he ASA Political Action Committee (ASAPAC) was founded in 1991 to serve as a proactive, bipartisan, nonideological political advocate on behalf of all anesthesiologists.

I would like to thank our valued supporters of ASAPAC. In this discussion, I will highlight the critical importance of ASAPAC, discuss the upcoming 2006 election season and summarize PAC Board of Directors initiatives and contribution data. I will conclude with a discussion of legislative priorities that will shape the future of our medical specialty.

Your ASAPAC Board is committed to increasing participation by ASA members until ASAPAC is sufficiently funded to protect your professional interests in our nation’s legislative arenas. Currently joining ASAPAC among the nation’s top 100 PACs are political action committees representing the American Association of Nurse Anesthetists (AANA), the Association of Trial Lawyers of America (ATLA), the American Hospital Association and Blue Cross/Blue Shield Association. In recent years, these organizations have energetically participated in the political arena. This is abundantly evident through ATLA’s impact on Democratic senators currently blockading tort reform in Washington, D.C.

The congressional budgetary process constitutes an ongoing review of our nation’s resources and obligations. Congressional initiatives impacting funding and regulation of medical care arise during each congressional session. These issues directly impact our professional lives as well as the safety of our patients. ASAPAC provides important political support to our profession’s legislative initiatives.
The upcoming 2006 election cycle will impact 435 House of Representatives seats, 33 Senate seats and many gubernatorial and state legislative offices. ASAPAC and politically active anesthesiologists are involved in many of these elections.

With regard to races for the U.S. Congress, ASAPAC and local anesthesiologists are working in support of 140 pro-physician, pro-anesthesiology candidates — incumbents, challengers and open-seat candidates — in nearly 40 states. Among the targeted races for ASAPAC is the campaign of Rep. Clay Shaw (R-FL). Rep. Shaw, a longtime supporter of anesthesiology, is the author of legislation to scrap the flawed sustainable growth rate (SGR) Medicare fee schedule update formula and replace it with a mechanism that would provide physicians a more reasonable annual update mechanism. Rep. Shaw also is recognized as a strong advocate for medical research and education and is the author of legislation to fix the unworkable Medicare teaching anesthesiologist payment rule. Another targeted candidate for ASAPAC is Rep. Frank Pallone (D-NJ). Rep. Pallone, a senior member of the House Energy and Commerce Committee — a key Medicare committee — has worked with ASA and New Jersey anesthesiologists for years to address critical issues impacting the specialty. In particular he has been recognized by ASA for his leadership role in urging the Centers for Medicare & Medicaid Services (CMS) to address the underfunding of Medicare payments for anesthesia services.

ASAPAC also is directly involved in nearly half of this election cycle’s U.S. Senate races. Targeted campaigns for ASAPAC include the re-elections of friendly Senators in Ohio, Arizona and Missouri. Respectively, these races feature Sen. Mike DeWine (R-OH), a longtime supporter of anesthesiology and 2006 recipient of the ASA Excellence in Government Award; Sen. Jon L. Kyl (R-AZ), the U.S. Senate’s leader in pushing for reform of the flawed SGR Medicare update formula; and Sen. Jim Talent (R-MO), a longtime supporter of medicine. ASAPAC also has targeted for support Rep. Benjamin L. Cardin (D-MD), a coauthor of House legislation to repeal the SGR formula, as he runs to fill the Senate seat to be left vacant by the retirement of Sen. Paul S. Sarbanes (D-MD).

In addition to races for federal elected office, ASAPAC supports a number of candidates for state office. With ASAPAC support, John M. Zerwas, M.D., of Houston, Texas, a practicing anesthesiologist and ASA Assistant Treasurer, prevailed in a crowded Republican primary earlier in the year to position himself for possible election to the Texas State House of Representatives for the 28th district. If successful, Dr. Zerwas will become the sixth anesthesiologist serving in elected office. ASAPAC also has endorsed current U.S. Representative and gubernatorial candidate James A. Gibbons (R-NV).

A complete list of all ASAPAC-backed candidates is available on the ASAPAC section of the ASA Web Site at <www.ASAhq.org>.

