Douglas Huynh, JD, Director, Congressional Affairs, APhA
As a lobbyist, one of the many questions I get asked often is what became of a piece of legislation we supported or opposed as an organization. As is the case many times, the answer is – it’s complicated. If there is anything I’ve learned in the decades I’ve spent as an advocate is that nothing ever happens in a vacuum on Capitol Hill. There are both internal and external factors that can sway public policy and whether a bill becomes law. I’m sure many of you remember from your childhood, School House Rock. The simplicity behind the process of how a bill becomes a law seemed so elementary at the time. And if you think about it, that’s exactly how it should be. But as I’ve mentioned to many of you before, sometimes the politics gets in the way of the policy. With that said, I would love to give you a peak behind the curtain and explain to you how we come up with the issues we advocate for, how that process works, and what ultimately happens behind closed Congressional doors.
For starters, perhaps the most direct process for me to give you some insight on is how we, as an organization, identify an issue we support or oppose on the Hill. As you know, our House of Delegates dictates policy positions. These policy positions serve as the foundation behind what we support or oppose. Once a year, at the beginning of each calendar year, the Government Affairs Committee gets together to discuss the top priorities for the organization, using our policy positions as the foundation. These recommendations are then passed on to the Board of Trustees, who will sign off on the year’s priorities. In years past, the priorities were divided into tiers, with the top tier issues given the most weight and attention. What that would mean on a granular level is that the issues in the top tier receive more direct hands-on advocacy support and grassroots involvement. Examples of tier 1 priorities over the past few years included provider status legislation and PBM reform. I should make note, however, that being relegated to a lower tier does not mean the issue is forgotten. Issues in Tiers 2 or 3 are always monitored, and depending on the circumstance, may be given immediate attention and be moved to a higher tiered priority on a case -to -case basis.
Now, with the issues in hand, the process of advocacy begins. Fundamentally speaking, the next steps involved in this process involve coming up with a strategy for engagement, including the specific ask, and coming up with a list of members to target and educate. The vast majority of the time, the members we target sit on the key committees of jurisdiction in Congress (House Ways and Means, Energy and Commerce, Senate Finance, HELP), but this isn’t always the steadfast rule. There are instances, although rare, where we will seek champions that fall outside these buckets. These champions may serve leadership roles, have a vested interest in a particular subject matter, or have direct involvement in the issue at hand.
I wouldn’t be forthcoming if I didn’t tell you that at this point, relationships matter. Lobbyists and organizations spend years cultivating relationships with lawmakers and staff to lean on them when it becomes “go time.” Obviously, relationships guarantee nothing. Although public perception may dictate otherwise, we do not necessarily live in a world of quid pro quos, but it would be disingenuous for me to tell you that these relationships do not big part in how impactful our advocacy can be. There is a reason, after all, that staffers sometimes leave Capitol Hill with substantial offers from private lobbying firms to work with the very people that once actively lobbied them.
The relationships we build on Capitol Hill act as a two-way street. There is a give and take to everything we do. At the forefront of this dynamic is, how does this relationship benefit me? From a legislators perspective, they gain valuable pharmacy insight, clinical knowledge, public support, or even intelligence about a political or policy issue. Although lobbyists are technically on the outside looking in, we often have information we can share with Congressional offices based on our relationships and conversations on the Hill. From a lobbyist perspective, the benefit we receive from legislators does not simply come down to a sponsorship of a bill or a vote in favor of legislation we support. It also involves being able to formulate legislation or policy, opining on a strategic or policy issue in Congress, or intelligence gathering as well. Much like relationships in day to day life, the relationships we build on the Hill are created through trust. We cultivate these relationships understanding what is expected of us, and what we, in turn expect from the Member. Done right, this paradigm benefits everyone.
So getting back to the question I mentioned at the beginning of this blog – What ever happened to that piece of legislation? As you can see, the answer can be complicated. Once a bill is introduced, assigned to committee, and possibly marked up or voted on, a million things can occur during the advocacy process to shift the end result one way or another. It could be the Administration calling a member asking them to hold off on a vote, it could be a group of legislators killing the bill or attempting a filibuster, or it could simply be Elon Musk sending out a tweet.
The vast majority of bills introduced each Congress (typically more than 90%) wind up failing and never passed into law. That statistic is not meant to dissuade you from supporting our advocacy efforts or becoming involved in grassroots. That statistic is to help you get an idea that there are a myriad of events that have to take place for a bill to become a law. In the interim, we continue to state our case for each and every issue we advocate for, literally on a daily basis. Some issues move further along than others. Some become stalled or never make it out of committee. But at the end of the day, we still have to do our part to educate members and remind them that we are here.