to whom the candidate is indebted, in the long run it is your credibility that will result in sustained influence. Don't let your legislator get blind-sided by information that you failed to provide. Equipping a legislator to refute opposing arguments usually means you have to raise the opposing arguments and then provide the rebuttals. Don't hesitate to do so. The candidate's mind-set. It is important to remember that a legislator is always crafting his or her own message and that a legislator is always running for office. Even as you are speaking, he or she is considering how the issue or position you are advocating is likely to play with voters. Your job is to construct your message in a way that serves the political needs of the office holder. Keep it simple... Put your message in people terms. Avoid the temptation to speak of health care issues in technical jargon. Express the issue or problem that you want addressed in terms of its impact on voters. Remember, you are one of those voters. Relay in simple terms how an issue affects you and the people served by your AHEC. Remember, too, that the candidate must be able to communicate your issue to others. Provide them with simple, straightforward language and illustrative anecdotes. For example, suppose that you are making a pitch for more federal funds for AHEC programs. From the perspective of a member of Congress, the statement, "increasing the FY 2005 appropriation for section 751 of the Public Health Service Act by $4.625 million," is just not something the general public will readily understand or immediately support. A wording that would be more useful to a candidate for Congress is, "improving the health of citizens by providing them with the security of a readily available supply of high quality primary care providers." The point here is, don't make the candidate do the translation. Deliver your message in terms of how the issue affects you and those you serve. Only after providing your legislator with the more user-friendly version should you follow up with the technical specifications of what you want the legislator to address. Note: As a general matter, your messages to a candidate who is challenging and incumbent legislator will need to be more thematic and less specific than the messages that you would communicate to a current office holder. And, during election season, even an incumbent legislator may have little interest in the specifics of an issue. Keep it short, too. Always, always, always be concise. Time is short; attention spans even more so. If you really feel compelled to communicate a lot of detail, include it as an attachment. We all like to be appreciated. Begin your message on a positive note. Like everyone else, legislators appreciate recognition of their important roles and accomplishments. Thank the legislator for something. Let him or her know how much you appreciate the effort and skill that went to achieving some outcome of major importance. If necessary, use your imagination, but don't be gratuitous.


Three-part message An effective message has three parts, each of which must be communicated in order. Value -- The gut-level shared concern that establishes an emotional connection between

you and your audience. Idea -- The concept or general principle that you are trying to get across. Issue -- The specifics of your issue.

Too often messages begin with the details of the issue before any real connection with the audience has been established. This is a particular problem for health care providers and educators. Think about how a clinical case is presented. It begins with the history and physical exam findings and then moves toward a diagnosis that explains as many of the details as possible. It is the exact opposite of the way you need to communicate to your legislators. With legislators you must start at the value level. Do not assume that a politician appreciates the value of the detailed proposal that you intend to lay out. Connect with them first. Fortunately, health is a fundamental value, and anything you might wish to communicate can be put in terms of improved health. For example: “The increasing cost of health care is placing in jeopardy the health of a growing number of people who are without health insurance.” Having established some common ground on the value level, you can introduce the central idea of your particular issue. At the idea level you are discussing the root of the issue or the concept of what you wish the legislator to support. Using the example of AHEC funding from above, the central idea is the federal government's role in ensuring an adequate supply of primary care providers for under-served populations. Once you get conceptual agreement on your issue, you can go on to discuss the details of your proposal. In doing so it always pays to repeatedly show how the solution that you propose relates to the larger set of values and ideas that you have raised. Your task is to both educate and motivate. Conclude with a specific request and a commitment to follow up. For example: “Increasing federal funding of the AHEC program (Section 751 of the Public Health Service Act) by $4.6 million will increase the supply of primary care providers to underserved populations.” You can make a difference. Communicate to your legislator that they can make a difference, that because of their particular qualifications they are uniquely able to address this issue. Their qualifications may be as simple as being a member of the community and, therefore, being able to fully appreciate the problem and address it. Or, they may have a professional background especially suited to the issue, or they may be on one of the health committees with jurisdiction over the issue. For whatever reason you can think of, or even invent, communicate to the member or the candidate that they are uniquely qualified to address your issue. Legislators need to be viewed by voters as someone who can make a difference; your job is to help meet that need.


No whining! Finally, don't whine. Always approach an issue with a well-developed solution in hand. You may not have all the answers, but you must present a plan that allows the candidate or elected official to articulate a solid approach to resolving the issue.


POSTION PAPERS – WHAT THEY ARE AND HOW TO USE THEM You will find several references to position papers in this handbook. These simple and direct documents are provided as a tool for you to use in your contacts with elected officials and their staff members as well as candidates and their campaign staff. Position papers reflect the priority issues that surface continually in health legislation. Position papers are drafted in simple, easily grasped and straightforward language of the sort used in political campaigns and by the print and broadcast media. Although some position papers may seem brief or focused on only one particular aspect of a larger problem, they are designed to be short, concise, and to provide a "snapshot" of the issue that immediately gets your point across for the candidate or media. In politics, it’s essential that the message not get lost in unnecessary verbiage. Generally speaking a position paper lays out an issue in one or two pages. It starts with the bottom line – a concise statement of your position or your legislative request. The next paragraph or two provides some background. Briefly stated, what is the problem you wish addressed? Why is this an important problem? In the next paragraph discuss your proposed solution. Conclude with a reiteration of your request. A sample position paper appears below. Position papers lend themselves to several specific applications. Educating your legislator. Sharing your position papers with your legislator helps establish you as a resource on health matters while informing the legislator and his or her staff of the priority issues in health care. Send to all campaigns. Whether or not you intend to throw your support behind a particular candidate, you may wish to send your position papers to all contenders for the seat. The responses are the barometer by which you can measure the sensitivity of a politician to AHEC issues. The document should be accompanied by a cover letter written on your personal stationary. Use your position papers at issue forums. These public gatherings are designed precisely for legislators and candidates to answer questions from an audience, so don't be shy about presenting the issues of concern to the AHEC community. You may wish to select the issue of greatest importance to you and then give the complete set of papers to the candidate or his or her staff after the event has concluded. Or, you might give your position papers to a legislator or candidate that you are supporting prior to their appearance at an issue forum. In this way, you will be preparing him or her to handle successfully questions on issues of importance to AHEC advocates.


Use your position papers to brief politicians speaking at AHEC meetings or other meetings you may personally arrange. When all is said and done, politicians want to be liked -- they want to deliver a message that constituents want to hear and to address their concerns if at all possible. Use your position papers to prep the legislator for a meeting or conference you may have helped to organize. Share the AHEC story with the media. Where do those reporters get ideas for stories? More often than not the media receives a tip from influential sources such as members of AHEC boards. However, most reporters are not conversant in health care issues. Sharing your position papers with the media is one useful way that you can educate reporters about key health care issues emerging in a campaign while helping to keep these issues in front of the candidates. Health care journalists and other media professionals appreciate story leads and often will tap you again as a campaign advances. Use your position papers within your own constituency. As an AHEC leader and activist, you may be involved with groups in positions to deliver candidate endorsements and contributions of time and money. Your position papers are a valuable yardstick by which to measure which candidate is most deserving of your group's valuable support. If your organization is hosting an event at which candidates will speak, for example, you should submit the position papers to the event moderator so as to keep the presentation focused precisely on issues of importance to AHECs. Repetition is the key to success! Keeping your position papers in the legislator's consciousness through repetition can lead to good things. If the legislator hears questions related to AHECs often, then over time he or she will be responding to our concerns and perhaps even echoing our own answers frequently enough to make them his or her own. There is something to be said for the power of cognitive dissonance!


Sample Position Paper

Area Health Education Centers Program

In Connecticut and throughout the country, Area Health Education Centers strive to eliminate disparities in health and health care, especially in underserved communities. AHECs are funded through a combination of state and federal funds. Federal support through Section 751 of the Public Health Service Act has remained flat at $28.6 million. An additional $10 million in federal funds are needed to complete the development of programs in Connecticut and other states as well as to bring services to the few remaining states without AHECs.

