Fall elections hold stakes for physical therapy's future: presidential politics dominate the campaign news, but key Senate and House races could shift the balance of power on Capitol Hill and affect physical therapy's federal agenda.

With the 2004 general election less than a month away, it may seem hackneyed to say that the nation faces a critical turning point in its political history. Nevertheless, it is impossible to look ahead to November without recognizing the impact the balloting will have on the country as a whole and, potentially, on physical therapy as a profession.

Most voters, naturally, will focus on the presidential campaign. APTA and its political action committee, PT-PAC, often are asked which of the two presidential candidates would be "best for physical therapy." The fact is that both President Bush and his opponent, Sen John Kerry, address health care policy from a more global perspective; neither addresses physical therapy specifically.

Neither APTA nor PT-PAC endorses a candidate or participates directly in the presidential race, but we know that many physical therapists (PTs) and physical therapist assistants (PTAs) are playing active rolls in the campaigns--some backing the president and others his challenger. Whatever the outcome, APTA will work closely with the next administration to emphasize the importance of physical therapy.

PT-PAC is a very active participant, however, in scores of congressional races across the country. It supports candidates who have demonstrated their support of physical therapy issues by such actions as cosponsoring bills to grant direct access to physical therapy services under Medicare and repeal the Medicare therapy cap. The cumulative impact of these Senate and House campaigns on the nation and our profession could be as great as the result of the presidential election. APTA members who want to know where candidates stand on physical therapy issues should visit the Legislative Action Center at www.apta.org, It provides cosponsor information and lines to candidate Web sites. APTA also encourages all members to meet the candidates at local events and ask them directly where they stand on issues of importance to the physical therapy profession.

The Senate: Election-Night Cliffhanger?

The Association takes a nonpartisan approach to educating legislators and candidates about physical therapy issues and interests, working with lawmakers in both parties. But our post-election advocacy strengths, weaknesses, and strategies could be dramatically affected by the voting this November.

For the past decade neither political party has enjoyed a reasonably "secure" majority in the Senate; the possibility of a change in control has arisen every 2 years. The balloting this fall could be so close that control of the Senate may not be determined until December, should Louisiana's hotly contested race result in a run-off.

In all, 34 of the 100 seats in the Senate are in play this year. Incumbents in 23 states are considered prohibitive favorites for reelection, however, meaning that the real race for Senate majority comes down to the following eight match-ups. Starting on the East Coast and moving west as the polls close on election night, these races will determine which party will control the Senate in the 109th Congress.

* South Carolina. With the retirement of seven-term Sen Ernest Hollings, the Democrats are forced to defend a seat in a state that President Bush carried in 2000 with 57% of the vote. Rep Jim DeMint emerged as the Republican nominee after a heated six-way primary and a runoff with former Gov David Beasley. He faces state Superintendent of Education Inez Tennenbaum.

* North Carolina. Freshman Sen John Edwards chose to run for president, a decision that ultimately won him the Democrats' vice presidential nomination but left the party in a fight to hold onto his Senate seat. The Democrats chose former Clinton White House Chief of Staff Erskine Bowles as their candidate, less than 2 years after he carried 45% of the vote in losing the 2002 Senate race to Elizabeth Dole. The Republican nominee is five-term US Rep Richard Burr, who entered the race before Edwards decided to run for the White House.

* Georgia, Incumbent Democratic Sen Zell Miller often voted like a Republican, and his decision not to seek reelection gives the GOP its best chance of taking a seat away from the Democrats. Rep Johnny Isakson avoided a run off by winning outright the state's Republican primary in July. At this writing, Rep Denise Majette was to face businessman Cliff Oxford in a runoff to determine the Democrats' nominee.

* Florida. In the wake of the 2000 presidential election, everyone expects the unexpected when Floridians go to the polls. Incumbent Sen Bob Graham is retiring. At this writing, both parties were awaiting their nominee for the job, with a five-way Democratic primary and an eight-candidate Republican primary scheduled in August. By now, the stage is set for a high-stakes, high-profile fall campaign.

* Illinois. If Georgia provides the Republicans' best chance to take a Senate seat away from the Democrats, Illinois appears to be the Democrats' answer. Republican Sen Peter Fitzgerald's decision not to run again seemed to set up a competitive campaign, but Republican efforts to find a viable candidate foundered, reaching a low point when primary winner Jack Ryan withdrew from the race. Meanwhile, Democratic state Sen Barack Obama emerged as one of the party's national stars, even delivering the televised keynote speech at the Democratic National Convention in Boston.

* Louisiana. Sen John Breaux's retirement leaves Democrats with another tough open Senate seat in the South. As of this writing, three Democrats and a Republican were vying for the scat. Under Louisiana's unique election law, all Senate candidates run on a single ticket in November regardless of party, and if no candidate gets more than 50% of the vote on Election Day the top two vote-getters--regardless of party affiliation--meet in a December runoff.

