As federal and state governments have become more active in regulating virtually all aspects of healthcare, it has become increasingly important for chapters to participate in advocacy efforts. Grassroots advocacy is the systematic effort to affect legislation by influencing the views of policy-makers on the state and local level. Grassroots advocacy makes an important contribution to effective and responsive government by making vital information available to public officials who cannot possibly know the full impact of every law and regulation that comes before them.
The College is committed to helping chapters develop and implement grassroots advocacy activities. Many useful resources exist on the College’s website to explain and simplify chapter involvement in local legislative activities. One of the best resources is the “Surgeons as Advocates: A Guide to Successful State Advocacy” guidebook.
This guide includes discussion of the tools needed to forge strong relationships with elected officials and their staff, state agency staff and other stakeholders such as other non-profit organizations. Among the important relationships that chapters can create when implementing advocacy is the relationship with the staff of the College’s Division of Advocacy and Health Policy. The College’s State Affairs team is able to specifically help with various aspects of state grassroots advocacy
Even though each state is unique, there are often common trends in state legislation. Medical liability reform, scope of practice, Medicaid reform and reimbursement issues are just a few, with provider taxes joining the list as a more recent trend. The State Affairs staff monitors all 50 states' legislative activity in order to not only defend Fellows from unwelcome legislation, but to proactively identify issues and develop strategies for the local level. Specific questions regarding the College's state legislative activities may also be directed to State_Affairs@facs.org.
The State Affairs team is also instrumental in implementing the Chapter Advocacy Lobby Day Grant Program. Under this grant program, ACS chapters may apply for a grant for up to $5,000 in a given year, with the stipulation that they will match one dollar for every two received. Once grant recipients are selected they will be assigned a member of the State Affairs team to assist with planning and on-site implementation of the event. Please visit the Lobby Day Grant Program website for more details.
Communicating with Legislators
It is important to know in advance of communicating with policymakers exactly what to say about an issue, as your time with the legislator, on some occasions (especially when communicating in person), may be only for a limited period of time. The College publishes articles, health policy briefs, and newsletters highlighting state and federal issues. Information on the College’s views on particular issues are available via many links on the Division of Advocacy and Health Policy website.
The Federal Legislative Action Center (LAC) is a user-friendly Web-based advocacy tool developed to help surgeons to advocate on their behalf. The LAC requires entry of a ZIP Code, which helps identify the user’s federal legislators. The site contains action alerts on such as Medicare payment, trauma funding, and federal tort reform, and provides sample letters to legislators that can be sent by e-mail directly from the LAC. These letters are easy to modify to reflect a surgeon’s personal situation and the effect that proposed legislation could have on his or her patients. The LAC also conveniently links a surgeon to local media outlets (newspapers, magazines, television and radio stations), so that surgeons can get the message out to the public and to patients, who can serve as effective advocates on any issue.
Whether communication is conducted in written or oral form, it is important to understand and follow a few simple “dos and don’ts” for writing letter or emails, phone conversations or setting up meeting dates.
Phone Outreaches
To find contact information for Congressional representatives go to directly to their individual websites which will provide address and phone contact information for any offices that the representative works from, as well as provide links to the representative’s social media sites, such as Facebook and LinkedIn. Websites for specific legislative posts, such as state senator or U.S. Senator, etc., will also contain a great deal of information relating to bill status/history and text, list of legislative names in each area or state, and webpage links for state senators and representatives, and lists of legislative committees and their hearing schedules.
Remember that when making phone contact with legislators that generally a staff member, and not the member of Congress, will answer. Ask to speak with the legislative representative’s aide who handles the issue on which you wish to comment. After identifying yourself, tell the aide you would like to leave a brief message, such as: “Please tell Senator/Representative (Name) that I support/oppose (S.____/H.R.____).” Also, be prepared to briefly state reasons for your support or opposition to the bill. Ask for your senator’s or representative’s position on the bill. You may also request a written response to your telephone call. Be sure to provide the most direct contact information for yourself in case the office or the representative should want to contact you for more background information surrounding the issue that you are communicating about.