The AHEC Program brings the resources of the University of Connecticut Health Center to virtually all of Connecticut’s 169 towns and cities. While based at UConn, the program is actually implemented through four regional centers in Norwich, Hartford, Waterbury, and Bridgeport, which serves the New Haven area. Together the four AHECs provide statewide coverage. The four AHECs always work in collaboration with local organizations and always seek to build local capacity. The federal AHEC Program is 30 years old and is intended to improve access to primary and preventive care. It focuses on underserved communities and strives to eliminate disparities in health and health care. Forty-six states currently have AHEC programs. The Connecticut AHEC Program was established in 1995 with state funds. Federal funds were first received in 1997. AHECs perform three basic functions: Assisting in the ambulatory training of health professionals. Health professionals who train in underserved

communities are much more likely to serve those populations when their training is done. Providing continuing education, especially for providers to the underserved. Continuing education programs

improve the quality of care and enhance professional satisfaction, both of which contribute to provider retention.

Recruiting minority students into the health professions. Minority health professionals are substantially more likely to serve vulnerable populations than their majority counterparts.

The real contribution of AHECs is their collaborative efforts. Within dozens of Connecticut’s local health collaborations AHECs play a neutral facilitative role, one that is devoted primarily to the task of making the process of the collaboration go. It is the AHEC’s job to ensure that the collaborative process works and that the collaborators succeed in improving the health of their communities. Federal funding for AHECs is authorized in Section 751 of the Public Health Service Act, which requires a substantial match with state and local funds. The current appropriation for Section 751 is $28.6 million. In FY 2004 the Connecticut AHEC Program receives approximately $450,000 in federal AHEC funding, $600,000 in state AHEC funding, and approximately $500,000 in funding from other sources. In order to ensure the full implementation of the Connecticut AHEC Program as well as programs in other states, an increase in the federal AHEC appropriation of $10 million is necessary. This increase will ensure the availability of funds for the Connecticut AHEC Program during its third 3-year cycle of federal funding.


LETTER WRITING A personal letter is the basic tool for expressing your views to legislators. The guidelines below build on the earlier section on Message Making. The correct address for a legislator's office may be obtained from many sources, including the telephone operator or on the legislator’s Web site. Keep your request or comments short and to the point. If at all possible, keep your letter to one page. Summarize your message in the first paragraph. A reader should have a clear idea of your message from reading the first paragraph alone. Use the three-part format discussed in the section above on message making: (1) a gut-level summary of the issue, (2) a concise description of the issue, and (3) what, in specific terms, you want the legislator to do. Refer to any pending legislation by name and number. Limit your letter to one bill or issue. If you want to communicate more detailed information, include it as an attachment. Use personal stationary and write legibly or type. Your letter will be given greater attention if it is immediately recognized as personal and coming from a constituent. Handwritten letters are okay as long as they are easy to read. Identify the subject clearly. Use simple direct language. If you want the politician to respond to a position paper, then say so. Don't clutter your request with extraneous, unrelated commentary. Be polite but firm. Abide by the commonplace business letter conventions and include, if appropriate, a date by which you would like a response. For example, if you are hosting an issue forum event, then let the politician know that you would like his or her response to the questionnaire before his or her appearance at the event. Avoid clichés that give your letter the appearance of a form letter. Legislators receive hundreds if not thousands of pieces of mail each week. Many are form letters that garner little attention. Make your letter stand out as a personal communication from a concerned and active constituent. Always include your return address, phone number, and e-mail address to ensure you receive a response. U.S. representatives and senators will almost always respond. You will know you caught the attention of your legislator if the response is specific to the issues you raised and not just a form letter.


Always send a copy of your letter to the health aide. The health aide is your ally and your conduit to the legislator. Help them fulfill their responsibility by always keeping them in the loop. Maintain contact. If your legislator votes favorably on an issue, express your appreciation. Much of the mail that a legislator receives is from disgruntled constituents. A letter of thanks will be remembered the next time you make contact. Mail versus fax versus e-mail Because all mail sent to the U.S. Congress is first screened for possible contaminants, a significant delay can occur in using the U.S. Postal Service. Time sensitive communications are best sent by fax. Congressional offices are flooded with e-mail everyday, and few e-mail messages are give much notice. However, e-mail can be an effective form of communication when you have an established relationship with your legislator or his or her aide and the aide has indicated that it is okay for you to use e-mail.


Sample Letter

Connecticut Area Health Education Center Program

University of Connecticut School of Medicine 263 Farmington Avenue, MC 2928

Farmington, CT 06030-2928 (860) 679-7968 (voice)

(860) 679-1101 (fax) [email protected]

July 15, 2004 The Honorable Christopher Dodd 448 Russell Office Building United States Senate Washington, D.C. 20510 Dear Senator Dodd: As Associate Director of the Connecticut AHEC Program I am requesting your support for an increase in federal funding for the Area Health Education Center (AHEC) and Health Education Training Center (HETC) Programs. The House Appropriations Committee recently approved level funding of $28.6 for the AHEC program and $3.8 million for the HETC in FY 2005. These amounts are level with FY 2004 funding, but approximately 12 percent FY 2003 funding levels. The Senate Labor-HHS Appropriations Subcommittee has yet to act. If the AHECs and HETCs are to continue to meet the needs of underserved populations in the U.S., an increase in funding is needed this year. I request that you express your support for the restoration of AHEC and HETC funding to their FY 2003 levels to Senator Arlen Specter, Chair of the Senate Appropriations Labor-HHS Subcommittee. The AHEC/HETC Programs are 30 years old and improve access to primary and preventive care through academic-community partnerships. They focus on underserved communities and strive to eliminate disparities in health and health care. Federal funding for AHECs is authorized in Section 751 of the Public Health Service Act, which requires a substantial match with state and local funds. Federal funding for the HETC is authorized under Section 753 of the Public Health Services Act. The Connecticut AHEC Program brings the resources of the University of Connecticut Health Center to virtually all of Connecticut’s 169 towns and cities. While based at UConn, the program is actually implemented through four regional centers in Norwich, Hartford, Waterbury, and Bridgeport, which serves the New Haven area. Together the four AHECs provide statewide coverage. The four AHECs always work in collaboration with local organizations and always seek to build local capacity. In order to ensure that our AHEC Program continues to meet the needs of underserved communities in Connecticut, please express in writing your support for the restoration of AHEC/HETC funding to their FY 2003 levels to Senator Specter at the your earliest convenience. Thank you for your assistance in this matter. If you have any questions, please do not hesitate to contact me. Sincerely, Charles G. Huntington, MPH, PA Associate Director


MEETING WITH YOUR LEGISLATOR Meeting with your legislator or his or her health aide is, perhaps, the most tried-and-true tool of legislative advocacy. The act of meeting with your legislator, especially in his or her Washington, DC or state capitol office, can take on an intimidating aura. The guidelines below are intended to demystify this important event and make it both productive and enjoyable. Scheduling the appointment. Depending on the timing and urgency of the meeting you may choose to meet either in the legislator’s home district office or in his or her capitol office. Members of Congress have schedulers in each office, who can advise you as to possible meeting dates. The farther in advance that you make the appointment the better. Treat the schedulers well; your access to the legislator depends on them. The health aides to most members of Congress are based in the Washington, DC office and travel to the district much less frequently than the member. If you want to meet with the health aide (most often, you do!) your options will be greater if you are able to travel to Washington. When you call for the appointment, indicate that you are a constituent, state the reason for your visit and who will be attending. Leave a phone number or numbers where you can be reached right up until the time of the appointment, in case there is a need to reschedule. Many legislative offices are small and cramped. A party of two or three people is an appropriate size. Don’t bring more than the agreed-upon number of people. Arrive on time. Identify the primary spokesperson. Almost always, your meeting will include the legislative aide who handles your issue, usually the health aide. In fact, it is often advisable to have a meeting with the health aide in advance of scheduling a meeting with the legislator. By doing so, the aide can be fully conversant in your issue, and he or she can appropriately brief the legislator in advance. If you make an appointment in the Washington, DC office when Congress is in session, be prepared for cancellations, postponements, and delays. The schedule of hearings, meetings, and votes is out of the control of most members of Congress. Not infrequently you will meet only with the health aide, or the portion of the meeting that includes your representative or senator will be relatively brief. This is not a bad thing. The health aide will heavily influences the legislator’s position on any issue, and it is the aide with whom you will work mostly. Know that legislators and their health aide often need different information. Legislators are often less well versed in the details and will prefer a more basic presentation. Health aides are quite knowledgeable about health care issues and will appreciate a more in-depth presentation.


