Chuck Cohen: Welcome, everybody! We are lucky to have Mike Graham today from the ADA, who heads up the education-slash-lobbying operations in Washington. I used the word “education” because as we got started, he made it very clear that lobbying is not what we do in the ADA in Washington. We spend a lot of time (on) education.
Chuck Cohen: Congratulations, Mike, on being one of the 32 most influential people in dentistry. We’ve run this list now for four consecutive years. No surprise, you have been on the list every one of the four years, and probably (will be included) in the future. Thank you for being influential, and thank you for being here with us today.
Mike Graham: Thanks, Chuck. Appreciate being here.
Chuck Cohen: Thank you. Mike, tell us a little bit about your journey—how you got where you are, and a little bit about where you see yourself in the future.
Mike Graham: I started in politics when I was in college in 1976. It was not my major, but one of my parents’ best friends was over the house for dinner. He was the County Executive of Montgomery County, Maryland, which at that time had a budget larger than four or five states.
Mike Graham: We got into this discussion. He said, “Kids today don’t care about what’s going on in politics.” I said, “No, I think you’re wrong. We follow it.” He said, “All right, come and work for me this summer. I’ll give you a paid internship.” They paid $5 an hour, which beat the $3 an hour I was making working (in) construction during the summer. I loved it, and I got [inaudible]. From there, I worked for a US senator, a congressman, a state rep, and two governors. Eventually, I went into private practice. In 1995, I started with the American Dental Association. So now, I’m in my 25th year and representing the greatest profession on earth.
Chuck Cohen: So, you started in politics itself first and then moved over to the lobbying influence area, right?
Mike Graham: This is actually what a lot of lobbyists do, quite frankly. They get their training. They learn the players, the policy, the process, and the politics. And if you’re a good lobbyist, you learn to be persuasive and perseverant. I tell my staff all the time, “You got to know all the P’s.” Good lobbying usually begins in an office, and then you slide over into representing whatever profession is your passion.
Chuck Cohen: Talk a little bit about the influence side because that’s the theme of the day. As a person on the side to try to get influence and (be) educated, now you’ve moved over to the side of doing the education, the influencing. How do those two roles differ, and what are the keys to success in what you do now?
Mike Graham: They differ substantially. In fact, many people who work on Capitol Hill and then go into the private sector realize, “Oh, I don’t like being the person who chases after people. I want people to come to me.”
Mike Graham: For me, having been involved at all three levels of government, I found what my political philosophy was over time. It aligned so much with dentistry. I believe in smaller government, and allowing businesses to operate on their own, with some guidelines. You have to trust the system.
Mike Graham: In my opinion, the reason why we’ve been so successful is because of the reputation of dentists and dentistry. Year in and year out, dentists are included in the “Top Five Most Respected Professions,” and that is something that they’ve earned. That is something that I tell my team and myself all the time. We have to protect the reputation of the profession. Everything we do is under a microscope. They’re going to look at us, and they’re going to make judgments about the profession. Any success that my staff and I have achieved is because of the great reputation that dentists and the profession have earned over many years.
Chuck Cohen: Wow. So you packed a lot in there. I want to unpack it a little bit. One of the things that came through loud and clear is your influence. From what you just said, your influence comes from the dentists and the dental profession being so respected and influential itself. Talk a little bit about that. What is it like to represent 100,00-plus very respected professionals? How does that allow you to be an influencer?
Mike Graham: If you ever read one of our letters that goes up to Capitol Hill, it always starts with, “On behalf of the 163,000 members of the American Dental Association.” That number may have ticked up a little bit. We want to show (Congress) that we’ve got a significant percentage of dentists belonging to our organization, which is extremely impressive. I’ve got some great stories I could tell about that, but I won’t go into it right now.
Mike Graham: When you represent almost two-thirds of all dentists in the country, that’s impactful. Members of Congress know that. They go, “OK, so you’re not representing a percentage of dentists. You represent the majority of dentists, if not close to the vast majority of dentists.” You represent what dentists around the country think and feel. Along with the great reputation that dentists have, that representation gives us tremendous influence.
