State advocacy: It starts with the grassroots

December 1, 2009

With guidance from the American Association of Clinical Urologists, Inc., urologists have scored key grassroots victories in state legislatures across the country over the past year.

I never understood the old adage, made famous by Otto von Bismarck: "If you like laws and sausages, you should never watch either one being made." I always thought, why not be part of the process? Become a close friend of the sausage maker and maybe you'll get the kind of sausage you want. If you felt like Italian sausage one day or kielbasa the next, you'd know just who to talk to, and more importantly, what's going in it.

With guidance from AACU, urologists have scored key grassroots victories in state legislatures across the country over the past year including:

Yet despite these state legislative victories, the battles for urology will continue.

Michigan urologists just recently faced a serious legislative threat during the budget process. Legislators tried to impose a Gross Receipts Tax, or a levy on a physician's total revenues in an attempt to capture more federal dollars for the state's Medicaid program.

Michigan legislators believe that if they can tax doctors 3%, they can turn around and return 3%-plus back to the providers in federal matching funds. What is truly troubling about this scenario is that money from one tax rarely get distributed for its intended use. Governments use the extra money where it is needed, and in Michigan, sadly, it is needed everywhere. So the tax on physicians might access federal matching dollars, but why should this tax revenue from physicians be redistributed to road construction, land conservation, or another worthy cause that is not related to health care?

Urologists and most physicians operate on such thin margins that this would cause incredible stress on their practices' bottom line. In addition, many urologists who do not treat a large number of Medicaid patients would be disproportionately affected because they would not receive any of the assessment returned. As Billy Joel said in song, "It's a matter of trust." At this time, urologists cannot trust legislators to return monies generated from this assessment.

Gratefully, this tax has not been enacted due to the determination of a coalition of Michigan physician groups that includes urologists. Urologists across the state have been calling, e-mailing, and writing the legislators they know (and those they don't know yet) to express how this will affect their patients and their practices. So far their efforts have been successful, but the price of a final victory will be constant vigilance.

The budget battle has been extended another 30 days, and Michigan's governor and house speaker seem determined to impose this tax on physicians. So contact your legislators today and continue to speak out.

To learn more about the 3% Gross Receipts Tax in Michigan, how to build a better relationship with your "sausage makers," or how to increase advocacy efforts on behalf or urology, please visit AACU's Action Center today at http://www.aacuweb.org/.

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