2019 State Lobby Days: Advocating for patient care in state capitols

The American College of Surgeons (ACS) Chapter Lobby Day Grant Program continues to grow year after year, leading to increased surgeon influence on public health policy moving through state legislatures. In 2019, the College’s Lobby Day Grant Program received the largest number of applications in the nine years since it was established.

ACS chapters in 27 states—Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia*, Illinois, Indiana, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Virginia, Washington, and Wisconsin—received lobby day grants, with Delaware, Maryland, and Minnesota receiving the lobby day grant for the first time. The financial grants can be as much as $5,000 with a $2,500 match, along with ACS State Affairs staff support for planning and on-site implementation of the lobby day event.

For the third year, an ACS Chapter Lobby Day Enhanced Grant was awarded to qualifying College chapters. The Michigan Chapter received the Enhanced Advocacy Grant of $15,000 in 2019 to engage the state legislature on securing funding for the state’s trauma system. The Michigan Chapter held a lobby day in Lansing on May 23, in conjunction with the Michigan State Trauma Coalition and the Michigan Committee on Trauma. An array of multidisciplinary trauma professionals from around the state met at the capitol to promote bleeding control education and funding for the statewide trauma system. Because Michigan is a year-round legislature, the chapter will continue to work with elected officials and stakeholders throughout the year to pursue comprehensive trauma system legislation. At this time, Michigan is one of the only state systems in the nation that lacks permanent funding for its trauma system.

Chapters achieve wins for Stop the Bleed

ACS chapters in 11 states incorporated Stop the Bleed^® training into their 2019 lobby days: California, Delaware, Illinois, Indiana, Louisiana, Maine, Nevada, New York, Ohio, Tennessee, and Virginia. Additionally, the Indiana, North Carolina, and Texas Chapters used their lobby days to garner support for state legislation to require Stop the Bleed training in schools, as well as placement of bleeding control kits in public schools and buildings.

The Stop the Bleed program has gained significant interest among the state legislatures through its inclusion in state lobby days. In 2019, 10 states—Arkansas, California, Illinois, Indiana, Massachusetts, Michigan, Missouri, New York, Tennessee, and Texas—introduced ACS-supported bills specific to Stop the Bleed, with legislation being enacted into law in Arkansas, Indiana, and Texas as a result of direct efforts from chapter lobby day advocacy.

On January 24, the Arizona Chapter hosted its annual Chapter Lobby Day in Phoenix to promote Stop the Bleed and colorectal cancer awareness, and to discuss legislation aimed at improving trauma care in the state. The chapter hosted a luncheon for elected officials who serve in leadership roles on state health care committees, as well as their staff and health care lobbyists. At the luncheon, the chapter offered Stop the Bleed training to attendees, who learned to pack wounds and apply tourniquets. In addition, Ross Goldberg, MD, FACS, addressed the state legislature in his capacity as Doctor of the Day, which helped to improve the chapter’s visibility before the entire legislative body. Doctor of the Day is a program where a physician volunteers as the on-call doctor in the state capitol building. The programs are typically run by the state medical societies; however, not all state capitols have the program.

The Northern and Southern California and San Diego Chapters met for their joint lobby day on April 24. This event took place in conjunction with the California Medical Association Doctor Day in Sacramento, with more than 600 physicians in attendance. Representatives from all three ACS chapters engaged with state legislators to advocate for A.B. 1708, legislation mandating the placement of trauma kits in all public facilities. In addition, they conducted Stop the Bleed training for physicians attending the event. A highlight of the event was the keynote speech by California Gov. Gavin Newsome (D), who reiterated his support for ensuring access to health care for all Californians.

The Delaware Chapter cohosted a Stop the Bleed training session May 14, with several groups, including the Office of Lt. Gov. Bethany Hall-Long and the Office of Emergency Medical Services (EMS)—the EMS and Preparedness Section in the Delaware Department of Health and Social Services Division of Public Health. The training for legislators and their staff occurred in the capitol building.

The Metro-Chicago and Illinois Chapters organized a joint lobby day May 15 centered on gaining support for legislation to require Stop the Bleed training and bleeding control kits in public schools. The chapters provided Stop the Bleed demonstrations in the capitol building for legislators and staff. Illinois Rep. Camille Lilly (D) and Sen. Laura Fine (D) both introduced and read resolutions in their respective chambers recognizing the Stop the Bleed campaign. Both women declared May 15 as Stop the Bleed Day in Illinois and noted the chapter members in the capitol for the lobby day.

The Indiana Chapter of the ACS had a productive year, achieving passage of H.B. 1063, legislation mandating the placement of bleeding control kits in public buildings. At the chapter’s lobby day February 12, surgeon-advocates worked with the Indiana State Medical Association, representatives from state agencies, and trade groups to educate lawmakers and stakeholders on the importance of bleeding control education, training, and readiness, as well as to highlight other relevant issues, including scope of practice for advanced practice registered nurses and physician Maintenance of Certification. The chapter’s efforts were successful, and H.B. 1063 passed the House and Senate unanimously. Gov. Eric Holcomb signed the law June 14.