Written Outreaches
A letter is the most popular choice of communication with a congressional office. If you decide to write a letter or send an email letter, this list of helpful suggestions will improve the effectiveness of the letter:
- Your purpose for writing should be stated in the first paragraph of the letter. If your letter pertains to a specific piece of legislation, identify it accordingly: [House bill] H.R.____, [Senate bill] S.____
- Be courteous, to the point, and include key information, using examples to support your position.
- Address only one issue in each letter; and, if possible, keep the letter to one page.
Letters should be addressed as follows:
To a U.S. senator:
The Honorable (full name)
____ (room #), (name of) Senate Office
United States Senate
Washington, DC 20510
Dear Senator:
To a U.S. representative:
The Honorable (full name)
____(room #), (name of) House Office Building
United States House of Representatives Washington, DC 20515
Dear Representative:
Note: When writing to the chair of a committee or the Speaker of the House, it is proper to address them as:
Dear Mr. Chairman or Madam Chairwoman:
Dear Mr. Speaker or Madam Speaker:
Other Grassroots Advocacy Activities
As part of the College’s advocacy requirements, all chapters also should participate in the state-level Medicare Carrier Advisory Committees (MCACs.) MCACs are responsible for determining the amount of payment for Medicare services and/or the eligibility for reimbursement. MCACs are managed by each state’s Medicare carrier. To contact the MCAC for your chapter, visit the Centers for Medicare and Medicaid Services website. Also, the College’s staff in the Washington, DC, office can be reached for assistance at 202-337-4271 or ahp@facs.org.
A grassroots advocacy program can be most effective when carried out by a coalition of state organizations willing to work together for a common purpose. Chapters should develop collaborative efforts with state surgical specialty societies, local community organizations, state and county medical societies and others. Taking the lead on issues of importance to the surgical community, such as medical liability reform, is a mantle of responsibility that should be carried by chapters. Surgeons of various specialties look to the College and its chapters to provide leadership in advocacy. Chapters that do so will play a prominent role in the surgical community for years to come, and build good will among physician organizations. In addition, shared advocacy efforts permit multiple organizations to share expenses for these efforts.
ACS Professional Association
In 2001, the ACS Board of Governors unanimously approved the formation of a political action committee (PAC). To implement the Governors’ mandate, the College established the American College of Surgeons Professional Association (ACSPA), a separate 501(c)(6) tax-exempt organization.
The mission of the ACSPA is to provide a broader range of activities and services to benefit surgeons and their patients, including an expanded legislative action program that features a PAC. This corporation allows the College to continue the standard-setting and educational activities that have always been at the heart of its mission. It also expands the opportunities to provide more direct benefits to surgeons and their patients.
Established in 2002, the ACSPA-SurgeonsPAC is governed by an appointed Board of Directors, which seeks to support an advocacy agenda for surgeons and their patients across specialty lines. Through a grassroots educational and political investment program, ACSPA-SurgeonsPAC and its members provide nonpartisan financial support to federal office holders who share surgery’s perspective on health care policy issues and are positioned to influence surgery’s legislative goals. It is very important to the ACSPA that the contributions are distributed to friends of the medical community and in compliance with FEC regulations. Fellows who wish to support political activities on behalf of the College can voluntarily contribute to ACSPA- SurgeonsPAC. To make a contribution, or for more information about ACSPA-SurgeonsPAC, visit the PAC web page or contact PAC staff directly at surgeonspac@facs.org or 202-672-1520.
Division of Advocacy and Health Policy
The College has committed considerable staff resources to its Division of Advocacy and Health Policy (AHP). Contacting a staff person at the Division of AHP is a great first step toward learning more about any state or federal issue, gaining advice on which legislators or government officials would be best to contact for a particular issue.
