WASHINGTON — While tourists bake above ground or wrestle with their umbrellas during summer storms, staffers and lobbyists and politicians make their way between the U.S. Capitol and its outlying office buildings mostly out of sight.
A network of underground passageways, trams, escalators and narrow stone staircases is dry and air-conditioned. Plus, it’s usually the quickest way to navigate the 274-acre complex.
Pat Votava, who works for the Medical University of South Carolina, moves comfortably in this hidden stream of foot traffic. She walks purposefully from one appointment with lawmakers to the next, but her job isn’t made any easier by the fact that some of South Carolina’s congressmen keep switching offices. It’s hard to keep track as they jockey for better space.
“Everybody’s moved around,” Votava said during a series of meetings on Capitol Hill last week. “It keeps me on my toes.”
Votava is not a registered lobbyist. She’s not an expensive K Street consultant forging back-room deals for her client’s special interests.
She’s based in Charleston, not Washington, and works as an advocate for the MUSC Children’s Hospital and the 6,000 pediatric patients it admits every year.
Her routine trips to Washington are spent talking to South Carolina’s congressional delegation and their health care advisers about work the Children’s Hospital is doing in the state.
“Pat does a great job educating us,” said Rep. Joe Wilson, R-S.C.
That’s mainly because she does her homework. She knows where each congressman went to school and what he studied. She knows all their committee assignments and their children’s names. She knows the staffers’ names. She even knows some of the staffers’ parents’ names.
All this information comes in handy when she pitches health care legislation, including a recent proposal to coordinate Medicaid coverage for children with such grave conditions as cancer or cystic fibrosis who need to cross state lines for treatment.
But she’s not asking Congress to spend more money. If anything, she’s asking them to spend what they’re already working with more efficiently.
“There’s no money,” Votava said. “Everyone now who asks anything from the Hill has to be part of the solution in terms of cutting costs, improving quality, finding a way to do things better.”
For this, she has their close attention.
In the 1990s, MUSC maintained a full-time lobby in Washington. Some higher institutions in South Carolina, including Clemson University, still do.
“There was a time when federal-directed appropriations were just a major part of the budget process and so we and everybody else had representatives in Washington, whether it was our own employees or consultants,” said MUSC President Ray Greenberg said. “The Hollings Cancer Center wouldn’t be here today if it weren’t for the resources that Sen. (Fritz) Hollings helped bring in.”
The Hollings Cancer Center, built in 1993, cost an estimated $100 million, almost all of it federal money sent directly to MUSC.
“I started earmarking and I squirreled away millions,” said Hollings, the former senator and a Charleston resident.
Hollings said a project like that would be virtually impossible to build with federal money today.
“Under the Constitution, the congress appropriates; the president executes. It switched around now,” he said. “They think the president’s budget is really legislation and (Congress) in turn should not legislate or earmark. Baloney!”
The golden age of earmarks is definitely over, said Votava, who worked for Palmetto Health in Columbia before joining MUSC eight years ago.
“That’s the part that’s changed completely. There’s no more appropriations money coming back to the state,” she said. “We’re not really advocating for funds. We’re advocating for changes in legislation, new legislation. To be advocating for funds in this climate right now would be a deal breaker with really everyone, I think.”
Before any bill is officially introduced in the House of Representatives or the Senate, the Congressional Budget Office gauges its price tag.
“If CBO scores something and says this is going to cost X, it’s dead before you even start,” she said.
Things are different in Columbia. At the Statehouse, MUSC and most other universities in South Carolina still dispatch full-time lobbyists when the General Assembly is in session each year.
“I think it’s much different at the state level. You get to know most everybody on an individual basis,” said Mark Sweatman, a registered MUSC lobbyist in Columbia. “In Washington, you’re so crowded amongst numerous staff and numerous lobbyists, I couldn’t even begin to think how many registered lobbyists they have in Washington.”
There is also occasionally some state money to help finance special projects. The Legislature approved about $12.5 million to expand MUSC’s telemedicine program next year and $600,000 to upgrade the Hollings Cancer Center mobile van.
The telemedicine program, which connects doctors and health care providers in Charleston to residents in rural parts of the state, is intended to help cut health care costs, Sweatman said. That makes it an easier sell to state lawmakers.
“It’s a cost savings to the state and it saves lives … I don’t think they look at telemedicine as an earmark,” he said. “In this case, the director of Health and Human Services had some extra reserves and agreed that more money needed to be invested in telemedicine.”
But there are recent failures, too.
MUSC and the South Carolina Hospital Association couldn’t convince the General Assembly to expand the Medicaid program to more low-income South Carolinians, even though the federal government offered to fully finance the expansion for three years.
“When you’re trying to educate 172 legislators and they have a multitude of issues, it’s just tough,” Sweatman said. “It takes time.”
When Sen. Tim Scott, R.-S.C., was appointed to fill the Senate seat that Jim DeMint resigned last year, his new job came with a perk. Scott and his staff moved into DeMint’s suite of offices in the coveted Russell Building.
It’s Pat Votava’s favorite congressional office building. It’s classic Washington architecture and, since DeMint occupied the same office for years, Scott’s new spot on the Hill is easy to remember.
Votava sat down with Scott on Thursday to discuss proposed legislation that could affect the Children’s Hospital, including a bill to create a national Medicaid network for children with expensive medical complications. Medicaid plans are currently managed on a state-by-state basis.
Nationally, the bill would affect about 2 million children on Medicaid. They only representative six percent of the total Medicaid population, but 40 percent of the entitlement program’s budget, the Children’s Hospital Association estimates.
“If we really want to save money in the long term, then we don’t want to replicate or duplicate everything everywhere,” Scott said after Votava made her pitch. “If we can get that synergy across state lines, we may save money and save lives.”
“Absolutely,” she replied. “You got it extremely succinctly.”
Votava also pushed a bill that would direct the National Institutes of Health to spend more of its annual budget on pediatric research.
“It’s not going to cost any more,” she told Scott. “Your support on that bill would be huge.”
Neither of these mean more money for MUSC, but they could have broad implications for the Children’s Hospital and other similar hospitals across the country. Votava makes these pitches seem easy, like a friendly back-and-forth, because she understands the most important part of government relations is the relationship.
“It’s all about a relationship,” she said. “You want to try and find out what common ground there might be or what interest there might be and then bring that up in the conversation.”