Texas Society of Anesthesiologists

Betty P. Stephenson Lectureship


Remarks of Manuel Bonilla
ASA Chief Advocacy and Practice Officer
2018 Betty Stephenson Lectureship

This is a very special honor for me.  I am both honored and humbled to present the Betty Stephenson Lectureship this year.

I held Dr. Stephenson in very high esteem.  She was so accomplished and was an energetic advocate for anesthesiology.

I am grateful for this opportunity to speak about role the Texas Society of Anesthesiologists and Texans, like Betty Stephenson, played in the creation and building of the American Society of Anesthesiologists Political Action Committee. 

I believe I bring a unique perspective to this lectureship because I am not an anesthesiologist; but I am also not a complete outsider who observes the specialty from a far. 

Every day, I work closely with ASA members to advance and secure the future of the specialty.

I have done that for 21 years, genuinely feeling privileged for the opportunity to work with such a fascinating specialty and wonderful physicians. 

I have read about and know the history of the giants of anesthesiology.  In our DC office, our conference rooms are named after the giants of the specialty – Wells, Morton, Safar, Hingson (epidural innovator), Beecher (informed consent).  I live with this history every day.  Every Monday, we have our All-DC staff meeting in the Long Conference Room.  Our lobby team meets later in the day in the Apgar Room.  

But I have also been privileged to personally know and actually work with some of the giants of anesthesiology advocacy – those who have built the advocacy voice of the specialty – including those who helped build our political action committee. 

Today, ASAPAC is the largest physician PAC in the United States. We are larger than the American Medical Association PAC, AMPAC.  We passed AMPAC during the 2009-2010 election cycle.   

We are top 10 in the nation among trade association PACs and a top 60 of all PACs in the U.S.  Take out the large labor PAC and we are a top 50 PAC – of all federally registered PAC. Last year, we raised over $2 million and we hope to do the same this year to bring our total fundraising to over $4 million for the 2017-2018 election cycle. 

Why does this all matter?  Our PAC, which so many Texans helped build, gives anesthesiology stature.  It give us political visibility and a political voice.  Most importantly, it gives ASA members the chance to actively and tangibly participate in the election process. 

Supporters of our specialty whether at the federal or state level are made, they are not born.  Beyond John Zerwas, Tom Oliverson and Andy Harris, few elected officials go to their state capital or Washington, DC office mindful of anesthesiology. 

Our supporters are made by the sweat equity of our grassroots and key contacts at the campaign level.  Our ASA advocates develop relationships with candidates, who hopefully will go on to be successful lawmakers.

It is important to appreciate that political campaigns are truly where the rubber hits the road.  What is a candidate's most important job?  Getting reelected.  Without a seat on Capitol Hill or in Austin from which to legislate, you are just a person writing your blog or tweeting your wonderful ideas that no one will read or care about.  Its all about winning the election and earning a position where your views, as a elected official matter – where you can legislative and influence policymaking. 

Campaign's matter and because of the strength of our PAC, we are able to play a major role in campaigns - building political relationships and helping people who understand anesthesiology get elected.

When this election cycle is complete - November 7 - the day after Election Day, ASAPAC will have worked with over 200 candidates.  We will have had a particularly consequential impact on around a dozen highly competitive seats and we will have helped elect or reelect around a dozen physician lawmakers.

But it wasn't always like that. And the TSA and Texans were instrumental in changing that.

In truth, ASA was late to the political game.

Well into the late 1980's, anesthesiology had no national political presence. We had no PAC, no mechanism for political involvement.

The AMA had started their PAC in 1975, as had the Texas Medical Association.  The Emergency Physicians had started their PAC in 1981. Ophthalmology geared up in 1985.  On the non-physician side, the American Nurses Association and the American Podiatric Association also started their PACs in 1975.  And the American Association of Nurse Anesthetists were in the game before ASA.  They started their PAC in 1983. All of these organizations had a national political presence, a national political voice.