The Louisiana Chapter organized a May 22 lobby day. Chapter members met with Lt. Gov. Billy Nungesser to get his support for a bill to study expanding insurance access to bariatric surgery and met with Louisiana Speaker of the House Taylor Barras to attain support for legislation to require Stop the Bleed training and bleeding control kits in public schools. The chapter also partnered with the Louisiana Emergency Response Network to provide Stop the Bleed demonstrations in the capitol rotunda.

This year, the Nevada Chapter hosted its first state chapter lobby event April 11. Surgeons from across the Silver State traveled to Carson City to meet with their legislators to discuss legislation addressing balance-billing, firearm trigger locks, and bleeding control education and training. Working with the Nevada State Medical Association, the Nevada chapter hosted Stop the Bleed training in the capitol building, which was well attended by elected officials, legislative staff, and members of the public.

The New York and Brooklyn-Long Island Chapters joined together to host a Stop the Bleed training for legislators and staff as part of their lobby day at the state capitol April 30 in Albany. The morning began with a Stop the Bleed training in conjunction with Albany Medical Center.

Before heading to the capitol building, members of the chapters met to review the key legislative issues pending before the legislature, including a state-run single-payor health system, authorization for physicians to collectively negotiate with health plans, prior-authorization reforms, and requirements for pretrial expert witnesses in medical liability cases. New York Fellows met with legislative leaders and their staffs, including Senate Majority Leader Andrea Stewart-Cousins (D), Senate and Assembly Health Committee Chairs Sen. Gustavo Rivera (D) and Assemblyman Richard Gottfried (D), Senate Insurance Committee Chair Neil Breslin (D), and Senate Higher Education Committee Chair Toby Ann Stavisky (D), in addition to meeting with personal legislators.

A small group of Fellows returned to the New York State capitol building May 20 to support Assemblyman Colin Schmidt and Senator Rivera as they introduced a resolution calling on Gov. Andrew Cuomo to proclaim May 2019 as Stop the Bleed Month in the State of New York.

Surgeons from throughout the state convened May 1 in Raleigh for the North Carolina Chapter’s Second Annual Lobby Day. Following a breakfast briefing at the North Carolina Medical Society’s office, participants met with legislators to discuss support for placing bleeding control kits in public schools and addressing distracted driving.

The Ohio Chapter hosted a Stop the Bleed training event May 9 at the statehouse in Columbus. Chapter leaders also hosted a luncheon, which more than a dozen legislators and their staff attended. Elected officials sat down with surgeons to discuss issues of importance to the chapter, including advanced practice registered nurse independent practice and bleeding control education and training.

As part of the Tennessee Chapter’s initiative to pass legislation providing Stop the Bleed training and kits for public classrooms and buildings, the February 5 lobby day played a key role in meeting with legislators, legislative staff, and other officials to advocate for H.B. 215/S.B. 259. A total of 25 chapter members, nurses, and injury prevention professionals staffed the Stop the Bleed training stations, and more than 50 legislators and staff attended the event and spoke with surgeons about the Stop the Bleed legislation. Both the House and Senate sponsors of the bill attended and had an opportunity to talk with their colleagues about the bill, and surgeons attending the lobby day visited their legislators’ offices to talk about it as well. Media coverage was amplified by the local National Public Radio affiliate covering the lobby day.

The North and South Texas Chapters hosted a joint lobby day April 11. Participating Fellows and residents met at the office of the Texas Medical Association (TMA) to receive a briefing from TMA government affairs staff on the status of several important physician-related bills, including a surprise out-of-network bill before the legislature. Additionally, Tim Schauer, a lobbyist for the American Board of Medical Specialties, described the political environment in the capitol, as well as the status of a bill related to Maintenance of Certification. After the updates, participants headed to the capitol to meet with their representatives and senators to garner support for the chapters’ Stop the Bleed in school bill H.B. 496, as well as the chapters’ positions on other active health care legislation, such as tobacco 21, optometry scope expansion, and graduate medical education funding. The chapter members also provided each of their legislators with a bleeding control kit and demonstrated its use. The chapters’ advocacy efforts during the lobby day were instrumental in securing the votes to pass H.B. 496 later in the legislative session. Gov. Greg Abbott (R) signed H.B. 496 into law on June 15.

The Virginia Chapter hosted a Stop the Bleed training session April 3 during the legislature’s veto session.

Patient access to care

In addition to Stop the Bleed, ACS chapters used their lobby days to advocate for public policy to advance patient access to care, including bariatric surgery coverage and Medicaid expansion, as well as to raise concerns about expanding scope of practice for nonphysician health care practitioners.

The Connecticut Chapter cosponsored a March 1 Physician’s Day at the capitol with the Connecticut State Medical Society. Chapter members lobbied on several priority issues, including opposing a bill that would prohibit trauma centers from charging a trauma activation fee and supporting legislation to expand private insurance coverage for bariatric surgery, and requiring all motorcycle riders and passengers to wear a helmet.