Prepare, prepare, prepare… This is a good time to review the section above on Message Making. Legislators are extremely busy, and you want to make the most of the brief time you will have for your meeting. You should go into the meeting not just knowing who is going to say what, but having rehearsed who is going to say what. You can anticipate a 15 to 30 minute meeting, but make sure you can deliver your entire message within 15 minutes. Divide your message into three parts: Summary statement of the problem

Craft your summary to address the issue on a gut level. This is the hook; it is what will keep the legislator interested in the rest of what you have to say. Relate the issue to the legislator’s constituents. This portion should be devoid of technical details.

Description of the issue and your proposed solution

It is okay to use data to document the problem, but keep the numbers to a minimum and express them in general terms. Be familiar with any pending legislation that addresses your issue, and cite it. Bring a copy of the relevant sections of pending legislation in case you need it. Come prepared to recommend a solution to your issue. You don’t need to have legislative language, just a general description of the fix. This is something that you may have worked out previously in discussions with the health aide.

Specify what you want the legislator to do

Finally, you want to come away from the meeting with a specific course of action laid out. Legislative timetables may well dictate the schedule for follow-up activities. Whether it co-sponsoring legislation, speaking to the chair of a committee, offering an amendment, or voting for a bill, don’t leave your legislator guessing what you want him or her to do next.

The art of the one-pager. Reduce your entire three-part message to a one-page position paper that you can leave with the legislator and his or her aide. (See the section on position papers above.) The act of composing the one-pager will force you to develop a concise presentation of your issue. If you want to leave more lengthy reports or studies, include them as attachments. Following up. Be profuse in the appreciation you express to the scheduler and receptionist as you leave the office. Immediately after the meeting, send a note thanking your legislator for the opportunity to meet and summarizing (in one page or less) the points covered during the meeting. Be sure to copy the health aide on the letter. If you promised to provide any additional material after the meeting, do so immediately. Additional tips. Small talk


If you know the legislator personally or know of some personal information, it’s okay to acknowledge that in your initial greeting. Excessive small talk wastes valuable time, there are other more appropriate opportunities for light banter.

Know both sides of the issue

If there are arguments against your position on an issue, be prepared to state them and provide the counter-arguments. Don’t let your legislator get blindsided by information you failed to provide.

No BS

If you do not know the answer to a question, say so. Promise to get the answer or the additional information and communicate it back to the health aide by date-certain. Unless you have pockets full of money to donate to the legislator’s campaign fund, the only thing of value that you have to trade on is your own credibility. Don’t compromise it.

Stay in touch

As your issue progresses through the legislative process, keep in touch with your legislator’s office. This follow-up conversation will probably be with the health aide. If you have information to pass along, do so. Check in occasionally (but, not too often) on a bill’s progress. Find out how the aide likes to communicate best (e.g., mail, phone, fax, e-mail).

Relationship building

Ideally, your visit is either the start or the continuation of an ongoing relationship you are building with your legislator and his or her aide. You want your face to be familiar and your counsel to be trusted. You know you are getting somewhere when your legislator starts calling you for something other than money!


MASTERING THE MEDIA Because so much of our political discourse occurs in the media, you may have occasion to be involved with the media in communicating your message. It is also important to remember that legislators thrive on media coverage. Any free coverage that you can help a legislator garner will be greatly appreciated. If at the same time you manage to get some exposure of issues of importance to AHECs, so much the better! In addition, legislators regularly follow the opinion pages of local media to get a sense of how constituents feel about key issues. Becoming a presence either through op-eds or letters to the editor can help position you with the legislator and the media as an expert in the community. While it is unlikely that you will ever bear primary responsibility for dealing with the media, having some basic understanding of how the media works will enable you to identify opportunities when media coverage can work to your advantage. Moreover, it may help you to avoid running afoul of the media. Also, whenever you are working with the media it is important for you to always be aware of your message. The position papers that you develop can guide your messages while you are working with the legislator. Below is some basic guidance for media outreach. Earned media. Earned media is a term that means making news and gaining publicity for your cause without paying for it. Legislative efforts and campaigns thrive on free media coverage. Earned media also gives a legislator credibility that they cannot get through paid advertisements. Being a newsmaker is important in positioning a legislator as someone who is worthy of holding public office. In any case, paid advertising is very expensive and often beyond the means of many candidates, especially challengers and those seeking state and local offices. You can help generate earned media in a number of ways. For example, suppose you invite a legislator to tour your office or to address your AHEC’s advisory board. Let the legislator’s press secretary know the press is welcome to the event and that you will work with them to accommodate the media. Also tell the press secretary that you are willing to talk to the media as a member of the AHEC community. Know what's news. Here are some general characteristics of what makes news: Is it out of the ordinary? Is it timely? Is it a significant event? Is it news in the eye of the reporter, news director, publisher, or station owner? Does it have local appeal? Is it emotional?


Will it prove embarrassing for someone? Does it have general interest? Is there an element of conflict? Will it jolt the viewer? Does it mention the names of prominent people? Is it what people are talking about?

It is important to remember that something that is blatantly self-serving is not news. Working with the legislator’s press secretary. Someone, and usually just one person, in a legislator’s office or political campaign is in charge of earned media. Generally speaking, it is only the press secretary and the legislator who are allowed to speak for the legislator. It is their job to control the media’s coverage of the legislator. So you need to be careful and aware of their turf. If you are going to try to help garner some media attention for the legislator, then acquaint yourself with the press secretary and coordinate all efforts to arrange media coverage with that individual. He or she will also want to draft much of the press material. You may wish to be available to talk to the media as a member of the AHEC community. In addition, tell the press secretary they can quote you in their press materials -- but make certain they clear those quotes with you before they send the release out. Generating earned media coverage. There are several opportunities for you to work with a legislator’s office to help generate earned media coverage: Develop a newsletter for colleagues or the community with an eye towards distribution to

the media. Announce an endorsement of your legislator or a position that your legislator has taken by

a group of AHEC community members, and put out a release announcing the endorsement.

Create a health issues task force for the legislator and have the legislator’s office announce its formation.

Release your position papers to the media and arm your legislator with the best responses. Organize a VIP visit to your center and arrange media coverage. Write an opinion column on health care issues in your community. Working with the press secretary, invite the media to any functions you organize --

candidate forums, center visits, etc. Draft a letter to the editor in response to an important story or development.

These are all opportunities for you to help generate media coverage for a legislator. Working closely with the legislator’s press secretary you can be a real asset to the legislator and his or her campaign -- not only in helping to generate media but being someone the legislator can turn to for assistance and advice around important issues.


