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Hard Choices in An Election Year — How and Why Medical PACs Decide to Contribute

How did medical societies use their political action committees (PACs) in 2008? This question was particularly important in an election year beset with fresh campaign promises and an economy in free fall.


As it has done in the past, the American Association of Neurological Surgeons (AANS) PAC, created in August 2005, made direct campaign contributions to Congressional candidates (both incumbents and new contenders) — based on campaign pledges, legislative records, committee assignments, and their relationship with individual neurosurgeons — to advance neurosurgery's advocacy agenda, said Katie Orrico, JD, ex-officio member of the NeurosurgeryPAC Board and director of the AANS Washington, DC, office.

The NeurosurgeryPAC raised $480,000 for the 2008 election cycle (including 2007 and 2008), just shy of its $500,000 goal. These funds came entirely from individuals through raffles and other fundraising activities.

In 2008, the NeurosurgeryPAC sent direct appeals to neurosurgeons regarding four races — Sen. Susan Collins (R-ME), Sen. Norm Coleman (R-MN), Senate candidate Mark Udall (D-CO), and Rep. Mark Kirk (R-IL) — spending about $120,000 in each race.

“This allowed us to help support their elections above and beyond the $10,000 maximum direct campaign contributions,” Orrico said. “We selected these four members because they consistently supported neurosurgery's legislative priorities.”

The NeurosurgeryPAC also contributed to Congressional leadership PACs (established by sitting members of Congress) as well as the National Republican Congressional Committee and Democratic Congressional Campaign Committee. “While political contributions certainly do not guarantee that a particular legislator will co-sponsor a bill or vote a certain way on a piece of legislation, it does allow us to get in the door to make our case,” Orrico said. “This is particularly true since Congress passed tough gift-ban legislation, significantly curtailing our ability to meet with legislators outside the political process.”

It is difficult to predict how the economic downturn will affect their fundraising for coming years, Orrico said, but the PAC remains committed to galvanize support around its legislative priorities: among them, medical liability reform and improvements in emergency neurosurgical procedures; as well as advocacy against the sharp cut in Medicare physician payments in 2010 and proposals to increase reimbursement for primary care by taking it out of the pockets of specialty doctors.


As a 501(c)3 tax-exempt organization, the AAN is permitted to engage in some advocacy activities but it cannot form a PAC. That's where the AAN Professional Association comes in. It was created in 2007 as a companion 501(c)6 organization so that it could form a PAC and raise voluntary contributions from Academy members.

“We've used these funds to help the political campaigns of candidates for federal office who are favorable to neurology and to build relationships with current and potential members of Congress,” said Mike Amery, the AAN Legislative Counsel, and the Academy's primary lobbyist in Washington, DC.

All members of the AAN are also members of the professional association, and the organizations share board members. The Academy sends e-mail alerts on Congressional actions to members and hosts the annual “Neurology-on-the-Hill” event where Academy members advocate on Capitol Hill.

The BrainPAC's initial 2008 election goal was $50,000, but Amery said that “Academy member interest was much higher than expected” — they raised more than $125,000.

BrainPAC donated funds to more than 45 candidates for Congress this year, Amery said, but did not participate in the presidential campaign. The advantage of contributing to congressional campaigns versus presidential ones, Amery said, “is that we have established immediate contact with the candidate (often an incumbent) and their top staff.” The maximum a PAC can give to a candidate (both congressional and presidential candidates) is $5,000, he explained.

Like the NeurosurgeryPAC, BrainPAC supports candidates who are likely to have influence over health care policy in the US Congress, and will be open to supporting positions held by the Academy — including members of key committees such as the Senate Finance Committee and the House Ways and Means Committee.

A 10-member executive committee creates criteria for distributing the funds. “One of the criteria is that funds should only be given at an event where an Academy representative has an opportunity to talk directly with the candidate about issues that are important to the Academy,” Amery said.


KATIE ORRICO: “While political contributions certainly do not guarantee that a particular legislator will co-sponsor a bill or vote a certain way on a piece of legislation, it does allow us to get in the door to make our case.”

Top legislative priorities in 2008 included increasing Medicare reimbursement, raising awareness about stroke, and creating the Epilepsy Centers of Excellence (ECoE) at the VA. Thanks to the BrainPAC, Amery said, “AAN members and staff were able to push for approval of the ECoE legislation with key members of Congress at ideal times.” Also, the very first BrainPAC donation went to Congressman Ed Perlmutter (D-CO), who authored the ECoE's legislation in the House.

Goals for 2009 are not yet set, but among priorities, the BrainPAC will contribute to candidates who will support eliminating the Medicare reimbursement cut and will push for a long-term solution to declining reimbursement and participation by physicians in the Medicare program,” Amery said. “As the economy worsens, it is even more important that physicians participate in the process to ensure that patients have access to care.”

“In the eight years that I have worked for the Academy, nothing has done more to increase the awareness and influence of neurology in Washington, DC, than the creation of BrainPAC,” said Amery. “Academy members and staff now frequently meet with members of Congress and their top staff on issues that are important to neurology. In the past, those doors have always been open, but the degree of access to true decision makers has improved dramatically.”