Pediatrics and the legislature: Suggestions for lobbying your legislature

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Four recent changes will make it increasingly more important, yet difficult, for any group or person to effectively lobby their local legislature. First, state governments throughout the country are feeling reverberations from the recent economic slowdown. According to a recent national conference, state legislatures report that revenues in 43 states in the early months of fiscal year 2002 were below forecast. At least 36 states have reduced spending levels or are considering doing so, and 24 states have dipped into budgetary reserves or are considering doing so. Second, change at the national level is clearly influencing the way business is being conducted in state legislatures, as more powers to control resources are returned to the states. Third, the 1994 elections have brought more political balance to state legislatures throughout the country. Before the 1994 election, Democrats maintained a clear edge in the state legislatures, controlling 64 chambers to the Republicans' 31. Today, Republicans control 50 chambers to the Democrats' 46. Instead of the 8 states controlled in 1994, Republicans now hold the majority in both chambers in 19 states. (National Conference of State Legislatures) Fourth, and equally significant, nearly half of all state legislative leaders are new to their positions.

The resulting changes in political composition will dramatically alter the way in which persons and groups lobby their state legislature. This becomes progressively important for those who advocate children's services, because most of those advocates use volunteers and professionals to get their message to state legislators. Experienced legislators know the various groups that lobby them, and with the large number of new legislators, the professional lobbyists on the ground at the state capitol will have even more of the upper hand.

It is obviously clear that, with the changing political landscape, those advocating for children's services will have an increasingly difficult time. A grass-roots group of volunteers can be a potent force when they are adequately focused and dedicated to getting their message out. Clearly, these groups have their work cut out for them compared with the seasoned, highly paid lobbyists employed by business, education, labor, and other more organized groups.

The challenges faced by those advocating children's services was clearly made evident when a study commissioned in 1994 by the State Legislative Leaders Foundation, with the support of the Annie E. Casey and Ford Foundations, found that state legislative leaders are not familiar with how children are faring in their districts or in their states and that they are not well informed about the policies and programs that work, or the evidence of their impact on children (State Legislative Leaders; Keys to Effective Legislation for Children and Families). The benefit of this situation, however, is that legislators clearly need accurate information regarding children's issues, thereby making the advocates a resource and source for information, ideas, and proposals.

One specific obstacle for child advocacy lobbyists may be their lack of intimate knowledge and understanding of how the legislative process works, particularly behind-the-scenes. It is not enough to understand the mechanics of how legislatures work. To effectively lobby your state legislature you must have an appreciation of the intangibles that exist: the personalities of the legislators, the importance of timing, an understanding of the legislature's inner circle, and a willingness to compromise. The necessity for compromise is not generally understood, but it is at the heart of the legislative process. Legislation is rarely enacted without change from the form in which it started. A peculiarity found in academics and particularly in academic medical centers is the need for unanimous consensus on an issue. This does not occur during the legislative process. Seldom do you have a unanimous vote, either in committee or in floor action, on any legislation, particularly on an issue that involves money or departs from the status quo. Success is often measured by a 50% plus 1 vote. The final result may not be perfect but it works.

Another intangible is the legislature's inner circle and how the system works. Those most successful at the State Capitol are those who understand these issues. In the legislature today, it is unrealistic for legislators to become experts on every subject that comes before them, including the details of billion dollar budgets that are now common in most states. The most effective legislators are those who concentrate on becoming experts in one or two specific areas or subjects. In other subjects, these legislators may rely upon members whose knowledge and judgment they respect and upon nonmembers with expertise, including legislative staff and lobbyists. At first glance, this reality may be seen as a hurdle. However, further analysis makes the legislators' “ignorance” an opportunity for lobbyists. Because legislators are routinely looking for authorities related to various issues, child advocacy lobbyists can fulfill that need.

One institution that has been able to build a long and trusted relationship with the state legislature is the University of Oklahoma Department of Pediatrics. This relationship began several years ago with a direct infusion of public funding to support the Department of Pediatrics when Oklahoma moved its Medicaid population to managed Medicaid. During the 2000 and 2001 legislative session, that success continued with a 220% increase in funding for the Child Study Center, as well as the funding of several new positions by the Legislature. Although the College of Medicine (COM) had to compromise on certain priorities to gain this support, in the long run the COM and the Department of Pediatrics will be stronger with the newfound support.

There is no best way to approach legislators and no single method that guarantees success. However, the University of Oklahoma has found great success by using the lobbying methods and tactics presented below.

