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Advocacy Toolkit


Advocacy – Includes identifying, embracing and promoting a cause; any attempt to shape public opinion, and promote the interests of your community. Advocacy is an ONGOING PROCESS.

Lobbying – A specific, legally defined activity that involves stating your position on specific legislation to legislators and/or asking them to support your position. You can lobby your representatives directly, and through grassroots can urge others to contact their representatives.


    100 U.S. Senate Seats
    435 U.S. Representative Seats

    Every 2 years:

    • Every U.S. Representative up for re-election
    • 1/3 of U.S. Senators up for re-election
    • Committee appointments and Chairs fluctuate with control of the House and Senate
    • Representatives are essentially always running for re-election
    • Access to both Senators and Representatives based on whether or not you will help then get re-elected
    • The larger the group, the more votes are at stake

    Congressman's Daily Schedule:

    • 10 Scheduled Appointments (15 requested)
    • 30 Drop-in Visits (100 requested)
    • 10 Phone Calls (75 requested)
    • 75 Faxes
    • 100 Emails
    • 125 Letters

    Both the Senate and House of Representatives have specific committees to handle specific areas of legislation. For issues that are relevant to Surgeons and Surgical Patients include:

      • Appropriations
      • Education & the Workforce
      • Energy & Commerce
      • Judiciary
      • Small Business
      • Ways & Means
    • SENATE
      • Appropriations
      • Finance
      • Health, Education, Labor & Pensions (HELP)
      • Judiciary
      • Small Business
  • Congressional Office Staff

    Washington, D.C. Office

    • Chief of Staff – Top staff person who is responsible for all office functions:
      • Oversees the staff and the budget
      • Advisor on political matters for Representative/Senator
      • Responsible for staff personnel hires, promotions and terminations
      • Establishes the staff policies and procedures
    • Legislative Director (LD):
      • Establishes legislative agenda for the office
      • Directs the rest of the legislative staff
      • Is a resource for the LAs
      • Responsible for briefing the Representative/Senator on legislative matters
      • Reviews constituent mail
    • Press Secretary/Communications Director:
      • Responsible for managing all communications with the media
      • Speaks directly with reporters
      • Prepares Representative/Senator for their press interviews
      • Drafts the Representative/Senator's press releases, newspaper columns, and speeches
      • Often has/shares responsibility for the Representative/Senator's social media presence
    • Office Manager:
      • Assists Chief of Staff in managing the office functions; this includes complying with Congressional Accountability Act and ethics policies, and financial disclosure reporting
      • Maintains the office equipment, supplies, filing systems, etc.
      • Responsible for managing the office accounts
    • Executive Assistant/Scheduler:
      • Is responsible for the Representative/Senator's schedule
      • Main person responsible for reviewing and researching received invitations
      • Handles Representative/Senator's personal files, correspondence, and their travel arrangements
    • Legislative Assistant (LA):
      • Handles Representative/Senator's priority issue areas
      • Is responsible for briefing the Representative/Senator on votes and hearings
      • Helps to develop legislation and strategies for the Representative/Senator's legislative priorities
      • Staffs the Representative/Senator at mark-ups and hearings
      • Meets with constituents on a variety of issues
      • Answers constituent's mail
      • Helps to prepare speeches and record statements
    • Legislative Correspondent (LC):
      • Helps to research and write legislative correspondence
      • Helps to conduct legislative research
      • Assists the Legislative Assistant(s) as they are needed
    • Systems Administrator/Mail Manager:
      • Manages all computer hardware and software systems used by the Representative/Senator's office
      • Maintains the Representative/Senator's office website, Internet and Intranet systems
      • Is the liaison with vendors
      • Answers the office staff's computer questions
      • Manages the Representative/Senator's mail processing
    • Staff Assistant/Receptionist:
      • Staffs the front reception area which includes greeting visitors and answering the telephone
      • Processes tours and flags requests for review
      • Responsible for responding to general constituent requests

    District Office

    • District Director:
      • Is in charge of the overall district operation and work flow
      • Responsible for managing district staff (including hiring, promoting and replacing staff as needed)
      • Is able to represent the Representative/Senator at events
      • Is responsible for monitoring district issues and politics
      • Conducts staff outreach
    • District Scheduler: 
      • Handles scheduling for the Representative/Senator in the district
      • Makes appointments for the Representative/Senator
      • Responsible for responding to invitations
    • Field Representative: 
      • Is under the direction of the District Director
      • Is also able to represent the Representative/Senator at meetings and events
      • Help to shape the Representative/Senator's district schedule
      • Accompanies Representative/Senator to various functions
      • Conducts staff outreach 
    • Constituent Services Representative/Caseworker:
      • Handles constituent casework
      • Can meet with consultants
      • Is responsible for contacting agencies and researching cases
      • Notifies constituents of any case resolution
  • Legislative Lingo

    Terms to help you understand and communicate about the legislative process:

    • Act – A bill once it has been signed into law (passed by both the House and Senate and either signed by the President or passed over his veto)
    • Adjourn – Close a legislative day
    • Amendment – A change to a bill; it usually is debated and voted on
    • Appropriation – Legislation that approves the withdrawal of specific funds from the Treasury
    • Authorization – Legislation defining or creating a program with defined funding levels
    • Bill – A law proposed by a member of Congress (House of Representatives bills are designated with H.R., Senate bills are designated with S.)
    • By Request – Phrase that is used by a Representative or Senator to introduce a bill at the request of an executive agency, or a private organization. This does not mean that the Representative or Senator endorses the legislation
    • Budget – Congress' proposal for federal spending during a given specified fiscal year
    • Calendar – List and the schedule of bills to be considered by a committee
    • Caucus – Meeting of a particular party (Republican or Democrat) of Congress to determine their policy and/or choose their leadership
    • Chair – Presiding Officer
    • Chamber – The place where the entire House and/or Senate meets to conduct their business
    • Clean Bill – Bill that has been revised in mark-up. Amendments are then assembled with unchanged language, the bill is then referred to the floor with a new number attached to it
    • Cloak Rooms – Small rooms off the main chamber floor where Representatives/Senators can rest and hold informal conferences
    • Closed Hearings – Hearings closed to everyone but the Representatives/Senators, staff and testifying witnesses
    • Closed Rule – In the House of Representatives, prohibition against amendments not approved by the committee which brought that particular bill to the floor. The House either can accept or reject the bill as-is
    • Cloture – Method of limiting debate or ending a filibuster in the Senate; 60 votes are needed
    • Co-sponsor – Representative/Senator who joins in sponsoring legislation but is not the principal sponsor or the one who introduced the legislation
    • Commit – To refer a bill or issue to a committee
    • Committee – A division within either the House or Senate, to which specified members of Congress are appointed, that has jurisdiction over a set area. Once a bill is introduced, it is assigned to the appropriate committee(s) for consideration. The committee(s) usually will refer the bill to a subcommittee
    • Committee of the Whole – Mechanism to expedite business in the House whereby the House itself then becomes a committee; this can allow for less rigid rules and a quorum of 100 (instead of 218)
    • Companion Bills – Identical bills introduced separately in both the House and the Senate
    • Concurrent Resolution – Legislative action used to express the position of the House or Senate but does not have the force of law
    • Conference Committee – A group of members of both the House and Senate charged with reconciling differences in a bill passed separately by both the House and the Senate
    • Conference Report – The outline of changes to a bill that have been agreed upon by the conference committee. The report must be accepted by the House and the Senate for the bill to be approved
    • Congressional Hearing – An official meeting of a committee or subcommittee held to obtain information on a bill or an issue.
    • Congressional Record – Official transcript of the proceedings in Congress
    • Continuing Resolution – Resolution enacted to allow specific Executive Branch agencies to continue operating even though their funds have not been appropriated for the following fiscal year
    • Discharge Petition – Used to remove a bill from the control of a committee; needs to be signed by a majority of Members in the House or Senate
    • Engrossed Bill – Final copy of a bill passed by either chamber with amendments; the bill is then delivered to the other chamber
    • Enrolled Bill – Final copy of a bill that has passed both chambers in identical form
    • Extension of Remarks – When either a Representative or Senator inserts material in the Congressional Record which is not directly related to the debate that is underway
    • Filibuster – Tactic used in the Senate whereby a minority intentionally delays a vote
    • Final Passage – Adoption of a bill after all of the amendments have been voted on
    • Fiscal Year – Accounting year; for the Federal Government, the FY is October 1 to September 30 of the following calendar year
    • Five-Minute Rule – Allows any House member to propose an amendment and debate it for five minutes; Opponents and supporters of the amendment have five minutes to debate it
    • Floor – The area where the business of the full House or Senate is conducted
    • Floor Manager – Representative or Senator who attempts to direct a bill through the debate and amendment process to a final vote
    • General Consent – Unanimous silent vote; if there is no objection it is resolved without a formal vote
    • Germane – In the House of Representatives, all amendments must have some relation to the bill in question
    • Hearing – Committee sessions for hearing witnesses
    • Holds – A courtesy afforded Senators allowing them to delay legislation for a reasonable period; Majority Leader can override a hold
    • Hopper – Box on the desk of the Clerk of the House of Representative where sponsors submit their bills
    • Hour Rule – When the House of Representatives are sitting as a full house, each Representative has one hour to debate amendments; when they are in the Committee of the Whole, the Five-Minute Rule is in effect
    • Jefferson's Manual – Basic rules of parliamentary procedure that is adopted by both chambers