LEGISLATIVE COALITIONS ARE POWERFUL Coalitions or alliances are essential to the success of many legislative efforts. They combine the strengths of various people and groups to create a team that is stronger than the individuals involved. A successful coalition should attempt to include a wide array of groups or people who bring a variety of perspectives to the legislation. A diverse group will be able to approach legislators from many different vantage points with different credible arguments. Building and using coalitions is a vital piece of an effective legislative effort. You can make a dramatic difference in your community just by thinking through the community’s problems and taking action to mobilize those affected. To identify potential coalition partners, think about who is impacted by government action (or inaction) and ask yourself, who else is affected? Who benefits from the proposed change? Who is hurt? Are uninformed groups or people affected? Can these people or groups be reached and mobilized? Coalitions are of particular value to legislative efforts because they bring credibility to the legislator’s positions on specific issues. For example, a committee composed of AHEC community members can comment on health care issues with the legitimacy of first-hand expertise. This legitimacy gives the committee special credibility enjoyed by only a few and respected by almost everyone. What an AHEC committee cannot do is expect to garner attention outside its area of expertise. An AHEC committee is not seen as having any special expertise in the area of economic development, for example, but a coalition of local area businesses, including an AHEC, would be. Construct or consider joining coalitions that can communicate believably on your priority issues. Another reason for the effectiveness of coalitions is that legislators do not want to be in the position of refereeing battles between opposing interest groups. In attempting to do so, legislators will almost always disappoint some group and thereby create an adversary. It is a cardinal rule of politics that your enemies are much more vocal and strident than are your friends. When interest groups come together and present a unified position on an issue or a bill, legislators can support the coalition’s position without incurring the risk of creating enemies. An effective coalition effort can provide the winning edge to a legislative effort. The following steps will help you mobilize other people who share your position on important issues. Make a list of your priority issues. Refer to the section on Position Papers. Identify other people who share your interest and try to get them involved. Invite a core group to set up a special committee for the effort, or join an existing group and help them publicize issues of concern.


Publicly announce the existence of the group and define the group's mission in the announcement. Ask others with a similar interest to join. Legislators are more likely to listen to a coalition that represents most of the organizations with an interest in a particular issue. Privately seek to meet with and educate legislators on your concerns. Private meetings with legislators can reveal their interests in a particular piece of legislation, information that the coalition may wish to incorporate into its position. Assuming the legislator and coalition see eye-to-eye, publicly support the legislator on issues of concern. You could: Send a letter on behalf of the legislator to people with similar concerns, encouraging

support for the issue. Offer to hold a joint press conference with the legislator announcing your group's

endorsement. Pay for a radio or newspaper ad supporting the legislator on your issue.

Write letters to the editor on a weekly basis, with each member taking turns writing. Send a letter from the group itself in response to a major development or event. Rules of engagement. There are a few protocols governing the behavior of members of legislative coalitions. Single issue coalitions

Coalitions usually form around single issues. Membership in a coalition does not imply endorsement of the other coalition members or the positions they take on other issues. Organizations will come together around issues about which they agree and go their separate ways on issues about which there is no agreement.

Leadership

Generally speaking, one organization will act as the nominal leader of the coalition. Leadership duties include organizing meetings, writing and distributing meeting summaries, organizing press conferences and news releases, and similar activities.

Decision-making

Early in its deliberations a coalition must establish the methods by which it will make decisions. Most often decisions are made by consensus. In large coalitions, decision making may be delegated to a steering committee. The membership of a coalition may change based on the particular positions that it takes. Groups will drop out if they disagree with a policy, and others may join on the basis of a new policy being adopted.


Compromise

Few members of a coalition are able to participate without some degree of compromise. Compromise is the method by which the pluralism in our society is mediated. Coalitions hang together because the power gained in adopting a single group position is greater than the loss incurred by compromising one’s individual position.

No cutting separate deals

Coalition etiquette prohibits individual members from going around the coalition to cut a separate legislative deal. If an organization cannot abide by the coalition’s position on an issue, then it must resign its membership, recuse itself from coalition deliberations, and pursue alone its legislative agenda.


HOSTING A VISIT TO YOUR CENTER OR PROGRAM Visits by legislators to your center are an effective way to build ongoing relationships. Legislator visits illustrate how your ability to meet local health care needs relates to legislative issues and are an excellent tool for advocacy. Such visits also provide a powerful visual image of your commitment to improving access and quality of community-based primary and preventive care. Legislative visits showcase your strengths and allow you to selectively highlight your challenges. You are offering your legislator an opportunity to see first-hand how an AHEC operates and to see the positive effect you have on the delivery of health care. You are also offering an opportunity to meet with board members, staff, and other involved community members whose votes the legislator would like to have. In turn, the visit is an opportunity to establish yourself as a source of insightful and credible information. Your long-term goal is to establish the kind of relationship where your legislator and his or her health staff member will call you for advice when he or she is asked to take a position on specific health care issues. The following guidelines will help you plan a successful visit: Determine the objectives for the visit. Decide what issues you want to discuss and how best to link the issues visually with the operations of your center. Find out if your legislator has a particular interest and cater to it. Decide on your message. Keep it simple. Refer to the section on message development earlier in this manual. Issue the invitation in writing. You may want to send one invitation to the candidate's home or office address and one to the campaign. Offer a range of dates to accommodate busy schedules. Announce the legislator's visit to all board members and staff. Once the visit is confirmed, promote it throughout your community (to colleagues, employees, board members, coalition partners, committee members) by distributing a brief biography of the legislator and information about the issues you will discuss. Alert local health care reporters and suggest that they cover the legislator's visit. Publicity is a valuable commodity to legislators, and it is also good for your center (see section on Mastering the Media). Work closely with the legislator's press aide on publicity and news coverage. Offer to provide or arrange transportation. If your legislator is flying in for the event, arrange to have a driver meet him or her at the airport and provide transportation back after the visit.


Provide the legislator information about your center prior to the visit. For example, include the total number of employees, the range of programs and collaborations, special accomplishments or challenges. You should also brief your legislator on issues of importance by sharing your position papers prior to the visit. Map a tour. Develop a tour schedule and route that illustrates the objectives you set for the visit. Know when the legislator has to leave and allow for extra time if the legislator wants to remain longer in one location. Conducting the visit If possible, begin the visit in your office.

Provide the legislator with an overview of important facts about your center, including the range of community needs you are attempting to address, the programs you have developed to meet those needs, the range of collaborations in which you participate, the challenges of funding and a changing health care delivery systems.

Be sure to introduce staff.

The staff and board members that the legislator encounters during the tour are the candidate's voters.

Have someone take photographs during the visit.

Generally, black and white photographs will be more useful to the media and for your own publications.

Following up Send a written thank-you note to the legislator, reiterating the points discussed during the

visit. Forward any photographs taken during the visit for the legislator to use in his or her own

publications. Also, publish the photos and information about the visit in your center or program

newsletter. Send press clips about the visit that appeared in local newspapers and internal

publications to the legislator and his or her press aide. Update the legislator on developments in your center, indicating how your center will be

affected by current legislative proposals, policies, etc. Continue to discuss issues of interest by offering to meet with the legislator's staff and

serve as a resource on health care issues.


FORMING A HEALTH ADVISORY COMMITTEE If you would like your contribution to a legislator to relate directly to your expertise as a member of the AHEC community, then forming or participating on a health advisory committee may be the opportunity you have been looking for. Health advisory committees are mutually helpful to AHECs and legislators. The legislator receives expert advice on current and emerging health issues that is useful in the formation of position papers, legislative proposals, and speeches. You become an expert source of information on community-based primary and preventive care and health professions’ education issues, gain direct access to the legislator, and have an opportunity to advance policies important to AHECs. Below you will find suggestions for setting up a health advisory committee. Is the legislator interested? Contact your legislator and his or her health aide to determine if they actually want guidance on health matters from an advisory committee. It is difficult to believe that a legislator would reject the freely-offered advice of the experts. If the legislator serves on a legislative committee that handles health issues or is a candidate running against an incumbent that sits on such a committee, then your offer is likely to be more favorably received. Select other members to serve on the advisory committee. This task should be carried out with input from the legislator, his or her health aide, and, possibly, the campaign manager. The legislator may even wish to designate some of the committee members or have final approval over the membership. You can rely upon the legislator wanting to personally send the letters of invitation to people selected to serve on the advisory committee. Advisory committees are more useful to legislators if they include representatives of key constituencies rather than including everyone who wishes to join. If your goal is to establish an advisory committee limited to AHEC or community-based primary care issues, then make certain the panel is as all-encompassing as possible by including AHEC representatives who are educators, recruiters, librarians, residency directors, program directors, students, and practitioners from managed care and fee-for-service settings. The point is to include representatives of all your major programs and constituencies. If, on the other hand, your goal is to establish a panel representative of the larger health care community, then make sure the other participants are supported by their respective organizations and knowledgeable on the issues. A lot of effort and forethought in the selection process will ensure that your advisory committee maintains credibility with the legislator, the public, and the media. Make certain that all members understand the committee's role.