Contact the Division of Advocacy and Health Policy at:
20 F Street, NW, Suite 1000
Washington, D.C. 20001
Phone: 202-337-2701
Fax: 202-337-4271 or ahp@facs.org
Tax exempt organizations can participate in the legislative process, however, it is important to be mindful of the fact that the scope of allowed activities is rigorously controlled by federal election laws, the U.S. Federal Income Tax Code, special Congressional rules governing gifts that Member of Congress can receive and a variety of state laws. The complexity of these laws and regulations should not prohibit or deter chapters from becoming involved in legislative and political processes. However, chapter leaders should plan to obtain expert legal advice prior to engaging in certain legislative and political activities. In particular, chapter leaders should consult with the College’s Division of Advocacy and Health Policy and a tax attorney or legal advisor with questions about lobbying and political expenditures.
Lobbying activities are not clearly defined by the IRS, but generally, lobbying is considered as contacting Legislators and their staff members (either by phone, mail, email, or in person) to talk about pending or proposed legislation or regulations. This broad definition of lobbying by the IRS also has been extended to newsletters and other types of membership communications when a particular publication contains information about current or pending legislation or regulations, and especially if members are “encouraged” to contact their U.S. Representative, Senator or other legislator.
Depending on whether an organization is a 501(c)(3) or 501(c)(6) there are different regulations regarding lobbying
501(c)(3) chapters may conduct lobbying activities to support or oppose federal and state legislation. The dollar amount of lobbying expenditures that can be spent varies and is limited to a percentage of its total budget.
Generally, a 501(c)(3) organization that has a total budget of $500,000 would be permitted to spend up to 10 percent of its total budget on lobbying expenses. Most tax advisors agree that lobbying expenditures are insubstantial if they are less than five percent of the 501(c)(3) organization’s budget. Alternatively, the chapter can make a special election under 501(h) of the U.S. Tax Code to spend up to 20 percent of its total budget on lobbying. The maximum percentage, regardless of the size of a 501(c)(3) organization’s budget, is 30 percent.
A large majority of the College’s U.S. chapters are 501(c)(6) organizations, and the rules and regulations governing these tax exempt organizations’ lobbying activities are not as severe as those for 501(c)(3) organizations. For example, there are no limits on the amounts that can be spent on lobbying by 501(c)(6) tax-exempt organizations. Therefore, a chapter could spend as much as 100 percent of its total budget on lobbying activities. While such a scenario would be unlikely, there are a few rules and regulations governing lobbying activities that 501(c)(6) organizations need to know.
Beginning in 1993, 501(c)(6) organizations and their members are required to comply with the provisions of the Lobby Tax Law, which was contained in the Omnibus Reconciliation Act of 1993 (P.L. 103-66). This law has three chief components affecting 501(c)(6) tax-exempt organizations and their members with regard to lobbying:
The “de minimis rule” provides that, if a chapter spends less than $2,000 per year on lobbying, no notification of chapter members is required, and no further documentation to demonstrate compliance is required.
If a chapter’s lobbying expense exceeds $2,000 in a year, then the chapter needs to determine in advance the percentage of the total budget that will be spent on lobbying and notify the chapter members on their annual dues statement that this percentage of their annual dues cannot be deducted on their personal income tax filing.
Rather than notifying members about the percentage of their dues that is not deductible on their personal income tax, chapters can pay a “proxy tax.” The proxy tax alternative requires the chapter to pay taxes on the total amount of lobbying expenses, which are computed using the corporate income tax rate.
Political Action and Contributions for Political Activities
501 (c)(3) organizations are prohibited from undertaking activities on behalf of, or in opposition to, any candidate for public office, whether federal, state, or local. This prohibition includes amounts paid to a candidate for speeches, travel, polls, publicity or any other activities that serve to promote that individual’s candidacy. Violations may result in loss of tax-exempt status and tax penalties.
In contrast, a 501(c)(6) organization may engage in some legal political activity, although this activity can never be its primary mission. However, any direct political expenditure such an organization makes are subject to a special tax. More importantly, federal election law prohibits all corporations, including incorporated associations, from making campaign contributions to candidates for federal office. The Federal Election Commission (FEC) considers contributions to include direct and indirect payments or gifts of money, services or anything of value.