Interestingly, the North Carolina Society of Anesthesiologists had started a federal PAC in 1987.  Similarly, the San Diego-based Anesthesia Services Medical Group – ASMG - had also started a federal PAC in 1987. Anesthesiology had a local and state presence, but there was no national political voice for the specialty.

Advocacy leaders within ASA began to be realize that the specialty was literally falling behind.  The federal government was going to have an increasingly prominent role in the future of the specialty. Yet, anesthesiology had no visibility on Capitol Hill. 

In contrast, the nursing community including the nurse anesthetists and other physician groups were very organized.  Visible.  Politically active.

ASA had long considered a federal PAC.  We know from ASA Newsletter articles that, in 1983, the ASA's Committee on Governmental Affairs, Chaired by past-ASA President, John Haddox, M.D. of California had "explored the merits" of establishing an ASA political action committee.  Dr. Haddox was a member of the San Diego group, ASMG, that was politically active.  He was also personally politically active having been the President of the California Society of Anesthesiologists in 1966 and having been very active in the efforts of California's organized medicine in the 1970s to enact the states Medical Injury Compensation Reform Act or MICRA law.  

The Committee on Government Affairs debated the creation of a PAC.  Ultimately, the committee decided against its formation.  At the time, it was urged that ASA members support AMPAC. In fact, at the time, there was a lot of talk about foregoing a PAC and piggy-backing on AMAPAC. 

Again, in 1984, more discussions took place about a PAC.  Again, it was deferred.   

The problem was, and unfortunately, its remains to some degree today, some ASA members find politics, campaigns, lobbying distasteful.  This despite the fact that so much was at stake and that our opponents and other stakeholders were building their political voices.  Sadly, there was stiff resistance to ASA getting involved in politics.

The question of an anesthesiology PAC continued to languish.

By the late 1980's voices for political involvement were becoming stronger.  In 1988, Orin Guidry of Mississippi and later to be ASA President was named to Chair the Committee on Government Affairs. Dr. Guidry came to the job with a high level of political sophistication.  He had just ended a term as Chair of the Mississippi Medical Association PAC.   

According to ASA Newsletter article, at that time, ASA found itself reacting to "HCFA proposals for Medicare reimbursements included sweeping changes the would produce significant reductions in anesthesiology reimbursement.  This included geographically adjusted decreases in the conversion factor…changes in units for cataract procedures…and reduced fees for medical direction of CRNAs.  There were also proposals to not allow full reimbursement for concurrent resident supervision…"

The legislative and regulatory landscape was growing increasingly challenging.

Fortunately, also joining the scene was Dr. Jim Arens as he joined the ASA Executive Committee in 1987.  Dr. Arens brought a firm understanding of Advocacy to the EC.  During his tenure as President and even afterwards, he was ASA's go to person for Congressional testimony and Washington, DC meetings.

Dr. Stephenson arrived on the leadership scene in 1988. She brought incredible advocacy bona fides to ASA.  She was an ADVOCACY workhorse – President of TSA 1983, President of Harris County Medical Society in 1986.  Active in TMA, AMA and ASA.  She was also a very effective Key Contact for a number of federal lawmakers.

In October 1988, later-to-be ASA President, John Neeld nominated Betty Stephenson for ASA First Vice President.   Neeld said "Each of you knows very well that decisions and regulations of the federal government have had an increasingly important and far-reaching effect on our Society and upon all of medicine.  I'm sure that all of us sense that the effects of decisions reach in Washington will become even more important in the immediate future."  His speech subsequently praised Dr. Stephenson for "years ago, she foresaw that legislative and regulatory activities would someday determine our future," and that she had attended, all the, still in their infancy, ASA Legislative Conferences and was "already educated in the issues, their history, our policies and our adversaries."

Dr. Stephenson, of course, was subsequently elected first-Vice President for 1989.

All of the right pieces began to come together.  With folks with legislative and political sophistication in ASA's leadership, an increasingly challenging federal legislative and regulatory environment, and a long simmering interest in a PAC on the Committee on Government Affairs, the time was right.

Additionally, pressure was building from local ASA members and the small ASA D.C.-based government affairs team, Adrienne Lang, the head of ASA D.C. office, and Dan Maldonado, our outside consultant at the time.  The physicians and government affairs staff were being squeezed for individual campaign contributions.