The day’s event included a breakfast program, featuring guest speakers Lt. Gov. Susan Bysiewicz (D); Rep. Jonathan Steinberg (D), co-chair of the Public Health Committee; and deputy president pro tempore Sen. Saud Anwar, MD (D).

Members of the South Florida, Jacksonville, and Florida Chapters met in Tallahassee January 23 to discuss surgeon-specific priorities in the state. Representatives from the Florida Medical Association, leaders from numerous state specialty societies, and elected officials and their staffs attended. Four state legislators—Sen. Dennis Baxley (R), Sen. Gayle Harrell (R), Sen. Lori Berman (D), and Rep. Ralph Massullo (R)—spoke at the event and discussed issues pertinent to Florida surgeons, including scope of practice and opioids.

The Kansas Chapter cosponsored a January 30 Advocacy Day with the Kansas Academy of Family Physicians. Chapter members met with their state legislators to discuss their legislative priorities, including broadening private health insurance coverage for bariatric surgery and expanding the state’s Medicaid program.

The Kansas Advocacy Day program included speeches from Kansas Gov. Laura Kelly, state insurance commissioner Vicki Schmidt, and state legislators, including Rep. John Eplee (D), vice-chair of the House Health and Human Services Committee, and Sen. Barbara Bollier (D), ranking member of the Senate Public Health and Welfare Committee. Expanding the state’s Medicaid program, KanCare, dominated the discussion. In 2018, the state legislature passed a Medicaid expansion bill only to be vetoed by the previous governor. Governor Kelly is a strong proponent of expanding Medicaid, but the new House and Senate leadership oppose it.

The Maryland Chapter hosted its first lobby day March 22 in Annapolis. Participating Fellows and residents met at the office of the Maryland State Medical Society for a briefing on the top health care issues before the legislature. The group met with Sen. Clarence Lam, MD (D), staff for Delegate Terri Hill, MD (D), and staff for Sen. Steve Hershey (R) to discuss support for legislation to reform the prior authorization process, as well as the potential for Stop the Bleed legislation next year.

The Nebraska Chapter organized its first chapter lobby day, joining with the Nebraska Medical Association to host a legislative breakfast February 12. Chapter members met with legislators throughout the breakfast to discuss priority issues, including support for legislation to prohibit the use of tanning beds by individuals younger than 18 years old and opposition to a bill to expand the scope of practice of optometrists to include surgery.

The Oregon Chapter of the ACS hosted its chapter lobby day March 4 at the state capitol in Salem. Working with the Oregon Medical Association, surgeon advocates from around the state met with their elected officials to discuss legislation addressing surgical smoke evacuators, caps on noneconomic damages in liability lawsuits, and tobacco taxation and regulation. Moreover, the chapter invited speakers from the Oregon Healthcare Authority; representatives from the insurance industry, the Nation Federation of Independent Business, and medical specialty societies; and state legislators. The speakers shared unique perspectives on issues that affect the practice of surgery in Oregon and took time to answer questions and learn about the state Stop the Bleed program.

The Wisconsin Surgical Society cosponsored the Wisconsin Doctor Day 2019 on May 19, joining more than 400 physicians from around the state. The main program included a speech by Gov. Tony Evers (D) outlining his support for expanding Medicaid in Wisconsin, as well as policy to promote the use of vaccinations. Chapter members then joined other physicians to meet with legislators and their staffs.

The Washington Chapter had planned a lobby day for February 12; however, bad winter weather forced the chapter to cancel the event.

Fall Lobby Days

Most state legislatures convene the first half of the year, but a few meet year-round, which provides an opportunity for chapters to schedule their lobby days later in the year. Additionally, scheduling meetings when the legislature is out of session can make it easier to gain key lawmakers’ attention and participation. The Minnesota Surgical Society will host a legislative event as part of its fall meeting October 3 in St. Paul, and the Massachusetts Chapter is scheduled to host its lobby day October 10.

To learn more about how to participate in a state chapter lobby day, contact your local chapter or visit the College’s website. For more information, e-mail state_affairs@facs.org or call 202-337-2701.

*Editor’s Note:  Following publication of this article, it was discovered that the Georgia Society of the ACS lobby day was inadvertently left out of the article.  The State Affairs Team apologizes for overlooking this omission, and would note that the Society’s lobby day held February 13 exceeded expectations for attendance with over 100 surgeons and others engaged with state legislators.  During the day, attendees “worked the rope line,” where constituents are able to request that their legislator leave the Senate or House chamber and come out into the hallway to talk about a specific bill or issue.  During this lobby day, surgeons were able to discuss continued budget support for the Georgia Trauma Commission and the reinstatement of bariatric surgery coverage for the State Health Benefit Plan.  In addition, legislators were thanked for their support of passage last year of the Hands Free Georgia legislation which bans the use of any cellular device while and reminded that their passing the distracted driving legislation had a direct impact on the number of lives lost on Georgia highways.  To top it off, information and training tables were set up in the Capitol to provide additional opportunities to discuss issues with legislators and their staff, as well as provide Stop the Bleed training and remind legislators of the importance of their support for bleeding control kits in public schools passed a number of years ago.