Tom Nickels, the AHA's senior vice president for federal relations, said the increase in independent expenditures reflects the changing dynamics of campaign finance. In the wake of the U.S. Supreme Court's 2010 Citizens United ruling striking down spending restrictions by corporations, associations and unions, the so-called super-PACs—which typically are supported by multiple donors—have grown to create an outsized influence on political expenditures. That's made it more difficult for traditional PACs like the AHA's to break through the noise, he said.
“PACs like us need to participate far more aggressively in races that are really in play,” Nickels said. “It's a relatively finite number of races that are in play.”
Among hospitals' biggest priorities is persuading states that have been Medicaid-expansion holdouts to extend coverage to adults earning less than 138% of the federal poverty level. In those holdout states, hospitals face the prospect of shouldering additional charity care costs. Congressional Republicans generally have opposed Medicaid expansion. But Nickels said the AHA doesn't take that into consideration in determining which federal candidates to support, because those decisions are made by state officials.
The AHA PAC's early presence on the airwaves has been predominantly aimed at supporting congressional Republican incumbents facing more conservative, Tea Party-aligned primary challengers. The AHA spent just over $100,000 each on ads supporting congressmen David Joyce of Ohio and Mike Simpson of Idaho. Both triumphed in May primaries by comfortable margins.
The AHA also poured $200,000 into supporting Sen. Thad Cochran (R-Miss.), who barely survived a runoff election last month against Tea Party-backed challenger Chris McDaniel. Cochran “is a candidate who has been very, very supportive of hospitals in the state,” Nickels said, noting that he will be a prohibitive favorite in the general election, owing to Mississippi's heavily Republican bent. “Getting him to that point was really important,” Nickels said.
The AHA is also targeting the Senate Republican primary contest in Kansas. The association is spending $200,000 in the state to bolster Sen. Pat Roberts, who faces a challenge on his right flank from Dr. Milton Wolf, a radiologist. The AHA ads praise Roberts for being a leader on rural healthcare issues.
Nickels said the AHA learned the importance of weighing in on such races from the 2010 and 2012 election cycles, which saw moderate Republicans such as Sen. Richard Lugar of Indiana and Rep. Michael Castle of Delaware lose to conservative primary challengers. “We want to be helpful to mainstream candidates who listen to their hospital constituents,” he said.
The hospital association also is providing early support to a pair of Senate Democrats who face difficult general election contests. The AHA has spent roughly $180,000 each on ads supporting Mark Pryor of Arkansas and Mark Begich of Alaska. Both of their races are rated toss-ups by the Cook Political Report, and are among roughly a dozen election contests that likely will determine whether Republicans can pick up six seats and take control of the Senate.
The Federation of American Hospitals, which represents for-profit hospitals, doesn't expect to make any independent political expenditures this election cycle, according to a spokesman. Its PAC focuses solely on financial support to candidates and causes. As of the end of June, it had contributed roughly $450,000 to campaigns and political committees. That included $7,500 in contributions to Republican House Majority Leader Eric Cantor of Virginia, whose stunning defeat in a primary contest last month led to a shakeup in the leadership of the GOP-controlled House.
Other major healthcare lobbying groups also typically stay away from independent political expenditures. The PACs funded by America's Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America have stuck to political contributions in the last three election cycles.
But Nickels indicated that the AHA thinks it can have an influence on competitive contests by communicating directly with voters. He expects that tactic to continue in the months leading up to Election Day. “For the races that are really being watched, PACs like ours want to get involved in a big way,” he said.