Interest in developing a political voice was particularly pronounced from Texas and California.

During those years, the ranks of federal lawmakers working on health care issues were dominated by Californians and Texans. 

From California, you had the famous or infamous, Henry Waxman, the long-time Chair of the House Energy and Commerce Health Subcommittee and Rep. Pete Stark, Chairman of the Health Subcommittee of the powerful House Ways and Means Committee. Both Waxman and Stark had strong interest and expertise in a range of health care issues including universal health insurance, Medicare and Medicaid issues.

From Texas, you had Senator Lloyd Bentsen, Chairman of the Senate Finance Committee; Bill Archer of Ways and Means; Democrat JJ Pickle of the Ways and Means Committee;  Ralph Hall of Energy and Commerce; Jim Wright, Speaker of the House (until 1989); and Charlie Stenholm, a highly influential conservative Democrat.  Tom Delay and Dick Armey were in the wings.

At the 1990 ASA House of Delegates, Dr. Tom Joas of California introduced a resolution for ASA to create "a good government fund." 

Joas was a colleague of Dr. Haddox from the large San Diego group. He understood the value of political engagement. 

Additionally, Dr. Joas was ASA's key contact for Congressman Bob Matsui.  Like Pete Stark, Matsui was a member of the powerful House Ways and Means Committee, a committee with significant jurisdiction over health care issues including Medicare.  Joas had built a good relationship with Matsui.  Matsui was thinking about running for U.S. Senate in California, which is a massively expensive political undertaking. 

He had started trying to get contributions from Joas.  Joas felt ASA needed a PAC to be able to provide our friends the political resources to run successful campaigns.

The Joas resolution was referred to the Committee on Government Affairs, now fertile territory for political action under Dr. Guidry.  The committee researched the issue.  Dr. Guidry traveled to Washington, DC and met with our then small government affairs team, and met with representatives of the emergency physicians' and ophthalmologists' PAC.  The result was a report at the March of 1991 ASA Board of Directors meeting recommending the formation of the PAC.  The Board approved the recommendation which was then approved at the 1991 House of Delegates.   

The ASAPAC statement of organization to the Federal Election Commission or FEC, authorizing the operation of the PAC was filed on November 12, 1991. 

ASAPAC's first FEC filing captured that three contributions were received initially.  Those contributions came from Dr. Stephenson, Dr. Neeld and Dr. Roger Litwiller, of VA, who had been named the first Chairman of ASAPAC.   Litwiller, another later to be ASA President, was selected because he had demonstrated his political chops through his successful involvement with the Virginia Society of Anesthesiologists state PAC.

As ASA President, Dr. Stephenson insisted on being the first to make a contribution.

From November to the end of 1991, ASAPAC raised a whopping $24,700 from 40 donor, 7 of whom were from Texas.  Texans contributed $2500 or over 10% of the first year's receipts. No disbursements to candidates were made were made.

By election year 1992 – a Presidential election year (Bush v. Clinton v. Perot) - the PAC was in full swing.  The PAC raised over $310,000, for a grand total of over 330,000 for the 1991-1992 election cycle.   

The PAC started making its first disbursements to candidates.  The first ASAPAC contribution went to Senator Bob Packwood of Oregon, the very powerful Senior Republican on the Senate Finance Committee.  Packwood would later resign the Senate, under threat of expulsion, in 1995, after allegations of sexual misconduct.

Other 1992 contributions went to Texans, Mike Andrew, a member of the Health Subcommittee of the House Ways and Means Committee; Ralph Hall; Charlie Stenholm. Stenholm had earned a reputation for building bipartisan alliances in areas of health care and the budget; and JJ Pickle.  $9000 in direct contributions were made to Texans - second, only to California lawmakers who received a total of $15,000 from ASAPAC.