* South Dakota. There will be no more high-profile Senate race in the 2004 campaign than Minority Leader Toni Daschle's bid to win a fourth term in South Dakota. As the Democrats' leader in the Senate, Daschle has become a focal point of Republican criticism, and the party is throwing its full support into former Rep John Thune's effort to oust the powerful Democrat. Thune lost the 2002 Senate race to Daschle's Democratic colleague, Sen Tim Johnson, by 524 votes.

* Oklahoma, Sen Don Nickles' decision not to seek a fifth term created an open seat that Republicans must defend. Both parties were heading into hotly contested primaries as this column was being written. Democratic Rep Brad Carson was heavily favored to win his party's nod, but the three-candidate Republican primary was considered competitive.

* Colorado. Republicans must defend another seat being vacated in Colorado, where incumbent Ben Nighthorse Campbell is stepping down. In the Republican primary in August, a brewing magnate, Peter Coors, defeated former Rep Bob Schaeffer. Coors is likely to face state Attorney General Ken Salazar, the heavy favorite to win the Democratic nomination.

* Alaska. Ensuring a late night for election-watchers, Alaska Democrats are aiming at vulnerable incumbent Republican Sen Lisa Murkowski, whose father, Frank, appointed her to complete his Senate term after he was elected governor. The appointment caused an uproar, and the governor's declining popularity added to the obstacles facing Lisa Murkowski heading into the August Republican primary. At this writing, the winner of that primary appeared likely to face former Gov Tony Knowles, the presumptive Democratic nominee.

The House: Status Quo?

Although all 435 seats in the House of Representatives technically are "up for grabs" in November, it's already clear who will be sitting in the vast majority of them when the 109th Congress convenes in 2005. Thanks to carefully crafted district boundaries and the political and financial advantages inherent in incumbency, more than 90% of the current House members who are seeking reelection will be successful. Given the Republicans' current 24-seat advantage, it virtually would take a tidal wave to sweep Democrats into the House majority. The "Republican revolution" of 1994, however, serves as proof that almost anything is possible when Americans go to the polls.

Of all the House seats on the November ballot, only about 30 are considered competitive enough that neither party can take anything for granted. There isn't sufficient space here to touch on each, but 11 races in six states merit at least some mention.

* Texas. Thanks to the state legislature's controversial redistricting efforts, five incumbent Democrats find themselves in races close enough to be considered tossups. Democratic Reps Martin Frost and Charles Stenholm find themselves pitted against Republican congressmen in two heated incumbent-versus-incumbent match-ups. Frost faces Republican Rep Pete Sessions in District 32 in Dallas, while Republican Rep Randy Neugebauer takes on Stenholm in District 19 in west Texas. Three other incumbent Democrats--Reps Chet Edwards (District 17), Nick Lampson (District 2), and Max Sandlin (District 1)--all are in tossup races.

* Louisiana Both parties must defend a vacant House seat. Veteran Republican Rep WJ "Billy" Tanzin is retiring from his District 3 seat in the southern part of the state, while Democrat Chris John is vacating the District 7 seat in southwestern Louisiana to run for the Senate.

* Arizona Rep Rick Renzi is considered one of the Republicans' most vulnerable incumbents. His reelection race in District 1 (northeastern Arizona) against Democrat Paul Babbitt--brother of former Arizona Gov Bruce Babbitt--is considered a tossup.

* Colorado. The District 3 seat seemed safe in the Republican column until incumbent Rep Scott McInnis decided to step down. Now it is rated a tossup.

* Georgia. Freshman Republican Rep Max Burns ranks as one of the most vulnerable House incumbents, having scored a 2002 upset in Democratic-leaning District 12. He's expected to have a very tough time holding it this year.

* Kentucky. When incumbent Democrat Ken Lucas decided to step down from his District 4 seat, it opened up a great opportunity for Republicans in an area that leans in their political direction.

PTs and PTAs Vie for Statehouse Seats

In addition to the federal campaigns, PTs and PTAs will be watching the results of three state-level races to see if colleagues are successful in winning seats in the legislatures. Incumbent state Rep Elizabeth Coulson, PT--the only APTA member currently holding a state-level office--is seeking re-election to a fifth term in the Illinois State Assembly. Two other members of the profession are campaigning to join her in their respective state capitals:

* Dee Thomas, PT, hopes to win an open seat in the Florida House of Representatives.

* Jamie Boomgarden, PT, is running for an open sear race in the South Dakota House of Representatives.

(Duane Dimmitt, PTA, lost an uphill primary fight in August against an incumbent member of the Missouri House of Representatives.)

These candidates took the next step in the physical therapy professions political evolution--not simply voting and campaigning for candidates who support physical therapy, but seeking office themselves. Their efforts underscore an important message: In order to shape the laws and regulations that govern physical therapy, PTs and PTAs must take an active role in determining the composition of legislative bodies.

Be sure to register and cast your vote in this fall's elections. The future of your practice and your profession are at stake!

Dave Mason is vice president of the Government Affairs Department at APTA. Michael Matlack is assistant director of grassroots and political affairs within the department. They can be reached at [e-mail] and [e-mail], respectively.