    • Joint Committee – Committee composed of both Representatives and Senators
    • Joint Resolution – Legislation similar to a bill that has the force of law if passed by both chambers and also signed by the President; it is used for special circumstances
    • Lame Duck – Representative, Senator or President who has not been reelected but whose term has not yet expired
    • Leader Time – Ten minutes given to the Majority and Minority Leaders at the beginning of each day that Congress is in session
    • Leadership – The most powerful members of the majority and minority parties – they are elected by the other members of Congress. "The leadership" usually refers to the majority party leaders.
    • Logrolling – Process where Representatives/Senators help each other get particular legislation passed
    • Main Motion – Motion that introduces the business or proposal to the assembly for action
    • Majority Leader – A position that is elected by the majority party membership in each chamber. This position basically controls the schedules and workings of both chambers. In the Senate, the majority leader is first-in-command, although technically the Vice-President of the United States is the President of the Senate. In the House, the majority leader is second-in-command behind the Speaker of the House.
    • Mark-up – The consideration of a bill while it is in subcommittee or committee during which the bill is actually written on to indicate revisions.
    • Minority Leader – Chief spokesman and strategist for the minority party, elected by the members of the minority party
    • Motion to Recommit – A call to send a bill that is currently being considered on the floor back to the committee of jurisdiction for further consideration.
    • Omnibus Bill – Bill regarding a single subject that combines many different aspects of that subject
    • Open Rule – In the House of Representatives, permission to offer amendments to a particular bill during floor debate
    • Override a Veto – Both the House and Senate vote by a two-thirds majority to set aside a Presidential veto of legislation
    • On the Floor – Under consideration by the full House or Senate.
    • Pairing – System whereby two Members jointly agree not to vote on a particular matter
    • Pending – Awaiting action.
    • Petition – Plea by an individual or organization for a chamber to consider particular legislation
    • Pocket Veto – When the President does not sign or veto legislation submitted by Congress within ten days of adjournment, the bill dies
    • President Pro Tempore – The temporary presiding officer of the Senate in the absence of the Vice-President of the United States.
    • Private Bill – Designed to benefit a certain individual or business
    • Public Law – Designation used for legislation that has been passed by both chambers and also signed by the President
    • Quorum – Number of Representatives or Senators who must be present before a legislative body can conduct any official business
    • Quorum Call – In the Senate, method of determining whether there is a quorum; used to suspend debate without adjourning
    • Ranking Minority Member – The senior member of the minority party on any given subcommittee or committee.
    • Recess – The conclusion of a legislative day that is accompanied by a set time to reconvene.
    • Regulation – A rule or order issued by the executive branch of government that has the force of law and usually is authorized by law.
    • Report – A document giving a committee's (or subcommittee's) opinion and actions on a bill, or the act of a committee (or subcommittee) concluding its consideration of a bill and referring the bill to the House or Senate to be placed on the legislative calendar for consideration.
    • Resolution – Measure passed only in one chamber to express the sentiment of that chamber, a simple resolution does not have the force of law
    • Rider – An amendment that has been attached to an unrelated bill so that the amendment will slide easily through passage. Riders are often attached to appropriations bills.
    • Roll Call Vote – In the House, an oral vote for which a record is kept
    • Rules – Regulations governing the conduct and processes of the Senate and the House.
    • Seniority – Length of unbroken service; often used to determine rank on committees
    • Seriatim Consideration – Consideration of a motion, line-by-line
    • Sine Die – Final adjournment at the end of a session; bills that were under consideration, but not enacted have to be reintroduced in the next session
    • Speaker of the House – The presiding officer in the House and first-in-command of the majority party – an elected position within the party membership. The Speaker is second-in-line (after the Vice President) to succeed to the U.S. Presidency.
    • Sponsor – Representative/Senator who introduces a measure
    • Subcommittee – A division of the committee having a more specific area of jurisdiction.
    • Suspension of the Rules – A procedure in the House to allow an expedited consideration of a bill on the floor – debate is limited, no amendments may be offered and the bill must receive a two-thirds majority to pass.
    • Table – To move to kill an amendment, bill or motion immediately without a direct vote on its substance.
    • Veto – The act by which the President rejects a bill, returning it to Congress along with a message stating his/her objections. Congress can override a veto with a two-thirds majority in both the House and the Senate.
    • Whip – The assistant to the party leader in the House or Senate – responsible for rounding up votes on bills.
    • Yield – Permission granted by a Representative/Senator who has the floor to another Representative/Senator who wishes to make a comment or ask a question