Is the committee expected to produce legislative recommendations and position papers on demand, or simply to report back to the legislator on a specific issue or bill? The scope of the advisory committee's action is an important item that must be coordinated with the legislator. Given the busy schedules of committee members, it is also important to set reasonable expectations for the length and frequency of meetings. Decide on process. The legislator will typically attend the first committee meeting, but do not expect him or her to regularly attend subsequent meetings. The demands of legislative schedules may keep the legislator away from some or most of the meetings. However, it is likely that the legislator's health aide will follow committee activities. Make certain that someone (a staff assistant or a member of the committee) is appointed as recording secretary, responsible for taking down the minutes and distributing them after the meeting. Select a meeting location that is comfortable and convenient. In order to maximize output and encourage continued participation by committee members, locate a meeting space that is comfortable and spacious. One approach is to rotate meetings between the offices of committee members. Arrangements should be made at each meeting to supply writing materials, refreshments, and coffee or tea. Remember that the advisory committee was created to serve the legislator. The actual output of the committee may take many forms, including position papers, speeches and talking points, draft legislation, fact sheets, briefing papers, or press releases. Regardless of the finished product, a few ground rules should be kept in mind. First, always make certain that the legislator has copies of the committee's work and that he or she fully understands the content and impact of the advice given. Second, share copies of the committee's work with the legislator’s health aide. Finally, never go public with your work without the full knowledge and consent of the legislator. Concluding thought. If you serve on a health advisory committee, draw as much as possible from the resources of the nationwide network of AHECs. Not only is there a vast supply of data on all aspects of AHEC activities that can help you to advance the interests of AHECs and the legislator, but it will promote nationally the notion of AHECs as dependable resources on health care issues.


PERSISTENCE PAYS If you have volunteered on your legislator’s campaign, raised money for your legislator or generally made yourself indispensable as a health policy advisor, you are in an advantageous position; keep up the good work. Your task now is to stay connected -- telephone, write, fax, e-mail, and visit your legislator on issues important to AHECs. Get to know his or her staff and maintain that health advisory committee you started. Even if you choose not to get involved in the campaign, you can still have a tremendous impact. As an influential member of your community you are important to your legislator. You can start by meeting with your legislator and his or her staff and talk about issues important to AHECs. If a face-to-face meeting is not possible, a telephone call or even a constituent letter mailed or faxed is a great way to initiate contact. Let the legislator know you are an authority on health care issues in the district and that you wish to get involved and are available to answer questions. Beyond frequent contact, your task is to keep issues that are important to AHECs in the spotlight. You can do this by writing articles for your center newsletter (and make sure your legislators’ offices are on the mailing list) and by sending any center press releases to your legislators. Be assured that legislators read carefully local newspapers and follow press reports, so take advantage of any chance you have to talk about AHEC issues with the media. In addition, utilize your position papers on health care issues -- an important way to alert your legislators to AHEC legislative priorities. Key contact programs. A key contact program is an important tool for orchestrating constituent lobbying. A successful key contact system ensures that at least one dedicated and dependable member of the AHEC community is assigned to each elected official serving on the key health committees of the U.S. Congress and state legislatures. The activities of key contacts are coordinated centrally by a legislative committee. Besides maintaining an ongoing relationship with their legislators, key contacts respond to legislative action alerts by contacting their legislators at crucial points in the legislative process. For example, at the time a state legislature’s health committee is scheduled to consider a bill funding the AHEC program, the key contacts for each member of that committee would receive an action alert asking them to contact their legislator and urge support for AHEC funding. Action alerts provide specific instructions regarding the issue at hand, when to contact your legislator, and the content of the message to be communicated. Action alerts are sent by mail, fax, e-mail, or via a web site. Characteristics of a good key contact. The characteristics of a good key contact include, but are not limited to, the following: responds in a timely fashion to legislative alerts; has access to their legislator; is reasonably informed on the issues of importance to AHECs;


regarded by their legislators and their staff as a reliable source of information, financial contributor, or fundraiser;

communicates regularly with the elected officials and their staff, not just when there is a problem;

willing to make a long-term commitment to the role of key contact (suggested commitment of 2 years for a U.S. Representative and 6 years for a U.S. Senator);

has a decent understanding of the legislative process or is willing to learn; agrees with AHEC legislative positions; good written and oral communication skills; involves other AHEC family members in area or state; and willing to undertake public relations activities (such as editorial board visits).

Key contacts are expected to have regular communication, including face-to-face meetings, with their legislators, and they are encouraged to get involved in fundraising. In a well-functioning key contact system, key contacts are supported by a detailed manual on being an effective key contact, a biweekly legislative update, legislative briefings conducted at the annual meetings, and a Web site that provides weekly legislative updates. Constituent campaigns. In recent years, grassroots lobbying has become a widely used tool in the legislative process. Electronic data and communications systems make it possible to quickly identify and communicate with constituents in a highly efficient and targeted fashion. Membership lists can now be sorted by legislative district, which makes it possible to individually target mailings to constituents of lawmakers serving on health committees. These targeted mailings typically provide a brief summary of a legislative issue and specific guidance on how to communicate with their legislators. In the final analysis, AHEC’s success or failure in dealing with federal and state legislation is squarely in the hands of individual members of the AHEC community. A national or state organization can organize and facilitate the direct involvement of AHEC community members in the political process, but it cannot substitute for that involvement.


PART TWO GETTING INVOLVED IN POLITICAL CAMPAIGNS

ENTERING THE FRAY As a member of the AHEC community, you now have the information you need to influence the legislative process. This section of the manual provides detailed "how to" information on a variety of political campaign activities that you may choose to undertake. Some require more effort, time, and commitment than others. The return to you will be in proportion to your investment. All of these activities are dual-purpose. They give you and your colleagues, friends, neighbors, clients, and employees an opportunity to access the candidates while ensuring that your message gets in front of as many contenders as possible. Some general thoughts to keep in mind... To have maximum impact, your activities must dovetail with the campaign needs of the candidate. Timing in the election schedule is an important consideration for your own planning. During the primary, focus on fact-finding, collecting, and sharing information about the candidates and their positions on your issues. At the same time, you should be working to feed your message into the campaigns early, so that by the general election your positions are an established part of each candidate's platform. During primary season candidates are especially hungry for name recognition and funds. They place a higher premium on smaller, more intimate events than they do during the general election, when candidates will focus more on statewide strategies and press. Resources. Being a successful candidate means running a successful campaign. In order to run a successful campaign, a candidate needs four basic resources: time, money, people, and talent. Time

Campaigns are not limitless affairs; just so much time exists before election day. The lack of time forces campaigns to prioritize their activities carefully and to achieve specific goals within specific time frames. Time constraints also compel campaigns to initiate activities rather than merely react to events.

Money


A modern campaign is an expensive enterprise. There are innumerable ways to spend campaign funds. Money must be raised and spent effectively to achieve the overall campaign plan. Having a war chest early in the race can deter potential opponents. Having a large campaign fund can spell the difference between victory and defeat. Well-spent money can sometimes make up for lost time, lack of volunteers, and talent.

People

Campaigning requires lots of people. The perception of wide community support for a particular candidate is an incalculable advantage in a campaign. In any case, no campaign can succeed without volunteers, especially state and local campaigns. Too many things must be accomplished in a short time. Rarely can paid staff compensate for a lack of volunteers.

