It is my firm belief that lobbying is not only an effective means of achieving health care reform, but is the most effective means of achieving health care reform. It is not the exclusive province of paid “hired guns.” Anyone who advocates a position on an issue in the legislature is lobbying. Some of the most effective lobbyists are interested citizens who have sincere personal positions on an issue. Nonprofit organizations like Common Cause, The Mental Health Association, and The Alliance for the Mentally Ill all lobby.

The media would have us believe that, the “hired gun” is pitted against the public interest, but in most instances, a business, professional or advocacy group opposes another business, professional or advocacy group. Lobbyists for plaintiffs’ lawyers are pitted against lobbyists for defense lawyers. Lobbyists for providers of health care are pitted against lobbyists for managed care entities, HMOs, and health insurance companies. When each side of the issue is represented by an effective lobbyist, members of the legislative committee are provided with both sides’ strengths and weaknesses. They are then better able to make intelligent decisions.

An effective lobbyist, whether a “hired gun” or not, must be credible, available, and reliable. Credibility is achieved by always telling the truth, as you know it whether it helps or hurts your cause. Any lobbyist who loses credibility loses effectiveness. Legislators say, “Fool me once, shame on you; fool me twice, shame on me.” Availability is important since each legislator’s schedule is demanding during the 90-day session and information may be needed early in the morning or late at night. Reliability is closely tied to credibility. Not only must the lobbyist tell the truth; they must know that it is actually true.

There is no “short cut” to effective lobbying. The lobbyist must learn all there is to know about each issue before testifying or meeting with individual legislators and must carefully evaluate the strengths and weaknesses of the opposition. Close cooperation is required between the client and the lobbyist. The client must help to educate the lobbyist, not hiding any weaknesses, so that the lobbyist can be credible and reliable and can avoid surprises at hearings.

The Senators and Delegates in the Maryland General Assembly do not have the large staffs necessary to thoroughly research every issue. While some Delegates and State Senators are full-time, most are part-time and have other jobs in-between the annual sessions. Legislators must rely on their own ingenuity to ask the right questions. They quickly learn which lobbyists they can rely on to answer truthfully and which have adequately investigated the issues.

One example of effective lobbying concerns legislation that provides for the inclusion of mental health coverage in health insurance contracts. Prior to 1973, many health insurance policies did not include benefits for mental illness. The health insurance companies argued that such coverage could be added as an option and they resisted attempts to mandate its inclusion. Effective lobbying by mental health care providers and advocates convinced the legislature of the need for such a mandate. Chapter 839 of the Laws of Maryland 1973 was enacted to require a mandated benefit in insurance contracts to cover outpatient expenses for services rendered to treat mental illness and emotional disorders, at not less than 25% of the benefits that the policy provided for other types of illness. In subsequent years, the mandate was increased -- first to not less than 50% of the benefits the policy provides for other illnesses, and later to not less than 65% for the first 20 visits and 50% for any visits thereafter.

Mental health professionals and advocates have always contended, that coverage for psychiatric illness should be the same as for other illness. As the result of a great deal of hard work by mental health care providers, advocates, and their lobbyists, a step toward parity was enacted in 1993, but it was challenged in court. Its proponents introduced an emergency bill which became Chapter 2, Laws of Maryland 1994 when signed by the governor on February 28, 1994. The legislation prohibits discrimination “against any person with a mental illness, emotional disorder or a drug or alcohol abuse disorder by failing to provide benefits for treatment and diagnosis of these illnesses under the same terms and conditions that apply under the contract or policy for the treatment of physical illness.” The legislation further provides that “it shall not be considered to be discriminatory” if outpatient benefits are provided at not less than 80% for the first five visits, 65% for the 6^th through 30th visits, and 50% for the 3lst and any subsequent visits in any calendar year or benefit period of not more than 12 months.

It took a great many years and a great deal of hard work to achieve this result, which is not quite full parity. Mental health advocates in other states use Maryland’s law as a model. This is just one example of the beneficial effects of lobbying –cooperation and dedication by the client and the lobbyist. This kind of result is the reward.