Mike Graham: The great thing is—of the 535 members of Congress, House, and Senate, I’m hopeful that every one of them goes to the dentist every year. Pretty sure they do. They get to see firsthand the value they receive, and then hear that from their constituents. And when they don’t perceive value, they’re happy to tell us because they themselves are consumers. It’s the great respect and closeness of the profession. The fact that we represent such a large percentage of dentists gives us an edge over everybody else on Capitol Hill.
Mike Graham: I say this, and for those who have heard me speak, I rarely leave this out. I asked them, “(How many) lobbyists lobby every single day on Capitol Hill?” Give me the number. What number do you think lobby every single day on Capitol Hill, either in person or virtually?
Chuck Cohen: 3,000?
Mike Graham: Seventy-six thousand lobbyists lobby every single day on Capitol Hill. How do we get our voice heard through all that clutter? Being a Congress and House member, you represent about 800,000 constituents and senators. Of course, it ranges from California to Delaware or Wyoming or Alaska, which have a pretty small percentage. How can we get our voice heard and all those things combined?
Mike Graham: It is the reputation. It is the fact that we speak on behalf of the majority, if not the vast majority. These are the things that make a difference. In addition to that, we have one of the best grassroots campaigns in Washington for an organization our size. We do a fantastic lobby day where we bring in about 1,100 dentists and dental students every year. In fact, this very week we’re doing virtual lobbying. This means we’re having our members of Congress call in with their members of Congress and our staff.
Mike Graham: We have a very good-sized political action committee, AIPAC, which I believe, is still in the top 50 largest PACs, (with) over 10,000 PACs. All of this gives us an opportunity to have our voice heard, and that gives us the edge.
Chuck Cohen: So one of the things you mentioned before, and I’ve heard it before, is a higher percentage of dentists are members of the ADA than generally other healthcare professions. Can you talk about that for me? How (does) that give you more influence on Washington’s dentists in general?
Mike Graham: Not to throw our medical colleagues under the bus, but the AMA (saw that) their membership over the years dropped down. It has ticked up to their credit, but it’s hovering somewhere around 25 percent. I think members of Congress know that—they know that the AMA, a very well-respected organization, only represents 25 percent of all physicians.
Mike Graham: When we’re speaking on behalf of dentistry, I think members of Congress know, they are speaking on behalf of the majority. It makes a big difference because that means (it) replicates in the states and those congressional districts. So they know, “Okay, they’re speaking on behalf of my dentists who live back in my county or counties.” It makes a difference.
Chuck Cohen: Interesting. The last few months have been fascinating for all of us. With COVID-19 and all the changes that have come, your team has been hugely active on Capitol Hill, trying to get the world to work better for dentists. Can you talk a little bit about what that’s been like, and maybe what your biggest success was? Because I think you’ve had a lot of them from my perspective. What’s it been like the last couple of months? How did things change from your perspective? And then what was the biggest success that you’d seen so far?
Mike Graham: Thank you. We have been amazingly successful. But again, in my way of thinking, all the things we have done leading up to mid-March impacted our ability to tell our story to members of Congress and staff once the shutdown occurred. All the relationships and the trust that we built between members and their staff were necessary at the very moment that everything shut down, and here’s why. (My staff and I) could no longer go in, but sit across the table from a member or a staff of Congress. We say, “This is our issue, and this is what we would like (to do).” We then had to do it by phone, email, and sometimes text message. We have those numbers because we built up this great relationship (with) members of Congress and their staff. (With) that, we’re able to make our case. There’s that great trust between the profession and (the) members of Congress.
Mike Graham: There had been four COVID (legislative) packages that passed. When the first package came up, we were able to make the case about what the dentists need to stay afloat. Because we didn’t exactly know what was going on with this whole COVID situation, many of our dentists shut down their practices except for emergency cases, right? Because where are those (patients) going if dentists aren’t treating the emergency cases? The dentist puts him or herself at risk by treating those patients, right? But they treated them anyway, so they wouldn’t end up in the ER, so they wouldn’t clog the hospital where the COVID patients were going. Many dentists across the country were taking their extra PPE and donating it to the hospital. It was on their own dime. And I’m sure your company was involved in that project, as well. It built goodwill because we have those good relations (and) we have that trust. When we said, “This is what we need. We need the EIDL grants, the EIDL loans, the PPP loans,” for example. And they were really in parts of the first and second package that the members of Congress said, “You’re right, and we’ll make sure you get it.” We were able to package that in the right way.