    *all definitions found from CQ's "Glossary of Congressional Terms"

  • Going from a Bill to a Law

    • Introducing the Bill & Referral to a Committee – Any member of Congress may introduce legislation.
      • Every bill submitted is assigned a number (H.R. for House of Representatives bills, S. for Senate bills), and once the bill is introduced and assigned a number it is referred to the committee that has jurisdiction over the issue the bill addresses.
    • Committee Work – After the bill is referred, the committee chairman then decides whether or not to hold a hearing on the bill, or to "mark-up" the bill.
      • If a hearing is decided, members of the committee gather information about the bill from a number of knowledgeable people on the issue and invite experts to come provide testimony during the hearing.
      • If a mark-up is chosen, committee members will amend the original text of the bill. Once mark-up is complete, the chairman will then move to vote the bill out of committee.
    • Floor Debate & Votes – In the House of Representatives, the Speaker of the House determines if and when a bill will come before the full body for a vote. This same role is taken by the Majority Leader on the Senate side. Each chamber has its own process for voting on and amending bills once they have been introduced.
      • House of Representatives – The Rules Committee sets the time allotted for debate and rules for offering amendments. In the House, all amendments offered must be relevant to the bill.
        • After debate occurs over the bill, the bill is reported back to the House for a vote.
        • A quorum (218 Representatives) must be present to have a final vote.
        • If a quorum is not present, the Sergeant at Arms is sent out to round up missing members.
        • For non-controversial bills, the Speaker may make a motion to suspend the rules and pass the bill.
      • Senate – There are no time restrictions for debate, unless cloture is invoked.  Senators can offer amendments, even if they are not relevant to the bill, like a rider.
        • Bills pass the Senate by majority vote or unanimous consent.
        • Senators can block passage of a bill by prolonging the debate using the technique commonly known as the filibuster, or they can place a hold on the bill.
        • A majority of non-controversial bills are passed by unanimous consent, without debate or amendments.
    • Referral to the Other Chamber – After a bill is passed by one chamber of Congress, it then has to be referred to the other chamber. The second chamber may consider the bill as it was received, reject it or amend it if they so choose.
    • Conference on a Bill – If there two different versions of the bill, one from the House and one from the Senate, a conference committee is created to reconcile the two different versions of the bill.
      • If no agreement can be reached, the bill dies.
      • If the committee is able to reach a consensus on the bill, it goes back to both the House and the Senate, and both must pass the new version of the bill.
      • If either side does not pass the new version, the bill dies.
    • Action of the President – After the final version of the bill is passed in both chambers, it is sent to the President to be signed into law.
      • If the president agrees, he will sign it into law.
      • If the president does not agree, he may veto it.
      • The president can also take an action known as "pocket-veto," taking no action for ten days after Congress has adjourned.
      • Any veto can be overridden by Congress by a two-thirds roll call vote. If that is successful, the bill becomes a law.
  • How To Be An Effective Advocate

    Click here for the SSAT Advocacy Self-Assessment Tool. See how strong an advocate you already are!!!

    The Face-to-Face Meeting:

    1. Overview
      1. The First Meeting – the initial meeting with official or staff member is for you to get to know each other first to start building a productive relationship.
        1. Identify yourself and your position (if you have one).  If you are meeting with staff (most common), determine their role in the office and do it subtly.
        2. BRIEFLY describe your area of expertise and interest.
        3. Ask what the member/staff health care priorities are for the year.  Try to get an idea on the timing of hearings or votes or other key events where the member might like to have your support.
        4. Make sure you volunteer yourself as a knowledgeable resource on selected issues.
        5. Briefly describe your key issues.  Make sure you tie them in to the member’s district/state – how it impacts your practice, your patients, the hospital and your colleagues – basically how it impacts the legislator’s CONSTITUENTS.
        6. Offer the member/staff to speak at an upcoming meeting or visit your institution or office.  Call SSAT for assistance in setting this up.
      2. Regular/Ongoing Meetings - Timing is always critical, and use the staff at SSAT to help learn what issues are current. Use these meetings to share your position and try and learn where the member stands on your issues.
        1. Be organized. Make your points in one to two minutes.
        2. If you are in a group, either plan what each person is going to say beforehand, or have one person as the primary spokesperson. And do NOT contradict each other.
        3. The most important information you can bring - Be prepared with examples of how the bill will impact either favorably or unfavorably your patients and the medical practices in your community.
        4. BE BRIEF. Let the member/staff ask questions. Ask them their position on the issue.
        5. Show respect at all times for the staff and legislators.
        6. Point out groups that support your opinion, those that don’t, and why. Acknowledge the opposition’s legitimate points (there usually is at least one) and respond to those that are false or misconstrued, with facts, not emotion.
        7. Give the member a one-page fact sheet listing the reasons why he/she should support your cause. More detailed information can be sent to the staff if requested. Make sure to leave your business card or other identifying information.
      3. After Each Meeting – What you do after the meeting can be equally important. Both written and oral communications serve as a constant reminder that you are a concerned constituent. Timing is important; don’t wait too long to follow-up with the office.
        1. Write a thank you letter briefly restating your position. Write a thank you letter even if the legislator did not support your requests in the meeting.
        2. Attach any information you agreed to provide during the meeting.
        3. Ask to be kept informed on the progress of the bill (but don’t count on it).
        4. Volunteer to present testimony, if appropriate, and ask to be notified of upcoming hearings.
        5. Check back from time to time, but don’t be a pest.
      4. Legislative Interviews: Five Common Case Scenarios
        1. “Don’t Call Us, We’ll Call You” – The Senator/Representative (and/or staff) listens carefully and asks few or no questions. When you ask about his/her position, you are told he/she will think about your comments. You are thanked politely for your time. This is a totally noncommittal meeting.
          1. What do you do?
            1. This is the single most common type of legislative meeting. It is not a bad one. You have established yourself and your position on relevant issues.
            2. But you can do more.
              1. First, respect the fact that the Senator/Representative has not made a decision; don’t try to press him/her for a commitment he/she is not ready to make.
              2. Do ask questions to find out what forces might be influencing the decision.
              3. Build your case – cite the impact on patient/physician populations back home, on their constituents. Cite other supporting groups.
              4. Discern the level of grassroots pressure the Senator/Representative has been receiving.  Also, try to discover if he/she has been contacted by other groups.
              5. Always ask whether you can provide additional information to the office.
              6. Always leave your name, address, and phone number (if you don’t have a business card, write this on the fact sheet you leave) and the phone number and staff name for the SSAT office.
              7. Ask if there are any other issues they would like to discuss with you. Don’t waste time. But there may be other issues where you can find a common interest. If you are meeting with staff, this is a good time to discover if he/she is from your area and other information that could provide the personal touch that adds to the relationship.
              8. As with any important meeting, follow-up is crucial. This is particularly true for the undecided. Write a thank-you letter, including any information requested at the meeting. For the undecided, it is also helpful to get others to write and/or phone the Senator/Representative to urge him/her to support your position.
        2. “I’m new” or “I don’t know much about health” – This is more likely to happen with staff. There is a lot of turnover in Senator/Representative’s offices.  Many staff – particularly those in the personnel office (with whom you will meet most often) – may know little about health care issues. In the personnel office, the staff may cover five or six issues, and it may not be a combination which makes sense. For example, he/she may cover defense, education, health and transportation.
          1. BUT, CONTRARY TO WHAT YOU THINK, THIS IS NOT BAD NEWS! – This is the best time to begin to develop your position as a valuable resource to the staff – a helpful expert on medical/health care issues. Best of all, you are an expert from back home. You are the constituent on whom they can rely on for accurate information, even when it is very technical. You can become an asset; you can make them look good and make their job easier.
            1. Start out with the basics – who you are, what type of surgeon you are, where your office (hospital) is. Tell them what the SSAT is and what it represents.
            2. Explain the advocacy “profile” of the organization – for example, that we are committed to patient-physician advocacy. Give them a cross section of issues you have worked on to support this profile.
            3. This is the perfect time to bring up information that describes the practice of medicine in your area.
            4. Give an overview of the issues you are most interested in and your position on those issues.  The one-page fact sheet again is always valued.
            5. Don’t use medical jargon. Don’t talk down.
            6. Let them ask questions. In fact, encourage it.
            7. In addition to the follow-up outlined previously, do what you can to develop this relationship.  Letters, phone calls, e-mails and visits are all tools to use, but don’t become a pest. Be ready to help, but do not become overbearing.
            8. Remember, new staff becomes experienced staff.  If you encourage an interest in health, he/she could become an ally in future years. If you underestimate them and don’t treat them with the same respect, they will remember that as well.
            9. Of course, some staff members are experts on health care issues; they are often pivotal advisors to the members of Congress. A relationship with such a staff is invaluable. Sophisticated staff will often ask you questions you don’t have answers to. Don’t fake it. Tell them you will get back to them with the answers, and remember to call the SSAT if you need help.
        3. “I agree” or “You are preaching to the choir” – After you introduce the issue, you are told that the Senator/Representative agrees with your position and is going to vote in support of the bill.