Talent

Volunteers bring with them a range of talents that must be utilized by the campaign to the maximum extent possible. Whether it is raising money, targeting activities, developing the message, or enlisting volunteers, the strengths of each individual volunteer are essential to the successful campaign.

Campaign organization. A successful campaign needs a coherent organization capable of supporting the broad range of activities it takes to win an election. The box on the next page will give you a flavor of the activities that go into a campaign. Your job is to figure out where you can fit in. Stay Positive! As a general rule of thumb, don't engage in political activities that are directed against a particular candidate. Mud fights only make you dirty. Regardless of a candidate's positions on issues of importance to AHECs, having a positive relationship with an elected official is worthwhile. That will be much more difficult if the candidate you too-vigorously or outspokenly "opposed" now occupies the incumbent's chair. Campaigns are always interested in volunteers with a knack for organizing events. If you are able to orchestrate well attended events that can expose a candidate to an audience of potential supporters -- your neighbors, other members of your AHEC board, or your medical school faculty colleagues -- you have something of real value to offer a campaign. Capitalize on it! This manual provides the tools, the ideas, and the basics of political activity. The only thing left to do is to put these tools to work.


Campaign Activities

Organization______________________________________________ Campaign personnel Volunteer Recruitment Administrative Programs

Headquarters Operation Management Structure Budget Management

Scheduling________________________________________________

Candidate's Time Surrogates' Time Public Relations

Spouse's Time Campaign Time line Community Inventory

Grass-Roots Organizational Programs_________________________

List Development Voter Blitz Program Yard Sign Program District Tours Telephone Bank Operation Events

Door to Door Walk Program Coffees and Receptions Coalition Development Absentee Ballot Programs Ballot Integrity Election Day Activities

Communications___________________________________________

Earned Media Press Releases Letters to Editor Program Interviews Events Actualities Media Conferences Speeches Research Debates

Paid Media Radio Ads Direct Mail Billboards Newspaper Ads TV Ads Bumper Stickers Brochures Yard Signs

Finance___________________________________________________

Personal Solicitation Small Donor Program PAC Solicitation Direct Mail

Major Donor Program Finance Committee Special Events


VOLUNTEERING Are you ready for hands-on involvement in the political process; that is, some activity beyond simply exercising your constitutional right and civic duty to vote? If so, this section tells you how to take the plunge into volunteer work. Volunteers are important to campaigns and candidates. Paid staff members are the political professionals responsible for developing overall strategy and organizing the daily routine of a campaign. But, without a battalion of dedicated local volunteers to execute all of these tasks, a campaign would quickly wither and die. Volunteers are a critical factor in all races and are especially important to new candidates. After all, paid staff is expensive and new candidates (with a few notable exceptions) are short on money. If you are feeling shy about volunteering or think your assistance may not be needed, just remember that no one, especially not a candidate, turns away free help. Why would you want to work for a political campaign without getting paid? The answer is that you will be compensated, not with money, but with experience and access to the candidate. Many people enjoy the team spirit and camaraderie that come with volunteering for a political campaign, and volunteering is a terrific way to meet others in the community who care about the same issues you do. More importantly, donating your time to a campaign is an effective way to make your voice heard. Your presence in and around campaign headquarters from time to time will make you an easily accessible source of information and expertise on complex health issues. You will be well positioned to have a substantive impact on the candidate's positions. Remember, once elected, officials are much more likely to consider the opinions of those who helped them get into office. Volunteering is easy. Once you have decided which candidate to support, assess the time and resources you have available to assist the campaign. Call or stop by the campaign headquarters and ask to speak with the volunteer coordinator. An incumbent's district office will give you the phone number and address for the campaign office. As you describe your interests and the activities for which you are available to volunteer, be clear about your limits. What do volunteers do? AHEC volunteers can do many valuable things for a political campaign: Use your expertise and knowledge as a member of the AHEC community to draft position

papers on health issues. Form a health advisory committee.

A health advisory committee provides the candidate with recommendations on health issues for his or her campaign platform (step-by-step guidance on this activity is provided in this handbook).


Contact other voters to get your candidate's message to them.

You might work at a phone bank, distribute campaign literature, or place yard signs in your neighborhood.

Register voters.

Organize events such as issue forums, a tour of your practice, or a neighborhood coffee.

Specific help planning these events can be found elsewhere in this handbook. Raise money, either by personally donating funds to the campaign or arranging a

fundraiser. Detailed information about fundraising is included later in this handbook.

Draft letters to the editor.

In addition to submitting letters in support of your candidate's positions to the editors of general circulation newspapers, you can draft articles and letters for the newsletters of your AHECs (hints for effectively using the media are elsewhere in this handbook).

Volunteer on an ad hoc basis, as your schedule permits.

Dropping by campaign headquarters for an hour will be much appreciated. You don't have to give up all your evenings and weekends to be needed and valued.


FUND RAISING / POLITICAL GIVING Over the long run, the best way to ensure that federal, state, and local legislators and other policy makers support positions favorable to AHECs is to help elect candidates whose views reflect those of AHECs. Because political campaigns are expensive and depend on voluntary private funding, contributions to like-minded candidates build good will and boost their chances for election. There are three main reasons why people contribute to campaigns: To support well-qualified candidates whose positions on important issues are similar to

their own; To express appreciation to candidates, especially incumbents, for supportive actions and

comments; To improve opportunities to be heard on issues and problems among legislators and other

elected officials. Money makes politics go. Money, some political pundit once said, is the mother's milk of politics. A successful campaign gets the message out and brings the vote to the polls, but without money, no press secretary exists, no radio or TV commercials exist, no phone bank exists, no mailings exist, no bumper stickers exist. Political consultants often advise candidates to spend half their money on raising more money. The larger the race, the more money required. A small town mayoral race can be won with just a few thousand dollars, but a congressional race can easily top several million dollars. Challengers face a perennial up-hill battle running against incumbents, who often have fifty percent of the funds they need before the race even starts. While having the largest war chest does not guarantee victory, lack of funds has felled many a qualified candidate. The reality is that in politics, money talks, and after the campaign is over those who are remembered most are those who helped raise the money. Candidates, both incumbents and challengers, engage in continual fund raising. While contributing to an election campaign does not automatically translate into political favoritism, individuals who either contribute to election campaigns or who sponsor fund raising events definitely earn the gratitude of elected officials. The influence of money on politics remains controversial, but no one doubts that money buys a degree of access. Campaign financing is a tool that you can choose to use or not to use, but you should know that it is there and that others will use it to great effect. Fundraising is often the hardest thing to ask any health care professional to do. Many people simply are uncomfortable asking other people to give money. Frankly, most of us hate it. Yet many do so every day for charity, for the Red Cross, children's hospitals, the United Way. Asking for money for a political campaign isn't that different. You are still asking people to contribute to a cause, to advance the vision and values a candidate represents.