Become familiar with the lobbying statutes. In almost every state there is a highly regulated environment of disclosure, reporting of gifts, honoraria, campaign contributions, and specific rules for how much can be spent on a legislator.
Understand the way politics works within your state and how the legislative process works. Keep up with the local climate of politics in your state. Is the legislature's party composition changing? What are the issues that are consistently in front of your legislature and how do they influence an issue you have?
Learn about the power structure, both formal and informal, within your state. Find out who can help you get what you want/need. You must also constantly keep abreast of the power struggles in your legislature, as well as be highly educated on the traditions of your legislature's power structure. The holder of the power is always changing. Most importantly, you must realize that just because a person is in a “leadership position,” that does not mean that he/she is necessarily part of the power structure!
Successful legislative lobbyists build reputations throughout a period of years for being reasonable, useful, and trustworthy. Leaders and legislators build personal relationships with other legislators and lobbyists, therefore you must quickly learn who to befriend. This is a profession that thrives and depends on loyalty and friendship. It is important to know when to get out of the process and let an issue die. Forcing a legislator to continue the fight will impair the trust you have built.
Develop a reputation as a resource for legislators to call upon. The more visible you are with legislators, the more likely they will think to call on you as an authority on children-related issues. Then, information that you provide should be solidly researched. An emphasis on data, figures, and statistics relating to individual legislative districts will be very appealing to them!
Become pro-active and develop personal relationships with the leaders of your state. These are the persons charged with identifying the important public-policy issues and developing strategies to resolve these issues.
Establish relationships with key staff members and learn what their responsibilities are. Staff can tell you quickly what the key issues are and the political realities of an issue or a legislator. But you must always remember that it is the legislator who votes, not the staff!

The University of Oklahoma has also learned some valuable tools in working with legislators on an individual basis. You must establish yourself as a competent, accurate source of objective and timely information. You must also realize that legislators are overwhelmed with information about every conceivable subject. Don't bury them with information but rather provide succinct (preferably one-page) summaries that emphasize your major points. Furthermore, as you are actively lobbying and talking with legislators, avoid using specialized jargon that may alienate or lead to misinterpretation of facts.

A specific tactic that you can use to further foster effective communication with your legislators is to write letters annually to them indicating the number of children served from their respective districts. You may also sponsor informal gatherings with key legislators whereby faculty present specific cases of children served throughout the state. You can further highlight how state support has contributed to the success of some of your specific programs. At the University of Oklahoma, we emphasized how state support had led to the university recruiting more than one dozen endowed faculty members to serve Oklahoma's children.

Another particular tactic that you might use includes identifying areas where services for children are lacking in your state, and then describing how a specific appropriation would improve those services. In Oklahoma, this included hiring a new endocrinologist to educate and serve the large Native American population.

Additional general guidelines that will help you reach your goals include being very cautious not to overpromise or develop expectations that are impossible to fulfill. Your credibility is important, and if you mislead a legislator one time, you will no longer be trusted. Along those lines, always provide those sponsoring your legislation all the information for which they ask. To further anchor trust between you and the legislators, communicate to them the anticipated opposition; this will allow them to be fully prepared. It will also prevent embarrassing or frustrating situations for the legislators.

After the passage of a new law, bill, or statute, always be appreciative of a legislative act, both to the individual member and to their constituents! Express gratitude constantly. It is the poor lobbyist who only receives and does not give back to the legislator. Also, do not avoid members of the minority party. Their vote may make the difference between winning and losing, and they may not be in the minority forever.

Legislators have extremely difficult jobs, and contrary to the public's negative perception, being a legislator is an honorable endeavor. To stand out from the crowd, anyone going to the State Capitol to lobby an issue must be thoroughly versed in the intricacies of the legislative process of their state. Although using the tips offered in this article is no guarantee of success, using the tactics will dramatically increase your odds.

Publishing and Reprint Information

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Brian Maddy is Vice President of Administrative Affairs at the University of Oklahoma, Norman, Oklahoma.

Michelle Cook is Director of Student Services at the University of Oklahoma Health Sciences Center, Norman, Oklahoma.

AMSPDC welcomes submissions in the area of academic pediatrics; see Instructions for Authors.

The opinions expressed herein by the author(s) do not necessarily reflect the official endorsement of The Association of Medical School Pediatric Department Chairs, Inc.

J Pediatr 2002;141:747-8.

0022-3476/2002/$35.00 + 0 9/20/129170

doi:10.1067/mpd.2002.129170

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