Medicare reform

Much ado has been made about AARP’s endorsement of Medicare reform legislation pending before the Congress. There is no doubt that AARP’s support is symbolically and strategically important. Symbolically, the endorsement energized supporters and caught Democrats off guard. Strategically, AARP’s grass-roots and advertising campaign will help to galvanize public opinion in favor of the legislation.

Democrats have lambasted AARP for the move and some of the association’s members have resigned in protest. But attacking AARP for supporting Medicare reform is a little like singling out the French for opposing war in Iraq. AARP, like the French, is an obvious rhetorical target, but is hardly isolated or alone.

More than 300 organizations have publicly endorsed the legislation, including health industry associations, medical professionals, patients advocacy organizations, employers, and business trade associations. Much of this support comes from organizations with strong grass-roots networks.

While much media attention has focused on the place of money in politics (hard, soft, malleable, you name it), grass-roots mobilization is an increasingly important card for interest groups to play. Building grass-roots support for a position encourages Congress to sit up and take notice because the electoral connection is obvious. If a constituent cares enough to travel to Washington to meet his senator or her staff, they would likely also care enough to work for (or against) the senator in the next election.

In the table accompanying, I report the top 25 most effective grassroots lobbying organizations for health care (based on in-depth interviews with 77 congressional staff). These organizations are highly successful in building connections between their members and Congress on a wide geographic basis. Many other organizations have members throughout the United States, but they may not be as effective in making their voices heard in Congress on health issues.

Among these 25 leading organizations, the balance of support leans toward enactment of Medicare reform. fourteen organizations are supportive, six are opposed or not positive, three are reviewing the legislation, and two have not announced a formal position.

The American Hospital Association is the health-interested organization with the broadest grassroots base. Every congressional district has a hospital. It should be no surprise that hospitals are among the biggest winners in this legislation, which significantly expands payments to rural hospitals and places a moratorium on the creation of specialty hospitals (which are economic threats to general hospitals).

The unions collectively, under the umbrella of the AFL-CIO, are offering determined opposition to virtually all aspects of the proposal. The AFL-CIO and its member unions are the only organizations providing significant grass-roots backup to the Democrats on this issue.

While organized labor is a vital force, it seems unlikely that it will be able to go-it-alone for the left. Especially since labor has focused its energies as of late on the prospect of ousting George W. Bush from the White House, a good guess is that it will not be able to mount a maximally effective campaign on multiple fronts.

The most obvious implication of this analysis is that the structure of grass-roots support makes it a safe bet that the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 will become law. A second implication is that the Democrats need to reconsider their general strategy for grassroots mobilization on important legislation. The defection of AARP leaves the Democrats virtually high and dry, with little well-organized backing outside the labor movement. Liberally minded patrons should consider donating to a diverse mix of grass-rooted organizations.

A third implication is that the Republicans should be wary of becoming too cozy with AARP. Sen. Chuck Grassley’s quip that AARP is the “Good Housekeeping Seal of Approval when it comes to seniors’ issues” will come back to haunt him and the Republicans. AARP will return to the Democratic fold before long and, when it does, Republican hyperboles will translate into liberal policies.

A final implication is that AARP has played its cards well over the last week. It has wedged itself effectively between the parties in a way that will make it sought after by both sides. The result will be a more powerful voice for seniors in Washington. This will create an opening for AARP to expand dramatically its already unrivaled citizens network.

Michael T. Heaney is a doctoral candidate at the University of Chicago and a fellow in the Centennial Center of the American Political Science Association in Washington, DC.

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