Following are some of the ways you can help raise money for political candidates: Contribute directly to the candidate. If you are supporting a challenger bear in mind that political fundraising works on the snowball principle; contributions received early in the election cycle help the campaign attract additional support by demonstrating public confidence in the candidate. A check sent early will be doubly appreciated. It will also get you on a list for future fundraising solicitations. If you support an incumbent, consider making small contributions several times a year. Even in non-election years, incumbents maintain a campaign fund and keep careful records of who contributes, how much, and how often. Legislators review the list of incoming contributions several times a year, and it is to your advantage to have your name appear on that list with some regularity. Volunteer early in the campaign to serve on the candidate's finance committee. The campaign finance committee is responsible for raising the amount of money estimated to be needed to win the race. It is usually composed of friends and associates of the candidate, those of influence within the party, and other individuals held in high regard within the community. Each member usually commits to raising a certain amount of money and fulfills that commitment. Bundle checks from AHEC-affiliated contributors. One contribution is valuable. Five checks are even more valuable. When you and other members of the AHEC community join together, you can become a major force for the candidate and a voice to which he or she needs to listen. To make the group as inclusive as possible, tier its membership according to what your potential members are capable of giving; e.g., for a state or federal candidate: under $100, $100-$250, $250-$ 1,000. For a local candidate, one-tenth those amounts are suggested. Host a fundraising event featuring the candidate. In contrast to other forms of campaign fundraising (direct mail, phone solicitations) a hosted event provides you and your guest contributors with an immediate return on your investment of time and money. You will have direct access to the candidate and be able to discuss your priority issues with him or her in person at a time when he or she is most likely to be receptive to your message. Local fundraisers are highly valued by political candidates for the same reason. They provide a forum to personally interact with community opinion leaders. Also, candidates would much prefer to fill their Federal Election Commission reports with contributions from their home states or districts rather than from big business or out-of-state contributors. Planning the fundraiser. Whom you invite to a fundraiser will depend upon the size of the event and the size of contributions you are requesting. Remember that direct contact with the candidate is the key to large contributions. Events that seek to tap major donors should be relatively small and intimate. Consider an elegant cocktail party in your home or a small dinner at a fine local


restaurant. If you have the time and ambition you might consider organizing a theater night for a slightly larger group. The amount you charge for tickets to these events will depend on the event itself and the amount you want to give to the candidate once expenses have been subtracted. It is generally appropriate to charge between $250 and $500 per person or per plate for more intimate events. If you are supporting a candidate in a local race, consider a low dollar event that will draw a wide audience. Particularly for challengers and local candidates, larger, low cost events are often as useful for the exposure they afford as for the money they raise. Voters will consider a $25 ticket for a spaghetti dinner and raffle whether or not they've ever heard of the candidate. Time the event so that it will be relatively convenient for the candidate to attend. If your candidate is a current officeholder, note breaks or district work periods in the legislative calendar and aim for these. Coordinate well in advance with the candidate's scheduler to determine when the candidate will be in your community. In some instances, candidates will make an extra trip to attend a fundraiser that promises to be well attended or that will put them in contact with important people. Send invitations a month to six weeks in advance. Include clear directions to the event, note parking arrangements, and provide a phone number. Include an RSVP date. Follow up written invitations with personal phone calls. Before sitting down to make those calls, review and commit to paper all the reasons that you believe your candidate is the best person for the office. If you are not sure of the candidate's views on a particular issue that may arise during your conversations, you can get talking points or issue briefs from the campaign. Most importantly, always get to the point. Describe the event in an appealing way, make it clear you are asking for a contribution, and specify the amount. It may take several follow-up calls before someone commits to buy a ticket. Follow up with an enthusiastic confirmation note and offer to pick up the check in person. Keep the agenda for the event simple. Remember, you want to provide as much opportunity as possible for your guests to interact with the candidate, so try to stay clear of long speeches and other formalities. Have your guests fill out 3x5 cards with their names, addresses, and questions they'd like to ask the candidate.


You can deliver these to the campaign before the event to help the candidate prepare, or afterward to help him or her follow-up with particular individuals. Note: the campaign will almost certainly use this information for future fundraising solicitations. Do not expect the candidate to stay for more than two hours. The candidate may spend considerably less time during the peak campaign season, when others will be demanding his or her time. Before the candidate departs, encourage him or her to call you for assistance on health-related campaign issues. Capitalize on the good will you have earned by hosting the event! Legal Issues Individual contributions

While non-profit, tax-exempt organizations, such as AHECs, may not make political contributions, the right to make individual political contributions is a constitutionally protected expression of free speech. Nevertheless, contributions are regulated by federal and state laws. Federal law allows a person to give up to $2,000 to each candidate per election. Individuals are also allowed to give up to $5,000 to a Political Action Committee (PAC). There is an aggregate ceiling of $37,500 in total contributions each person can make to federal candidates every two years. Laws for state elections are different and vary considerably. You should be familiar with your state’s laws and regulations regarding campaign contributions.

Political action committees

To encourage widespread political contributions by eligible members or employees and maximize political impact, many organizations have established political action committees. The sponsoring company or association can finance the administrative costs of the PAC. PACs serve to increase an organization's legislative influence and access to candidates. They also allow the individuals who contribute to the PAC to become involved in the political process. The Federal Election Commission regulates PACs and requires them to report all receipts and disbursements.

Other ways to support federal candidates

Gifts of goods or services are in-kind contributions and may be made by individuals or PACs. Items such as office supplies, mailing lists, and copying services could be given to a candidate as in-kind contributions. Independent expenditures expressly advocate the election or defeat of a clearly identified candidate, but are not made in coordination with the candidate (or his campaign). These expenditures can be made by individuals or PACs.

The rules for raising money for candidates can be somewhat complex so if you have questions please contact the Federal Election Commission at (800) 424-9530 or (202) 219-3440, or your State Secretary of State's Office for additional information. Information on federal campaign finance laws can also be obtained at http://www.fec.gov. Information and links to state campaign financing information can be found at http://www.campaignfinance.org/.


ISSUE FORUMS

Bonafede's Revelation: The conventional wisdom is that power is an aphrodisiac. In truth, it's exhausting!"1

At the birth of our nation, campaigning was thought by many people to be a distasteful and rude activity. Instead of shopping for votes, the prospective office holder sat on his front porch and chatted leisurely with interested voters about the issues of the day. That was then, this is now. The population has grown and diversified. Public issues have multiplied. People are too busy to seek out and interview political candidates, and world news and sitcoms compete for their attention in the media. Campaigns have to work harder than ever to get the candidate's message in front of the voters. In the final analysis, winning a campaign still means that one candidate got more votes than his or her opponents. The candidate's primary goal, therefore, is to reach as many voters as possible with his or her message. Today, events that offer the candidate an opportunity to speak with dozens or even hundreds or thousands of people simultaneously represent the most productive and efficient use of his or her time. For this reason, issue forums, at which the candidate shares his or her positions with an audience gathered in one location (or connected by teleconferencing), are highly prized by candidates and their campaign managers. They put the candidate in front of a group of people who, by virtue of their attendance, are interested in hearing what he or she has to say about a particular subject. Issue forums can be organized as: A Candidate Speech followed by a question and answer session with the audience, A Candidate Night in which all candidates speak in turn, A Candidate Debate between an incumbent office holder, his or her primary challengers,

or opponents from different political parties. These events grow progressively more difficult to organize as the number of featured candidates increases. Conversely, as the ability of your event to draw media and public attention increases, so does the likelihood that the candidates will commit to participating. What an issue forum can do for you. If staged properly, these events can do four things for the AHEC community: Educate you and your colleagues as to how the candidates approach issues of concern to

you; Signal to the candidates that members of the AHEC community are concerned and

involved members of their communities;

1 Dom Bonafede, article in the February 1977 Washingtonian entitled "Surviving in Washington."


Influence the agenda of the campaign -- if you can get the candidates talking about health care issues, those questions will become more visible to the candidates, to the media, and to the general public; and

Commit the candidates publicly to certain action once in office. Contrary to what the cynics think, once candidates go on record with an established position on a given issue, they are loath to change.

Following are some specific ideas for organizing candidate issue forums: Alert the campaign manager to your group's interest in hearing from the candidate in person. Identify who will be in the audience (physicians, other providers, community leaders, senior citizens) and the issues about which they will be most interested in hearing. Be open to inviting other groups or organizations, particularly if you believe the campaign needs help in reaching them, so long as doing so will not dilute your message. Make certain that you will be able to draw a large enough crowd to merit the candidate's personal appearance. Schedule the event with the candidate's staff. Make arrangements for the appearance with the campaign manager, deputy manager, or the candidate's scheduler. Send a letter as soon as possible to confirm the candidate's appearance at the event. Ensure that the location you select (in consultation with the campaign) has adequate parking and accommodations for people with special needs. Don’t allow logistical issues to spoil your event! Invite the voters to attend. Here's the real test of your organizational powers. You need to get enough firm commitments of attendance to make the meeting worthwhile. It is a good rule of thumb to invite between 8 and 10 times the number of people you actually expect. Arrange for an appropriate location and equipment, such as podiums, microphones, seating, lighting, and refreshments. A successful event depends on getting the details right! Work with the candidate's press secretary to arrange for media coverage of the forum. Don't forget to alert your program office to coordinate additional coverage of the event. Assume a role during the event that reinforces the important part you played in getting the meeting organized. You may arrange to introduce the candidates, present a question during a debate or question-and-answer period, or even serve as moderator. Your position papers will provide you with some good ideas for issues to raise with the candidate.


