Which of the two major party presidential candidates is best for the HME services industry? The answer is unknown. Neither candidate has said anything substantive on issues important to the industry or on the importance of home health care itself. Why? Because doing so could risk alienating larger constituencies with more money for campaign contributions.

It is a fact of life that any increase in spending on HME or home care comes out of the hide of competing interests such as physicians, hospitals, and nursing homes. These constituencies are better organized and have larger PACs to assist candidates.

The amount of federal funds spent on HME is, as they say, budget dust in Washington. As such, constituents interested in the industry issues are expendable in the scramble for attention of presidential candidates. Someday, an astute politician will see the error of this line of thinking, but that is not going to happen this year.

That is why the industry must focus its efforts on supporting key members of Congress this election year. Any efforts to reverse the harmful actions included in the Medicare Modernization Act (MMA) will have to start in either the House or Senate. Eventually, the next president will have to concur with changes made in Congress but they are going to be too busy with other things to initiate the actions that the industry needs to achieve stability.

As dark as things look at times, the industry has begun to make inroads in Congress. Rep Dave Hobson (R-Ohio), Sen George Voinovich (R-Ohio), Rep Sherrod Brown (D-Ohio), and Sen Hilary Rodham Clinton (D-NY) have all become advocates for home care and the HME industry.

Others such as Rep Richard Burr (R-NC) and Sen Blanche Lambert-Lincoln (D-Ark) have expressed an interest in helping the industry. The key to the industry’s future is ongoing support for these legislators and plowing the fields to build support with other legislators, especially those who will be entering the halls of Congress for the first time next January. The industry needs to have more people like Rep Hobson who are willing to stand up and tell their colleagues when they have taken action that is harmful to the industry.

This column started with the question on the presidential candidates, and although neither of the major party candidates stands out as a home care advocate at this time, they must be pressured to address the issues important to the HME industry. Despite early campaign sparring over issues such as who served their country “more” honorably 30 years ago, the campaigns will soon turn to the issues on which this election will be decided: jobs, the economy, and health care.

Health care will be a major topic of debate and will present an opportunity to draw positions out of the candidates as to whether or not they support less costly, more appropriate, and patient-preferred options such as home care. During the next few weeks, candidates will be reviewing their position papers, refining their speeches, and preparing for the presidential debate during which health care will be a central subject.

The industry should make every effort to inundate the campaign offices of President Bush and Sen Kerry with letters asking for their position on home-based health care in general, and making specific suggestions on what actions should be taken to correct the ill-advised actions contained in the MMA. A well-coordinated campaign directed at the two presidential candidates could result in one or both of them taking a strong position in support of the industry.

The HME services industry cannot afford to ignore the presidential campaigns. Who knows, one of the candidates may surprise the industry and take a strong position in support of its needs. However, the primary focus should remain building relationships and making new friends in the House and Senate.

Experience has taught the industry that getting Congress to change its mind is difficult if not impossible. Barriers are quickly erected to block such action. The first way is to ask the question: How are you going to pay for this? That is often followed by an assertion that the action was taken to close a loophole that facilitated unbridled fraud and abuse. If those two arguments fail, some congressional staffer will advise his boss to compare the Medicare program to that of the Department of Veterans Affairs.

It would be nice if the White House weighed in on the industry’s side. But neither candidate is likely to do that if they do not understand the issue. Campaigns are the best opportunity to teach them why many of the MMA provisions threaten the industry that is part of the solution to the health care crisis facing our country.

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a consultant for political and legislative strategy.