Mike Graham: Now, I will tell you one of the most influential things that occurred early on. The first four packages which occurred in the first three months was when we reached out to our dentists. We said, “We need you to contact your member of Congress and let them know to support these provisions in the bill.” We got tens of thousands of dentists to respond. To date, Chuck, we have had 150,000 dentists emailing their member of Congress. That produced 600,000 emails. In one of those, 286,000 emails went to Capitol Hill on the second COVID package. That’s phenomenal. Members of Congress were calling me saying, “We got it. We understand what you need.”
Chuck Cohen: That’s amazing.
Mike Graham: It is amazing. And they responded.
Chuck Cohen: One of the things you mentioned that others have mentioned in these prior podcasts is the relationship between trust and influence, right? I think one of the things everybody says: “Without trust, there can be no influence.” I think that’s been your experience, right?
Mike Graham: Trust is determined in the first 10 to 30 seconds in any conversation you’re having with a member of Congress. We represent professionals that are doing so much good out there. I have seen some number close to $3 billion worth of free or discounted dental care provided to Americans every year. Members of Congress know this—they know about “Give Kids a Smile,” and they know about Mom’s Programs. It builds that trust. All the veterans’ programs that dentists are involved in build that trust. When we walk into the room, if they (don’t) trust us, they’re not listening to (the conversation) after the first 10 seconds. So we have that with our members of Congress. Again, that makes all the difference.
Chuck Cohen: So one of the things we were talking about a little bit before we got on was that five dentists are members of Congress. Talk a little bit about how that happened. That certainly must increase the amount of influence that you and dentistry have (in Congress).
Mike Graham: First of all, I’d like to thank you for giving them the recognition they deserve. When I started in this position 10 years ago, we had one dentist (in) Congress. It was one of our goals to help get more dentists elected. There are places we cannot be in Congress, in the middle of the night when they’re in closed session and they’re talking about a certain bill. If there’s a dentist in the room, what do you think happens? If there’s a dentist in Congress, they’re going to turn to them. They’re going to say, “Hey, Dr. Mike Simpson. How do dentists treat this kind of situation, or does this impact dentistry this way?” To have someone like Mike and Paul Gosar, Jeff Van Drew, Brian Babin, and Andrew Ferguson there to say, “Yes, this is how it (makes an impact).” They’re not lobbying force. They’re representing their profession. Every single one of those gentlemen are proud to be dentists. You’ll see them wearing the tooth pin, which is a pin that we started in ADPAC. Dentistry doesn’t represent Republicans. It doesn’t represent Democrats. We say it represents the tooth party. It’s a tooth with the stars and stripes on it. You walk into the office of a member of Congress and they see the tooth pin. One or two times, they’ll say, “Oh, that’s neat, where can I get one of those?” And we give it to them. But they’re very proud to be dentists. While I know they represent all their constituents, they let them know they’re proud to be dentists.
Chuck Cohen: Wow, that’s exciting. As we emerge from the COVID-19 challenges, what do you think are the next two or three big issues that the folks on Capitol Hill are going to deal with as far as dentistry is concerned? And where are you focused?
Mike Graham: We’re talking about testing and vaccination, and how are the dentists going to play a role in that. Those are some things that are still up there. Also, some dental practices are not operating at the pre-COVID level. How are they going to fare getting through that? We still need to work through those issues. We’re thinking of ways to help every dental practice.
Mike Graham: If I’m not mistaken, you probably have or will interview Marko Vujicic, who’s our chief economist. He’s a brilliant guy who’s been so fantastic to the ADA team. His team at the HPI provides (us with) numbers. We’ve got 99 percent of dentists back to work, which is amazing. The others that haven’t come back to work did so by choice.
Mike Graham: I’m amazed at the number (of dentists) that have come back to work. A lot of people were projecting that many dentists would retire, but they didn’t. It just goes to show that these dentists are dedicated to the profession and their patients. Their dedication is phenomenal. I love representing them for that reason.
Mike Graham: We have a lot of issues moving forward. I think we’re going to have some economic issues. Some folks are predicting that the economy might take a second hit as things start to level out. We’re doing a lot of stuff on third-party payer issues trying to work with the dental insurance companies. Dental plans to come to some agreement on how dental practices can navigate all the requirements. Dental insurance provided great opportunities for consumers and dentists. But at the same time, that provided some challenges, and we’re trying to work through those challenges as well.