In an effort to improve communication among anesthesiology’s politically active members and recognize state support for our political activity, your ASAPAC Board has implemented a number of new policy initiatives. A new communications network will functionally link PAC Board members with directors and legislative chairpersons in each state. This bidirectional system will facilitate effective translation of ASAPAC initiatives to state and local levels, while local and state issues are communicated directly to the PAC Board. A listserve has been created to facilitate this network. All states will receive periodic updates regarding ASAPAC participation within their respective component society memberships. Additionally a trophy cup has been very graciously donated by the Alabama Society of Anesthesiologists. This attractive incentive – now known as the “ASAPAC Alabama Cup” — will be presented annually in recognition of the individual state ranking number-one in total ASAPAC dollar contributions as well as overall participation as a percentage of state society membership. The Alabama Society is currently ranked number-one in both categories. We thank our Alabama colleagues for their generous support and hope other states will be inspired by their strong commitment.

For 50 years, anesthesiologists have successfully worked to reduce perioperative morbidity and mortality. While anesthesiologists are recognized today as leaders in advancement of patient safety, our medical specialty finds itself at historic crossroads on essential professional and regulatory fronts. One way or another, legislative/political challenges currently facing ASA’s membership will shape and define the future of our specialty.

All anesthesiologists must become thoroughly familiar with the critical issues impacting our specialty:

• The U.S. Congress has scheduled 5-percent annual reductions in Medicare reimbursement to physicians through 2012, crippling the opportunity for anesthesiologists to maintain economic viability.

• In 1992, Medicare arbitrarily slashed the anesthesia conversion factor by 25 percent. Although explicitly unfair, this cut has never been remedied. Today the Medicare conversion factor for anesthesiologists is less than it was in 1990 in absolute and inflation-adjusted dollars and less than 40 percent of average private payment (compared to 80 percent for all other medical specialties). Private carriers and HMOs are vigorously strategizing to link payments to falling Medicare reimbursement.

• By law physicians are not allowed to collectively bargain with insurance carriers to address issues impacting the specialty.

• While liability insurance premiums remain a critical expense for medical practices, the medicolegal environment has gone unaddressed in Washington and in most state capitols.

• Fourteen states have opted out of Medicare’s physician supervision requirement. More states are currently considering the “opt-out” option under federal rules. Meanwhile anesthesia nurses are organizing Ph.D. programs to produce nurse “doctors,” trivializing the uniquely specialized professional training and skills of anesthesiologists and other physicians.

Every anesthesiologist must be deeply concerned by these threats to the viability of our profession and make a commitment to work for solutions. Additionally, all ASA members must understand the competitive political environment in which our specialty exists. Other influential lobbies representing AANA, trial lawyers and the insurance industry have their own agendas — agendas that rarely benefit our specialty. Members of Congress cite ASAPAC’s 10-percent participation statistic as a rationale for declining to support ASA priorities. If we cannot stop the annual 5-percent reductions in Medicare reimbursement and other current threats to our specialty, the practice of anesthesiology will change radically and permanently within the time frame of the careers of most current ASA members.

Please do not allow this to happen. Collectively and individually, each of us holds the power to stop it — but we all must choose to exercise that power now or else nothing will change.

I call on each and every ASA member to meet this responsibility and make this commitment now by engaging in our governmental affairs efforts.

Learn more about the issues that threaten our specialty and how they directly impact you. Learn about the public policy process and how it shapes these threats. Learn what you can do specifically to help.
We still have this opportunity to protect our professional environment and defend our livelihood.

I would like to thank Associate Director of Governmental Affairs and PAC Director Manuel Bonilla, M.S., and J. Franklin Cassady, M.D., for their editorial assistance with this article.

James L. Becker, M.D., is a partner in Associated Anesthesiologists, PC. He practices at Iowa Methodist Medical Center, Des Moines Orthopedic Surgery Center, Lakeview Surgery Center and Iowa Methodist Day Surgery, Des Moines, Iowa. He is a member of the Committee on Governmental Affairs.