          1. Great! Now what?
            1. First, don’t waste time. Thank them.
            2. Ask what they think the prognosis is for the bill. If it’s bad, ask their advice on what you and your organization can do to help address the obstacles.
            3. Find out if there are other issues or problems that you can help the legislator with.
            4. Ask if they need more information that would also be helpful, particularly relative to how the issue affects your state or district or how many patients would be affected.
            5. Thank them again.
            6. Leave.
            7. Keep the lines of communication open so you can be useful as the expert resource.
        4. “I agree, but…” – These are variations on the previous types but with a twist. You may hear many excuses at the end of “I agree, but…” These days, the typical twist (or “but”) is “there is no money, so how can we…?”
          1. Don’t let this throw you!
          2. Acknowledge the point – for example, no money. Reinforce the importance of the issue and its impact on the district. Ask the member for advice on what you and your organization can do make this issue a legislative priority given the financial problems.
        5. “That is not my position” or “I disagree” (Politely) – After opening the discussion and presenting your issue, the Senator/Representative or staff tells you politely he/she disagrees with your position.
          1. First and foremost, respect their right to disagree and act accordingly. They have the power to cast the vote in the Legislature; even if you disagree today, you will need to work with them again on this and other issues.
          2. Listen closely to learn exactly why they disagree. For example, sometimes two parties will agree there is a problem, but disagree on the solution – which can encourage dialogue about different strategies. Other times, parties disagree on whether a problem exists or the nature of the problem. In this case, facts can help.
          3. Attempt to discern whether the problem is the issue or the politics. Politics are a different story… and a fundamental part of the democratic process. Contrary to what most physicians think, “politics” is a good thing. Politics are the foundation of a democracy.
          4. Don’t dismiss criticisms and opposition automatically. There may be a solid basis for his/her opposition. Look for the one point you can agree with. You don’t have to “win” on every point. You will win points just because you listened seriously to his/her comments and gracefully accepted his/her point of view.
          5. Don’t debate the legislator or staff. Don’t try to negotiate. (That is a job for the lobbyist). Do try to understand their position; the factors, pressures, and forces affecting them; and what is important for them to resolve the problem. Do acknowledge their position and the importance of your issue to their district.
          6. Agree that no bill is perfect. Try to find out if his/her concerns can be addressed by you and your coalition.
        6. The Not So Common – The Adversarial Meeting – The adversarial interview is the one you are really worried about. But it almost never happens – almost…
          1. Senators, Representatives, and staff may disagree with you, but they will not attack you or your position… unless you draw their fire.
          2. If a legislator or staff is attacked verbally, like any human being, they will respond. NEVER USE TERMS LIKE “I pay your salary,” or “You know nothing about health care…”
          3. And, if you are in a meeting where one of your participants engages in the above-mentioned activities, politely interrupt your representative, acknowledge their right to their own opinion, but make it clear to the legislator or staff that those views do not represent the positions of your organization. As a leader, it would be irresponsible for you to allow a legislator or staff to think badly about your organization because one member was inappropriate.
          4. And most importantly, remember the two golden rules of advocacy.
            1. Today’s opponent can be tomorrow’s friend. – Everyone is entitled to their opinion and to disagree with you. If you have done everything to present the facts and a member still disagrees, let it go. There will always be another issue and maybe one where you agree.
            2. Compromise is the key to success. In the world of politics, there is no such thing as the “right” answer. Compromise is success. Learning to understand and see things from a legislator’s perspective – including all the attendant pressures – can allow you to position your issue and help him/her find a way to successfully resolve an issue.
      5. How to Schedule a Meeting
        1. Lobbying by Personal Visit
          1. HOW TO SET THEM UP – One of the most effective ways to lobby is a face-to-face visit. Most legislators have offices within their districts and have regular office hours during which they are available to their constituents. (See legislative interviews.)
            1. Write a letter to the congressman/state legislator requesting a visit. CC their scheduler and health aide. Identify who you are, the purpose of the visit, and who will be attending. Follow that up with a phone call to the office.
            2. Expect 15 minutes with a legislator – no more than half an hour. If you are meeting in their district office, you may get more time. If you are meeting in Washington, DC, expect interruptions or cancellations with the member. The staff will usually be available.
            3. It is usually best to visit your legislators in small and to keep your visits as brief as you can.
            4. Don’t detail your campaign contributions to the legislator or his/her party. It is ILLEGAL to discuss campaign contributions in legislative offices.
            5. Be clear about what your position is and what you would like your legislators to do. Identify your bill by name and number whenever possible.
            6. A short written statement of your position should be presented to your legislators to explain what the bill does and why they should support your viewpoint. Remember the fact sheet if you can.
            7. Always follow up with a thank-you note to the legislator and staff. ALWAYS.
      6. The Ultimate List of What Not To Do (If you read nothing else, read this!) – Taken from real-life stories… unfortunately!
        1. Malign, castigate, or in any way put down the opposition
          1. A fundamental rule in debating is to ban “ad hominem” attacks, e.g., against the person. Attacks on a profession or person are the sure sign of a losing side. Physicians are an educated, honorable breed. Please do not use tactics that undermine those qualities and the reputation of your profession. So no more comments about certain professions and no more asides about other people’s motivations. No lawyer jokes!
        2. Debate, fight, or argue with a legislator or staff
          1. It happens. A physician takes a legislator’s disagreement with his/her position personally and responds emotionally. As an advocate, you need to respect a legislator’s right to disagree and respect their right to their own opinion. Remember, they have the power because they vote. And while you may disagree on this issue, there will no doubt be future issues you will both agree on.
        3. Talk too much
          1. Learn to listen. Let them ask you questions. Your goal is not to prove that you are smart, but to convince them that you are a reasonable, decent person and that your position deserves consideration.
        4. Think you can “badger” them into agreeing with you
          1. There is a clear line between grassroots advocacy and organizing your colleagues to “badger” a legislator onto you side. It just does not work. 
        5. But I’m Right, I Should Win!
          1. You may not. In the legislative world, “right” is relative. Compromise is winning. Remember that.

