Advocacy During a Midterm Election Year

Ballot box
By Alpha Lillstrom Cheng, JD, MA
August 8, 2018

Being an active advocate this election season is more important than ever. Candidates are crisscrossing their districts eager to talk to voters, and how you engage with them could change the makeup of the incoming Congress and impact the laws it passes. Democrats, bruised by their defeats in 2016, are eager to reclaim political control where they can; they are seeking to regain the majority in at least one if not both houses of Congress. Republicans are working hard to maintain their current bicameral majority. These goals motivate candidates to more readily respond to outreach from their voters.

Fundamental to effective advocacy and representative democracy is the process of educating the policymaker. In an election season like this one, with so many new candidates, you should seize the opportunity to educate them and understand the need for you to do so. Each time you meet a candidate, be sure to identify yourself as a private practice physical therapist and emphasize the importance of your roles in the community as a small business owner, employer, and health care provider who has contact with hundreds of constituents a year or perhaps even each month. Also, describe where your practice is located and how many people work in your clinic. There are many methods, forums, and situations through which you can engage and educate those seeking your vote.

Direct Support

If you have the resources, consider making a monetary donation of any amount to the candidates. Upon donating, you are likely to be invited to campaign events before the general public. If you have evaluated the candidates and are willing to spend time as a campaign volunteer, please do so as this will provide you better access to the candidate. Regardless of the type of support you provide, be sure to tell the campaign staff that you are a private practice physical therapist and invite the candidate to stop by your clinic. The time you spend engaging with the campaign will provide valuable opportunities to educate both the candidate and his or her staff (as well as network with your fellow volunteers). The rapport you build with the campaign staff could be very valuable because it is not uncommon for some campaign staff of a winning candidate to transition to an official staff role for the member of Congress.

Public Meetings

Candidates eager to engage with voters will hold and participate in a variety of public meetings. Townhall meetings, listening sessions, or other semi-public gatherings are the most appropriate venues for engaging with the candidate. Rallies, however, are more focused on energizing volunteers and supporters, and the candidate will rarely have the time to engage in a policy discussion.

The format of some townhall meetings and listening sessions are topic specific; others are more open ended. You should attend as many as you are able. It is equally relevant for you to speak up at a townhall meeting focused on health care as it is for you to participate in a listening session that is highlighting small businesses or local economic development issues. If you have clothing with your business name on it, wear that to increase your visibility. Ideally, bring a colleague or two with you. It only takes a few people with the same message to really stand out in a diverse crowd. By attending and speaking up at events that are relevant to you as a private practice physical therapist, the candidate and campaign staff can associate you with the practice of physical therapy, as well as small business issues, and see you as a community leader.

Candidates seek out local leaders in their quest to meet and talk to as many voters and community influencers as they can. If you are a member of an entity such as the Rotary Club, Chamber of Commerce, or other benefit society, ask your organization to invite the candidates to speak at a monthly meeting or social gathering, then offer to be the one to extend the formal invitation and be the contact for the campaign when finalizing the logistics. These events often have two distinct parts—the formal presentation followed by an informal discussion. This is a prime opportunity for a short conversation about the value of physical therapy provided in a private practice setting. Introduce yourself, hand the candidate your business card with the date and location of the event written on the reverse, tell them where your practice is located and how many employees you have. Next, share a brief example of how the patient care you have provided has enabled someone to rejoin the workforce. Then offer to be a resource or sounding board should the candidate have questions about rehabilitation therapy. Finally, ask for a contact person on their staff you should meet with to further discuss physical therapy issues. Attending these types of events can raise the profile of physical therapy and how the care you provide to his or her (potential) constituents improves quality of life, enriches the local economy, and reduces federal spending. The more times you engage, the easier it will become.


Candidates are also looking for ways to raise significant amounts of money for increasingly expensive campaigns. Contact the campaign office and ask when the next local fundraiser will be held. You can often attend these limited-access events for a small fee. Once you have identified an event, reach out to APTA’s Physical Therapy Political Action Committee (PT-PAC); in some cases it can provide financial assistance to members attending a political fundraiser. At the fundraiser you will have the opportunity to meet the candidate and talk to them about your role as a physical therapist in private practice—sharing both your perspective as a small business owner and a health care provider with strong ties in the community. Ask to have your picture taken with the candidate so that you may use it for publicity. While posing for the photo, invite the candidate and their staff to visit your clinic for a tour.

Site Visits

One of the most effective ways to make a profound and lasting impression on a politician is for them to see your clinic in action. This summer and fall the candidates will be looking for ways to engage with their community. A visit to your clinic could be an ideal way to match their desire for voter contact with your interest in increasing your local profile while building a relationship with those who hope to represent you in Congress. Invite each candidate and their staff to come to your facility so that you can show them around. In order to set up a visit, reach out to the campaign (or in the case of a sitting lawmaker, the district office), ask to talk to the scheduler, and offer to host the candidate for a site visit at your clinic. You should expect the tour to last between 30 minutes and an hour. Candidate schedules are often determined weeks in advance, so be sure to be flexible and provide the scheduler with a few options for dates and times that work for you. Once you have a date set, reach out to the American Physical Therapy Association (APTA) for planning support and look on the Private Practice Section’s (PPS) website for summaries of policy priorities and one-pagers to give to your visitors. A site visit will give them the opportunity to understand what a private practice physical therapy clinic looks like, who you serve, and where you are located.

Social Media

When attending a townhall, public, or private meetings with the candidate, please use your professional social media accounts to engage with the candidate on the issues. This can be as simple as thanking them for listening to your concerns or, better yet, thanking them for coming to visit your clinic. If possible, have your picture taken with the candidate and post it on a social media platform and tag the candidate. If you take photos at your clinic during a site visit, please make sure you get permission from the patients in your photographs before posting those images online.