Send a prompt thank-you letter to all of the people who helped you organize the forum as well as the candidate. Use the thank-you letters to remind folks who sponsored the event and to provide any requested information. Coalition building. A multi-sponsor event may be easier to arrange, provided someone reliable is attending to the details. Just remember that all political communication begins with the audience. Who comes to the event will heavily influence the content of what is discussed. See the section on coalitions in this handbook.


CANDIDATE COFFEE If you would like to volunteer your time and energy to a candidate, but placing yard signs or drafting position papers aren't your thing, then hosting a candidate coffee may be the right activity for you. These informal get-togethers unite candidates with voters and allow them to become acquainted in a relatively warm and informal setting. Everyone involved benefits from the experience. Voters learn what values and issues a candidate stands for, and candidates gain exposure to the voters. The AHEC-affiliated organizer develops a reputation as a go-getter and a leader while advancing the candidate's campaign. A successful candidate coffee can be held with neighbors, colleagues, fellow board members, fellow faculty members, or those affiliated with other AHECs. Sitting down over a cup of coffee is a time-proven ice-breaker. Fortunately, a candidate coffee is also fairly simple and inexpensive to conduct. Here are some tips on arranging a candidate coffee: Timing Informal events like candidate coffees are usually scheduled very early in a campaign season. Determine the right location. Preferably, the event will be in your living room. Alternatively, the coffee could take place in a facility, such as a conference room or staff lounge that is comfortable for both the candidate and voters. Make sure there is plenty of parking available. Issue a written invitation to the candidate. It is advisable to send the invitation to the candidate's campaign headquarters as well as to his or her office or home. Offer a range of dates to accommodate schedules. Make the actual appointment with the candidate's scheduler. Double-check the candidate's availability when initially scheduling the event and reconfirm a few days before it actually takes place. Identify the issues you want to discuss and the voters you want to reach. This is an ideal situation in which to explore public policy issues in some depth with a candidate, while simultaneously bringing them to broader public attention. The campaign manager can provide information on the interest groups and areas of the district targeted by the candidate. Invite the voters to attend. Ensuring maximum turnout for the candidate coffee is the test of your skills as an organizer. Spread the word through written invitations, word-of-mouth, a notice posted at work, or e-mail messages to colleagues and friends. Send more invitations than the maximum


attendance you expect. Include clear directions to the meeting site and a phone number at which you can be contacted. Consider press coverage. Check with the campaign press secretary to see if press coverage is desirable. Depending on who is in attendance and what the topics of conversation are likely to be, press coverage may give an added boost to the event. Arrangements. Arrange in advance to provide a sufficient amount of hot coffee, tea, bottled water, or soda and a goodie or two. Coffee cake, muffins or fruit are commonplace offerings at these get-togethers. Also, make certain that space is provided for a sign-in sheet and the display of candidate materials. Your role as host. Rehearse your introduction of the candidate. Bring your position papers to lead off the discussion with the candidate or to fill in the gaps if conversation lags. Take notes for later reference or to share with other people interested in the candidate, such as colleagues, neighbors, and media. Send a written thank-you note to the candidate. The thank-you note should be sent promptly after the event and reiterate any important issues discussed with voters. Forward photos taken during the gathering to the candidate for use in his or her own campaign materials. Also send the photos and information about the event to your local newspaper and your program and center offices for use in their newsletters.


GETTING STAFF MEMBERS INVOLVED In the 2000 presidential election, only 51 percent of the voting age population turned out at the polls. Primaries, special elections, and run-offs have even lower turnout. Sadly, the U.S. ranks near the bottom for voter turnout when compared to the world's democracies. Now is a good time to talk to your staff members about political activism. Here are some ideas for activities you can undertake in a non-partisan manner. Conduct a tour of your center or program. Arrange an opportunity when staff members can hear from the candidates and speak with them about key issues (see the section in this handbook on Hosting a Visit to Your Center or Program). Educate staff members on how the political process works during a brown-bag lunch seminar. Include a discussion of how primaries work, the role of political parties, and the importance of volunteers and fundraising for campaigns. Set up a voter registration table in a prominent community location. Ask staff members to conduct the registration drive. Provide a small token of acknowledgment for those who register, such as a button or a sticker. Encourage staff members to volunteer for campaigns. Distribute lists of candidates for various federal, state, and local offices along with information on who within the campaign organizations your staff members can contact to volunteer. Remind your staff about the importance of registering to vote and voting in the upcoming election. Hang a motivational poster in your office. Ask friends or acquaintances who are current officeholders to share their experiences about the importance of being politically active. A guest article in the center newsletter or a brown-bag lunch with a headliner speech are two good ways to do this. Host an election night party. Staff members can watch televised election returns and discuss their implications. Remember to recognize employees for their political involvement. Small rewards go a long way!


Important Note: When designing a political involvement program, remember that if you are going to approach all of your staff members it must be done in a non-partisan manner. In other words, your organization may not call for the election or defeat of a candidate. Also, if asked, you must give equal exposure to opposing candidates.


PART THREE LOBBYING BY 501(c)(3) ORGANIZATIONS

In 1976, Congress adopted legislation clarifying and expanding the extent to which non-profit organizations can lobby with jeopardizing their tax-exempt status. Final regulations for this law were issued by the IRS in 1990. This section provides a very brief overview of the 1976 law and some suggested resources for obtaining more detailed information. The most important thing to understand is the definition of lobbying under the 1976 law. Lobbying is the expenditure of funds by the organization for the purpose of attempting to influence legislation. Where no expenditures occur, no lobbying exists. Where there is no attempt to influence legislation (e.g., a communication by an organization to its members that does not directly encourage members to lobby), no lobbying exists. The lobbying by members of a non-profit organization when that lobbying is not supported financial by the organization is not considered lobbying under the 1976 law. The other important aspect of the 1976 law is that lobbying activities are permitted just as long as fall within the established spending limits. The spending limits vary depending on the size of the organization’s budget. They start at 20 percent of first $500,000 and end at 5 percent of budgets over $1.5 million. Separate limits apply to different types of lobbying. Direct lobbying means communications by the organization with legislators or government officials who participate in the formulation of legislation and with the organization’s members. Grassroots lobbying refers to efforts to impact legislation by influencing the general public. Expenditures on grassroots lobbying are limited to one-quarter the overall limit. Certain activities are specifically excluded from the definition of lobbying: Contacts to support or opposed proposed regulations Lobbying by members for which the organization incurs no expenses Communications that do not encourage lobbying on pending legislation Responses to requests from a legislative body (not just a single legislator) Lobbying on matters affecting the organization’s existence Making available the results of non-partisan analyses on legislative issues Discussion of broad social, economic, and other policy issues

The extent to which the expenditures related to the employment of a lobbyist working on behalf of a non-profit organization must be considered lobbying depends on the nature of the work. Those activities that attempt to directly influence legislation are considered lobbying and must be applied to the expenditure limits. Non-profit organizations that lobby must report their lobbying expenditures to the IRS on Form 990.


Non-profit organizations that receive federal funds may not use any of those funds for legislative lobbying. However, they are not prohibited from using private resources for lobbying. Resources Much more detailed information about non-profit organizational lobbying can be found at http://www.independentsector.org.

New Legislative Advocacy for AHECs 2004 - National AHEC...

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