    Lobbying From Home

    1. Lobbying by Letter – A PERSONAL LETTER MAKES A DIFFERENCE!!!
      1. One way to communicate your organization’s view to a legislator is by letter. Legislators receive so much mail, the first thing they do is sort it to make certain you are a constituent. Remember that a legislator may read hundreds of letters each week.  The following are recommendations for writing effective letters to legislators:
        1. Write legibly or type.
        2. Write on your own personal stationery or business letterhead. If you are writing as a Representative of a group, write on the organization’s stationery. No postcards. Sign your full name and address so your legislator can respond. Include a phone number and e-mail address as well, as the legislator may wish to talk or e-mail with you about your communication.    
        3. If you are a constituent, begin your letter by saying so. If appropriate, thank the legislators for his/her work or support on a previous issue, cause, etc.
        4. Refer to the bill by name and number if possible. Concisely explain your position and why your support/oppose the bill.  Write about one bill or issue in each letter.
        5. Personalize your letter. Tell the legislator how the bill will impact his/her district. Cite your own experiences and/or local stories, if appropriate.
        6. Get whatever facts you can about the state, but remember to also bring the story home.
        7. After you have told your legislator where you stand, ask your legislator to state his/her position in a reply.
        8. If your legislator supports you with a vote on an issue, write and thank them.  Be appreciative of any positive votes in the past. Much of the mail received by legislators is from displeased constituents; a letter complimenting your legislator will be remembered favorably the next time you write.
        9. Timing is important. Time it with an important vote or debate.
        10. Do not send a photo or carbon copy to your other legislators when you have addressed a letter to one. Write to each legislator individually.
        12. Address your legislators properly. Examples are below:
          1. Governors:
            1. Address to His/Her Excellency John Doe
            2. Dear Governor Doe:
            3. State Senators:
              1. Address to The Honorable John Doe
              2. Dear Senator Doe:
              3. State Representatives:
                1. Address to The Honorable John Doe
                2. Dear Representative Doe:
                3. U.S. Representatives:
                  1. Address to The Honorable John Doe
                  2. Dear Representative Doe:
                4. U.S. Senators:
                  1. Address to The Honorable John Doe
                  2. Dear Senator Doe:
    2. Lobbying by Telephone
      1. The Goal – Most frequently, you will “lobby” by phone when the legislators are about to vote on a bill.  The point here is to share your position and who you represent.
        1. The following basic format works whether you speak to someone or leave a message. On the phone, be brief and be polite.
        2. Unless you really know the legislator (and I mean really), ask to speak with the health staff. Even if you know the legislator, you may talk to the health staff.
        3. Thank them for taking the call. Identify yourself by name, home town within his/her legislative district, and who you are representing.
        4. Identify the bill by name and number, state your position, briefly why the bill is important, and how you would like your legislator to vote.
        5. Show appreciation for his/her service on past votes. Be positive.
        6. If speaking to someone and not leaving a voice-mail, ask them to tell you the legislator’s position. If they have not decided, find out if they need further information. If yes, supply it quickly. If no, thank them for their time and get off the phone. If he/she is opposed, find out why and impress upon them how important this issue is to physicians. DO NOT ARGUE WITH THEM.
        7. Call or e-mail the SSAT to keep us updated or your progress.
    3. Lobbying by E-mail
      1. The rules that apply to letter writing also apply to e-mailed correspondence. While many e-mail communications tend to be informal, we recommend that advocacy e-mails retain much of the same formality of handwritten letters.
        1. E-mail has gained in popularity as a means of reaching congressional offices. Nevertheless, e-mail does NOT carry the same weight as a letter. Our best advice is to check with your legislator’s office to determine their interest in receiving e-mails as opposed to other forms of correspondence.
        2. E-mail advocacy is less effective at the State House because many legislators do not weigh it heavily and some don’t even read their e-mails regularly.

