Providers pumping up political muscle: With a political veteran leading, AHCA is mounting a campaign to grow access and influence

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St. Patrick's Day couldn't have arrived at a more fitting time for nursing home providers this year because that was when they discovered a potential pot of gold.

In the face of unlikely odds, Sen. Gordon Smith (R-OR) bucked his own party's leadership to successfully attach a Medicaid-relief amendment to the Senate budget resolution.
The measure would create a commission to study Medicaid funding and lessen proposed Medicaid funding cuts by $14 billion over 10 years. That would mean a huge boon to nursing home operators -- if the item survives the route to the president's desk.
Regardless of that outcome, it marked a highpoint for a coalition of consumer groups and providers, particularly the American Health Care Association, which has made no secret lately of its ambition to flex more political muscle.
"This is the first test, if you will, of our new voice," said Hal Daub, the political veteran who became the association's top executive last July. "I think we're much stronger, much more unified."
Some numbers clearly support him: AHCA membership has grown from about 9,600 to about 10,700 since his arrival. State chapters in Alabama and Oklahoma have rejoined the fold, bringing the number of AHCA state affiliates to 48, plus the District of Columbia. In his first six months, Daub visited 30 state affiliates.
"I get out on my horse and make house calls and tell them what we do, and explain the effectiveness of having a stronger voice," Daub says. "I'm optimistic about Montana and Louisiana rejoining soon."
Some advocates were practically giddy upon hearing Daub was hired. A lawyer, he was the mayor of Omaha, NE, from 1995 to 2000. He was also not only a member of the U.S. House from 1980 to 1988 but a member of the powerful Ways and Means Committee, as well.
Politically ripe
Although the 63-year-old Daub emphasizes two-thirds of his professional life has been in the private law and accounting sectors, it was clearly his political and bureaucratic acumen that landed him the job, said Steve Chies, AHCA's board chairman and head of the search committee.
"We wanted somebody who had a higher political profile and a higher political agenda than Chip (Daub predecessor Dr. Charles "Chip" Roadman II)," Chies said. "Chip was a great leader for us and is a close personal friend. But he didn't understand that Medicare and Medicaid are really about politics. Hal brought a clear understanding and made a clear decision that AHCA would be a player in this process."
Before Roadman's five-year term, AHCA was led for 15 years by Washington insider Paul Willging, who was once the interim head of what is now the Centers for Medicare & Medicaid Services. But that still didn't get AHCA the prominence it now seeks, Chies said.
"Paul was willing to raise the issues, but he was not able to get traction because people didn't feel it was in financial crisis mode. Now it definitely is," Chies said.
Even typical nursing-home operator foils sense a shifting balance of power.
"This makes it more lopsided. AHCA is getting stronger and probably more effective in their lobbying efforts," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform (NCCNHR). "AHCA is looking to widen any perceived advantage, too. Daub already has board approval to expand the association's Washington staff from 82 to 101 employees, including new lobbyists and communications experts, over the next three years.
"One of the reasons I decided to come here was the enhanced focus on advocacy that Hal has brought the association," said James B. Smith Jr., AHCA's senior vice president for government relations. "Hal truly 'gets' the whole advocacy piece, from communications to lobbying to political activity to grassroots field work.
"He understands that politics is not a dirty word," added Smith, who was formerly a senior lobbyist for a medical device manufacturers association and the American Medical Association. "He's not afraid to roll up his sleeves and get up on the Hill."
Training the troops
Daub is expecting members to increase their own number of visits to the Hill. This year's spring conference drew a record 350 AHCA members, a number Daub would

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