Research Problems, Purposes, and Hypotheses


This week we will be discussing the how Special Interest Groups (SIGS) influence the political agenda, and ultimately, the policies that are made.  SIGS such as the National Rifle Association, the American Medical Association, and the NC Association of Health Plans, enable individuals and organizations with similar concerns to work together to influence policy-making.  By working collectively, individuals in these groups are able to have a greater influence on the policy-making process than they could have working alone. Special interest groups play a major role in influencing health policy-making at the state and federal levels.  In the past few years, special interest groups in North Carolina have been involved in the following health policy issues, to name a few:

• Allocation of the tobacco trust fund
• Potential conversion of Blue Cross/Blue Shield from non-profit to for profit status
• Medicaid reimbursement rates for dentists
• Taxes on tobacco and alcohol
• Patient Bill of Rights for managed care enrollees
• Soda machines in the public schools

This is a particularly important time for health care professionals to join with SIGS as they work to influence health policy. Across the nation, states are facing budget shortfalls and making decisions about where to cut. At the national level, the current administration's commitment to tax cuts combined with new financial demands created by the war in Iraq are placing health care programs at risk.  For example, this past year both the state and the federal government have considered policy changes that would alter the Medicaid program which, since the mid 1960’s, has provided health care coverage for many of the nation's poor.  As you are very aware, Medicaid enrollees largely consist of poor children, single mothers, and disabled and elderly persons. Thus as a group, they have very little voice in the policy-making process. Therefore, it is essential that their needs are represented by SIGS concerned about the health of the most vulnerable in our population. One impressive advocacy organization is the North Carolina Health Access Coalition, an interest group that has repeatedly stepped into the health policy debate to protect the state's Medicaid coverage through grass roots organizing of its members, use of a professional lobbyist, and media attention on the topic.

The role of SIGS in policy-making is complex.  While they enrich the debate by providing multiple voices and perspectives, SIGS’ motives for influencing policy vary; improving health often has less priority than maximizing profits for the members of the SIG.  This fact will be abundantly clear as you read the Nestle article about the food lobbies.  It tells the “real story” of why the food pyramid is structured as it is . . . and it’s not based on what is healthiest for Americans!  The Scharfstein article about where the American Medical Association put it’s money in an election year is an eye-opener, too. As you read the assignments and do the Internet and group discussion activities, consider the following:

1. In what ways do SIGS contribute to the health policy-making process in the United States?

2. When SIGS work to influence policy, they are serving the interests of their members.  How do those interests vary across different types of SIGS?  What are some examples of SIGS interests that may conflict with policies that best serve the health of the public?

3. What SIGS do you belong to?  (For example, I belong to the ANA, ASPCA, National Wildlife Fund, etc.) What SIGS are working towards the policy changes that you believe would help your profession or would improve the health of the country's population?