ASAPAC first full election cycle was the 93-94 cycle (the years of the Gingrich Revolution during which the GOP picked up 54 House seats and 8 Senate seats), the PAC started the year with $206,000 in the bank and over the course of the two years raised $702,000, spending $626,636. Ended with $282K.  Contributions in the cycle went to Reps. Tom Delay, Joe Barton, Dick Armey and Gene Green. 

The PAC began its growth in size and influence and Texas continued to play a major role.

ASAPAC is governed by our Executive Board.  While the size of the Board has changed from year to year, the critical responsibility for the PAC's operations including fundraising and disbursements has always been the same.  Over the years, the physician members of the Executive Board have included many distinguished members of the TSA – John Zerwas, Scott Kercheville, Pat Giam, Cathy Scholl and currently, John Scott. All have played and continue to play a key role in the PAC.

We have relied upon Texas as a top donor state often challenging Alabama and Florida for our Alabama Cup, an award recognizing our top performing states. The Alabama Cup was conceptualized and created by now-Texan, Jeff Plagenhoef.  In 2009, Texas won the Alabama Cup as a top supporting state to ASAPAC, disrupting Alabama's 4 year run at the top.  Currently, TSA is leading the 2018 Alabama Cup competition.

And we have relied on the support of Texas' residency programs to help build our next generation of politically active key contacts and grassroots activists.  Building on the Alabama Cup, Texas has the Texas Pint competition, created by Cathy Scholl, which recognizes top supporting Texas residency programs.  It's a wonderful competition.

In 1991, ASAPAC had 40 donors, 7 of whom were from Texas.  Currently, ASAPAC has over 6000 donors, over 500 of whom are Texans. 

And the ASAPAC dollars have flowed back into Texas to build political relationships and support candidates of both parties who understand the important role anesthesiologist play in our health care system.  Today, ASA supports Ways and Means Committee Chairman, Kevin Brady; House Energy and Commerce Health Subcommittee Chairman, Mike Burgess, M.D.; and the senior Democrat on the Subcommittee, Gene Green; Chairman of the House Rules Committee, Pete Session; Henry Cuellar and Eddie Bernice Johnson.  Chairman of the House Appropriations, Military Construction, Department of Veterans Affairs Subcommittee, John Carter;   Senator John Cornyn.  We regularly support Dr. Zerwas and Dr. Oliverson and we have been a supporter of Governor Abbott, this year.

Texas has been a great delegation for our Advocacy efforts.  And we are fortunate, to be able to support these folks.

ASAPAC is the crown jewel of our Advocacy initiatives.  It is, in my opinion one of the most visible mechanisms of professional citizenship – going beyond being leaders in clinical care to be leaders in advocating for the specialty and its patients. The PAC allows us, as a medical specialty, to have a robust political voice in an increasingly competitive political environment. 

Our PAC allows us to punch way above our weight. The American College of Physicians, the leading primary care organization has over 150,000 members - nearly 100,000 more members than ASA.  The American College of Surgeons has 78,000 members.  The American Nurses Association claims 4 million members, not counting the 52,000 members of the American Association of Nurse Anesthetists.  And you have the health insurers and the hospitals.   It's a competitive environment. But our PAC is larger and more active.

Because of our PAC, we can have a strong presence and we are able to have meaningful impact on electing candidates to office who understand the specialty. 

ASAPAC is able to get involved in any federal race it wishes.  We get involved primaries, run-offs, general elections, challenger races for and against incumbents.  Some states allow us to get involved in state races for the legislature or Governor.  We have run radio, direct mail and TV campaigns with PAC dollars. 

As I said before, there are very few candidates who fully understand the incredibly important role anesthesiology play in health care.  It takes the hard work of our key contact and grassroots members to educate them.  Our PAC helps them do their work and do it well. 

Texans, like Betty Stephenson, helped make the birth of ASAPAC possible.  And Texans have played a major role in the growth and success of the PAC.  You've helped our specialty develop a unique culture of political action, the envy of other medical specialty.  You have helped to ensure that the voice of our specialty is heard at both the federal and state level. 

I am grateful and ASA is grateful to members of the TSA for the support.  We know we can count on you in the years ahead to keep ASAPAC a strong voice for anesthesiology.


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