One of the primary goals of a new candidate is to increase their “name recognition.” While incumbents do not need to focus on this, both types of candidates spend a significant portion of their resources on “paid media” in the form of television, radio, targeted online advertisements, direct mailings, and social media coverage to disseminate their campaign message. In order to stretch their campaign funds, those running for election also want the press to write stories about their interactions with voters and positively evaluate their ability to represent the district or state. This publicity produced by a third party is called “earned media.”

You can play a part in a candidate’s quest for earned media by providing them a platform in the form of a visit to your clinic, where they can be seen engaging with the community, learning about and visiting a local small business, as well as responding to the needs of the voters. When you are approaching a campaign office to plan a site visit, be sure to tell them if you are willing to have the local television, radio, or newspaper cover the event. Your willingness to do so may be a deciding factor in whether or not the candidate accepts your invitation. You and your business could also benefit from the media coverage for your practice. Many of you spend valuable resources seeking to increase local awareness of your clinic and gaining new clients. This earned media exposure can lead to an increase in your patient volume.

What Are the Stakes?

Each election year all 435 House seats are on the ballot. Democrats will need to win 23 seats in the House of Representatives that are currently held by Republicans in order to gain the majority party in that chamber. Many are saying that is possible, but if successful it will be by a small margin.1 In the Senate, Republicans hold a slim 51-49 majority. While there are fewer seats to flip, the reality is that Democrats have a significantly steeper hill to climb in order to achieve a majority in that chamber. Senators serve for six-year terms that are staggered; therefore, roughly one third of Senate seats are contested each election cycle. Due to the addition of two special elections, this year 35 Senate seats are up, of which 26 are held by Democrats. Additionally, six of the 26 seats are in states whose voters in 2016 chose Donald Trump to be their president by double-digit margins of victory.2 The tenor of campaigns and the results of elections that take place in the middle of a president’s term are often a reflection of the electorate’s opinion of the president of the United States. Historically, the party who controls the White House loses seats in the midterm elections. This trend could be significant this cycle because of the polarized positions taken by each party.

So far, three senators, all of whom are Republican, have declared their intent to retire: Chairman of the Finance committee and member of the Health, Education, Labor and Pensions (HELP) Committee Senator Orrin Hatch (Utah) as well as Senators Jeff Flake (Arizona) and Tom Corker (Tennessee), who both serve on the Special Aging Committee along with Senator Hatch. The biggest impact this will have on health care policy in the Senate is that there will be a new chair of the Senate Finance Committee, regardless of the outcome of the election.

While some members of the House of Representatives retire each election cycle, a record number are doing so this Congress. As of this writing, at least 59 House districts—39 held by Republicans and 20 held by Democrats—will not have an incumbent running for reelection. This is the second-highest number of open seats since World War II.3 Fifteen retiring members sit on the committees of health care jurisdiction in the House: nine (eight Republicans and one Democrat) sit on of the House Ways and Means Committee while six (five Republicans and one Democrat) are members of the House Energy and Commerce Committee. Additionally, the current Speaker of the House, Paul Ryan (R-WI), has declared his intent to retire.

A substantial number of candidates are vying for federal office. The demographics of those running for office are also significant. As of early April, 472 women, Republicans and Democrats alike, had filed candidacy papers to run for the House, and 57 women have filed or are likely to file their candidacies for the Senate.4 These numbers greatly eclipse the previous record of 298 women running for the House and 36 for the Senate that was set in 2012.5 There is also a great deal of diversity among those seeking a seat in Congress. More women of color and veterans are throwing their hat in the ring than in previous electoral years.

The results of this November’s general election could have a large impact on health care policy. As you know, in this past Congress, Republicans used their majority to seek to repeal and replace the Affordable Care Act and while they were not successful in that endeavor, they did repeal the effect of the individual mandate with a provision in the tax reform law passed at the end of 2017. Should Democrats regain control of one or both houses of Congress it is highly likely they will attempt to legislate responses to rising health insurance premiums and other facets of health care policy such as reimbursement for care provided using telehealth and the transition of payment from fee-for-service to payment for quality. Additionally, there will be significant changes to which legislators serve on the committees of health care jurisdiction next Congress, so it is critical that private practice physical therapists engage with candidates and work to elect those who will respond to PPS’s legislative priorities.


These advocacy tools can be used year-round. However, the campaign season is rife with occasions to engage with those who want to represent you in Congress. Your vote is what they seek so take this opportunity to educate them about the role of a physical therapist and ask them how they will represent PPS’s priorities. When your senator, representative, or a candidate hears the words “physical therapy” you want them to visualize you, your clinic, your patients, and your business. It is also important that candidates hear the same message from many providers. The better our members of Congress understand the value of private practice physical therapy for patients and for our national economy, the more effectively we can advocate for policies that will improve your ability to sustain and grow your practices while meeting the needs of your patients.







Alpha Lillstrom Cheng, JD, MA, is a registered federal lobbyist and a principal in the firm Lillstrom Cheng Connolly, which has been retained by PPS. An attorney by training, she provides guidance to companies, nonprofit organizations, and political campaigns. For six years, she served as Senior Policy Advisor and Counsel for Health, Judiciary, and Education issues for Senator Jon Tester (Montana), advising and contributing to the development of the Affordable Care Act, as well as working on issues of election law, privacy, government transparency, and accountability. Alpha has also directed Voter Protection efforts for Senators Bob Casey, Al Franken, Russ Feingold, Mark Begich, and Katie McGinty. She was Senator Franken’s Policy Director during his first campaign and was hand-picked to be the Recount Director for his eventual 312-vote win in 2009.

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