Advocating for patients with skin disease: federal dermatology lobbying and expenditure activity by the American Academy of Dermatology Association and SkinPAC from 2008 to 2021.

To the Editor: The burden of skin disease and the number of active dermatologists have grown in the United States.1Lim H.W. Collins S.A. Resneck Jr., J.S. et al.The burden of skin disease in the United States.JAAD. 2017; 76: 958-972. e952Google Scholar,2AAMC. PhysicianSpecialty Data Report.https://www.aamc.org/data-reports/workforce/report/physician-specialty-data-reportDate accessed: May 13, 2022Google Scholar Yet, little is known about the advocacy efforts of the 2 primary organizations, the American Academy of Dermatology Association (AADA) and AADA Political Action Committee (SkinPAC), representing the profession, providers, and patients. To understand the distribution and quantity of spending and lobbied legislation, we analyzed public data from 2008-2021. We collected Congressionally submitted AADA lobbying disclosure forms, containing information on expenditures, staff, and lobbying activities3United States SenateDownloadable Lobbying Databases.https://www.senate.gov/legislative/Public_Disclosure/database_download.htmDate accessed: April 14, 2022Google Scholar and SkinPAC campaign finance reports submitted in 2-year increments. PACs operate independent of lobbyists and contribute money to campaigns, elected officials, or other PACs.4Federal Election CommissionCampaign Finance Data.https://www.fec.gov/data/Date accessed: July 5, 2022Google Scholar We analyzed 177 submitted reports, employing inductive and deductive coding techniques.5Strauss A. Corbin J. Basics of qualitative research techniques. Sage Publications, 1998Google Scholar Before collecting data, we developed a codebook and variables of interest – including financial contributions, legislation, and advocacy policy topic. We expanded the codebook to reflect the nuances of lobbying activities. For example, the AADA lobbied for several provisions of the Affordable Care Act (ACA), which required including additional codes. We then combined distinct codes into larger categories to aid in the identification of themes. All data is publicly available, included no human subjects and did not require Institutional Review Board approval. AADA lobbying expenditures have increased by an average of $64,701 per year, but have varied across years, with instances where spending declined from the year prior (e.g., 2011-2012). SkinPAC donations were bipartisan in nature, with Republican and Democratics donations at $2,826,950 and $2,665,768, respectively (Fig 1). One hundred eighty-six members of Congress received SkinPAC funding, representing 35% of Congress, while the average SkinPAC contribution increased from $2777 in 2008 to $4408 in 2020. Additionally, the AADA has expanded the scope of lobbied policy topics. AADA lobbying has focused on Medicare reimbursement rates, raising awareness of dermatological diseases and prevention, and the adoption of health information technology (Table I). Yet, the AADA also lobbied for taxing tanning beds, expanding foreign medical graduates for underserved areas, and regulating sunscreens. They have also demonstrated flexibility in responding to a changing policy landscape, lobbying on the implementation and provisions of the ACA, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and other COVID-19 relief bills.Table IFrequency of lobbying topics by AADA, 2008-2021No. of instances lobbiedPercent of total lobbyingMedicare reimbursement8118%Disease prevention and raising awareness8118%Insurance regulations of dermatology5913%Federal research funding5813%Health information technology4710%Regulations of health care Organizations and practice4510%Pharmaceutical regulations337%Lobbying for particular populations225%Implementation of health reform184%COVID-19 legislation61% Open table in a new tab We find that both AADA and SkinPAC have expanded the scope of their federal advocacy activities in terms of money spent and on issues lobbied. SkinPAC donations have been broadly bipartisan in nature and have given to an increasing number of Congressional members. Concurrently, AADA has increased lobbying expenditures and lobbyists. These findings reflect a broadening advocacy footprint of dermatology and the potential to impact legislation addressing the needs of patients with skin diseases. The limitations of this study included the exclusion of state lobbying data. Enhanced advocacy capacity is significant as health policy continues to impact dermatologic practice. The AADA has successfully lobbied for changes that positively impact patients and practice, including restrictions on indoor tanning services and lifting restrictions on in-office dermatopathology. Given the sustained and expanding political engagement, dermatological patients and professionals can have significant impacts on future practice and policy. Dr George Hruza is currently Chair of the American Academy of Dermatology Association SkinPAC.