501(c)(6) organizations could sidestep many of these prohibitions by creating a separate segregated fund (that is, a political action committee, or PAC) to finance political activities, including contributions to candidates. Although a 501(c)(6) organization cannot create or direct a separate segregated fund, a separate organization with similar interests, including a newly created one, may do so. In either case, separate segregated funds must file periodic reports, maintain books and records, and take steps to ensure that the fund receives and makes only legal contributions.
Even if a separate segregated fund is not created, certain political activities are permitted. A 501(c)(6) organization may communicate with its members about any matter, including a partisan political one. 501(c)(6) organizations may encourage their members to register, vote, or otherwise participate in the political process, such as making personal campaign contributions to the candidates of their choice or volunteering for campaign work. These organizations may also solicit their members on behalf of an individual candidate. For example, the executive director or officer could ask an individual member of the 501(c)(6) organization to make a personal contribution to a candidate, attend a political fund-raising event hosted by others or individually host such an event. However, the 501(c)(6) organization cannot “buy a table” with its own treasury funds at a fundraising event, although its members could individually purchase tickets with their own funds
501(c)(6) organizations are also prohibited from facilitating political contributions by their members (for example, they may provide the address of a candidate’s campaign office, but they cannot provide an envelope addressed to the campaign). In addition, if the costs of partisan communications on behalf of an individual candidate reach $2,000 for any single election, the association must file a report with the FEC. A 501(c)(6) organization may also encourage political involvement by the general public, as long as any information disseminated is nonpartisan in nature. In other words, such information may not indicate any political affiliation or favor any specific candidates. The FEC provides relatively detailed guidance about the characteristics of nonpartisan communications, including voter guides and Congressional voting records.
501(c)(6) organizations may invite a candidate, a candidate’s representative or party representative to address its members about a campaign. During such an event, the candidate or representative may even solicit contributions to a campaign, and the organization’s leaders may encourage such contributions. Such an event could be viewed as a political fund-raiser, but attendance must be carefully restricted to the organization’s members and executives (in FEC parlance, its “restricted class”) and, as such, cannot be open to the general public. A 501(c)(6) organization may also issue a press release to its usual press contacts endorsing particular candidates.
501(c)(6) organizations, including ACS chapters, can use Congressional elections as an opportunity for meeting candidates and their campaign staff and educating them about issues of concern to their members.
Political Contributions by Individual Chapter Members
Of course, many organizations, including the College’s chapters, are comprised of individual members. Federal law makes specific stipulations on the amounts that individuals can contribute and specific details can be obtained from the Federal Election Commission website.
Contributions to the political campaign of a sitting Member of Congress should be sent to the candidate’s campaign committee or office and should not be presented during a meeting in his or her Congressional office. Contributions to other candidates are also best sent to the campaign office, rather than given directly to the candidate. In all cases, individuals making a political contribution should in no way imply that it comes as a quid pro quo for something the individual has done or will do.
Notable Local Regulations
Approximately 40 states have enacted charitable solicitation statutes. Although specifics vary, state statutes usually require organizations to register with the state before they solicit the state’s residents for contributions. After registration, the registrant is usually required to file some form of annual report that requests financial data and information concerning fund-raising activities. In many states, this filing consists of IRS Form 990. Since, by definition, 501(c)(6) organizations are less likely to solicit funds or to be regarded as charities, they are less likely to fall within the scope of these statutes.
A chapter, like any employer, must withhold federal income taxes from the salaries and wages that it pays to its employees and submit quarterly reports of the amounts withheld to the IRS on Form 941. Many additional federal, state, and local filing obligations and tax obligations exist. It is imperative that chapters seek professional advice regarding these obligations.
Chapters are not usually active in more than one state. However, in instances where a chapter is active in more than one state, it may need to register as a foreign corporation in the state in which it is active but not incorporated or organized. Registration would also be necessary if a chapter was not incorporated in, or organized under, the laws of the state in which it conducts its activities.
