American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

There are many variables that go into determining a successful state legislative strategy. Some of them are process-oriented, others are organizational, and all involve commitment and dedication on the part of chapter leadership and fellowship. Remember the State Affairs Team at the American College of Surgeons (ACS) is available to help with all of this!

Define, Prioritize, and Categorize

Defining and prioritizing the issues is the first and one of the most important steps in developing a legislative strategy. Many take this step for granted, but deciding exactly what the most important issues may be before the start of a legislative session is vital to determining what resources will be needed and will save time in the long run. An example is medical liability reform – while a hot issue in many states, it is important to define the reforms to be introduced as well as the individual “components” of each issue. Is a cap more important than alternative dispute resolution, and is alternative dispute resolution more important than limiting attorney’s fees? By prioritizing these elements, you are prepared for the inevitable negotiations that will occur during the legislative session.

After the issues have been defined and prioritized, they should be categorized into three lists: proactive, reactive, or opportunistic.

The terms “proactive” and “reactive” are fairly self-explanatory. Proactive issues are those important enough to take the initiative to introduce the legislation, or issues on which to be actively engaged. Reactive issues are often defensive in nature, and usually require a response. It is very important to try and identify defensive/reactive issues before they are introduced, so that you may start earlier and plan ahead. It’s especially worthwhile to define reactive issues so you are not caught unaware. This will give you the time to formulate a response, rather than scrambling to come up with a message at the last minute.

You may be less familiar with “opportunistic issues." These are issues that you will have a position on, but may not warrant an allocation of very many advocacy resources. For example, an increase in a state’s “sin tax” to pay for trauma funding may not be something that a chapter would specifically ask for (more likely to be proposed by a state committee on trauma), but is an issue on which it would have a position. Opportunistic issues may also be “piggy-backed” onto other legislation. Perhaps a state is considering an increase in the penalties for traffic violations -- you may be able to add an amendment to allocate some of the increased funds to hospitals and physicians for uncompensated emergency care. Again, defining these types of issues ahead of time will leave you with a better understanding of the big picture.

Some examples of each of these issues:

  • Proactive: Medical Liability Reform, Physician Reimbursement
  • Reactive: Self-Referral, Scope of Practice, Physician Taxes
  • Opportunistic: Trauma System Funding and Development

It is important to note that a particular issue may not stay in the category in which it started. Last year’s reactive issue may be this year’s proactive issue, requiring a re-evaluation of the overall grassroots advocacy strategy.