    Campaign Contributions

    1. Introduction to federal campaign finance
      1. In 2010, the Center for Responsive Politics estimated that candidates in the 2010 Midterm Congressional Election spent at least $3.7 billion. To finance their campaigns, these candidates rely on assistance from individuals, interest groups, corporations and unions.
      2. At the federal level, the primary source of campaign funds is individuals, followed by political action committees (PACs).
    2. Hard Dollars vs. Soft Dollars
      1. Hard dollars – Contributed by an individual directly to a candidate, political party or PAC.
        1. Reported to and regulated by the Federal Election Commission (FEC)
        2. An individual cannot contribute more than $5,000 per PAC per year
      2.  Soft dollars – Contributed from a corporate account or dollars spent by a union or corporation’s general account
        1. Until recently, soft dollars could not be used for political activity, but rather for administrative and educational purposes not related to the election of specific candidates
        2. In a 5-4 decision in Citizens United v. Federal Election Commission, the U.S. Supreme Court ruled that corporations and unions have the same political speech rights as individuals under the First Amendment, which reverses the ban on soft dollars being used to make election-related independent expenditures
    3. What is a “contribution”
      1. The FEC considers …”anything of value given to influence a Federal election” to be a contribution
      2. This does not include volunteer work – you can perform an unlimited amount of this if you are not compensated for it
        1. Donations of food, beverage, office supplies, printing or other services, furniture, etc., are considered “in-kind” contributions, so their value counts against contribution limits
      3. Questions should be directed to the FEC in Washington, DC at 800-424-9530 or 202-694-1100
    4. Individual Contributions
      1. Federal Campaign Finance Law places legal limits on how much and what you can give
      2. Individual contribution limits for 2011-2012 – This is for contributions from individuals directly to candidates for all Federal offices:
        1. $2,500 per Election to a Federal Candidate – Each primary, runoff and general election counts as a separate election
        2. $30,800 per calendar year to a national party committee – Applies separately to a party’s national committee, and House and Senate campaign committees
        3. $10,000 per calendar year to state, district & local party committees (combined limit)
        4. $5,000 per calendar year to any other political committee
      3. Married couples are considered to be separate individuals with separate contribution limits
    5. Political Action Committee (PAC)
      1. A group organized for the purpose of raising and spending money to elect and defeat candidates
        1. By law, corporations, unions, and certain special interest group cannot contribute directly to candidates for federal office – they must do so through a PAC
      2. PACs raise money from their eligible membership and then make contributions to political campaigns
      3. Federal multi-candidate PACs are limited in the amount of money they can contribute to candidate campaigns or other PACs or Party Committees:
        1. $5,000 maximum donation per candidate per election – Primaries, general elections and special elections are deemed separate elections
        2. $15,000 maximum donation per political party or party committee per year
        3. $5,000 maximum donation per PAC per year – An example is donating to a candidate’s specific PAC organization
      4. There are no limits to the amount to a PAC can spend on independently for or against a candidate – known as an “independent expenditure” or IEs – so long as there is no coordination or prior knowledge of the candidate or party committee
      5. To learn more about a specific, a great resource is
    6. Host an event
      1. In coordination with the SSAT and with a Congressman or Senator’s local and Washington offices you can also set-up  visits to your hospital or practice, or set up a fundraising event
      2. Hospital/practice visit – This is a great opportunity to give your member of Congress a tour
        1. You set this up with the Representatives’ office – call them and then follow-up that with a formal invitation via letter/email
        2. Coordinate around their schedule, not yours
        3. If you are going to give a tour of the hospital, involve your department head and your hospital’s administration is involved
      3. Fundraiser/Dinner – Coordinating with your society and PACs to help present contributions directly to a Representative in the setting of an event
        1. This can be at your house, a private event, etc.
        2. It is best to coordinate with your specialty PAC so that you can present an actual check to Representative at the event – great photo opportunity!
        3. Organize this with the local and national offices of the Representative
      4. Call SSAT to help coordinate these events

    Get in the Loop – How to Stay Informed

    1. Resources – Information is key to successful advocacy! A good legislative advocate knows how to access information so that his or her efforts – whether in-person, by telephone, letter, or e-mail – relay the facts accurately, clearly, and persuasively to the legislator. In addition to the general information available through the media, the SSAT and other organizations have provided a number of ways in which physicians can stay informed on legislative matters:
      1. SSAT website
      2. Advocacy guide
      3. Legislative Updates and Action Alerts
      4. Online Legislative action center
      5. Library of Congress THOMAS website provides extensive info on federal legislation and much more at

    The Top Rules of Advocacy

    10) Know who you are: a patient/physician advocate. What is good for your patients is good for your practice and for quality health care in your district.

    9) Know your stuff. Know your issue – why it is good for your patients/district/specialty or not, who supports it, who opposes it, and why. Be clear about the opposition’s strength and weakness; acknowledge legitimate concerns (if any) and refute those that are incorrect.

    8) Know your legislators – their interests, their district, their biases, and their voting records. Try to relate to them as individuals.

    7) Know the legislative staff. Nine out of ten times, these are the people you will speak with and write to. They are invaluable sources of information and the key to your entry into the legislative process.

    6) Your word is your bond. Never promise something you cannot deliver or overstate the relative importance of an issue.

    5) Build coalitions – there is strength in numbers. Look for allies everywhere.  In politics, an ally is someone who may disagree with you on every other issue but supports you on the one at hand. Don’t assume the opposition is homogenous, finding the one group from the “other side” that supports you can be the key.

    4) Don’t waste time on opponents (or legislators) who are publicly committed to opposing you on an issue. Focus on relationships with allies or people who have room to be flexible and are keeping an open mind.

    3) “Today’s opponent may be tomorrow’s ally.” Never allow a legislator to consider you a bitter enemy because you disagree.

    2) Thank those that help you.

    AND THE NUMBER ONE RULE OF EFFECTIVE ADVOCACY… “When you are crossed politically, don’t get mad, get even.” –Bobby Kennedy

    1) The power of the ballot box is yours – VOTE!!!



    1) Legislative Handbook. Massachusetts Medical Society.

    2) Federal Election Commission.

    3) Quick Answers to General Questions. Federal Election Commission.

    4) Open Secrets.


    Approved by PPA Committee, October 2012