Mike Graham: So there are third-party payer issues. We’ve been doing a lot with a campaign that we started about eight years ago called “Action for Dental Health.” It is a program with eight different initiatives that seek to improve access to dental care for Americans. The reasons vary: financial constraints, fear of going to the dentist, or not having a dentist in their area. This campaign seeks to help overcome some of those.
Mike Graham: I’m very proud of our community dental health coordinator program. We have someone in the field who educates patients on the importance of oral health. (They) navigate them to a dental office where they can get the care they need and find ways to pay for that care. We are trying to stop people from going to hospitals and bring them to dental offices. It’s very costly when someone walks into an ER, and it doesn’t usually solve the problem. We’re trying to get the right care at the right time. All these different programs that we’ve begun are taking hold in communities all across the country. Those are just two of the things that we’re focused on.
Chuck Cohen: Getting back to a little bit of a 50,000 [inaudible] the COVID deal, how do you figure out the issues that you should be educating or lobbying on in Congress? Do they come from the grassroots of the ADA membership? Do they come from the House of Delegates? Do they come from Kathy (O’Loughlin) and the administrative side? How do you figure out where to focus? I imagine there must be hundreds of things that you can talk about on Capitol Hill, but you got to get focused on the most important ones.
Mike Graham: Great question. At any time, I think we’re lobbying about 40 to 50 issues to varying degrees of importance and intensity. Now, how do we decide? Well, we are a membership-driven organization, period. The dentists are in charge. We have councils that provide leadership and guidance on the issues. They help prioritize those issues. Every year, I have two councils that I work with directly in government affairs. They prioritize the issues that a particular council thinks are important. We have an ADA policy. We don’t do anything on Capitol Hill unless we have a policy. If I don’t have a policy on an issue, I go back to leadership. I go back to the ADA board and say, “This is an important issue. If you think it’s important, we need a policy on it.”
Chuck Cohen: When you say policy, what does that mean? Does that mean a statement that says, “This is our position”?
Mike Graham: Exactly, yes. I’ll give you an example. Two years ago, there was not a conversation that I had with a member of Congress that did not include some discussion about opioid abuse. Two years ago, this issue had grown in such intensity and we had no policy at the ADA on opioid abuse. Some folks were claiming some of that opioid abuse started in the dental office. In other words, the dentist prescribed an opioid to the patient. The patient got hooked. (They claim) it’s the dentist that caused it.
Mike Graham: We went to the board of trustees. Dr. Joe Crowley, at the time, was President of the ADA. He brought the issue to the board. In one night, they passed a resolution, an interim board policy on opioids. Within two weeks, we had 1,200 at that time. I believe it was dentists and dental students flying into Washington to lobby. They (talked) to their members of Congress about the ADA’s interim policy on opioids. It built us such credibility because no other health care organization had come out with a stronger policy than the American Dental Association. Members of Congress said, “Wow, this is exactly what we need.”.
Mike Graham: I remember having a conversation a few days before with Senator John Thune, who is now the number two ranking Republican in the Senate from South Dakota. He said, “Wow, the dentists have led the way.” This is fantastic because we need this to get some serious discussion started on opioids and opioid abuse. Within three or four months, Congress passed some great laws to help stem opioid abuse. We’re seeing those numbers come down. It all began, in my opinion, with the American Dental Association and the policy that was created. So, Chuck, we need to have a policy—that’s how we begin every discussion. The ADA has this policy, and we share that with members of Congress. We try to get legislation that reflects the policies of the ADA as much as possible.
Chuck Cohen: Do you sometimes find the need to go back to the ADA membership and say, “You want to go in this direction, but here’s where it would be more palatable”? In other words, as part of your influence, not just in Washington—but part of the influence is in Chicago, where the ADA is headquartered, and dentists across the country.
Mike Graham: You asked the question. I gave you one example. You asked the question, “Where’s the public policy come from?” But it really comes from anywhere. We’ve had dentists who have called, written, and talked to us, and said, “I think this is a good idea.” Then that’s presented to the Council on Government Affairs, for example, or the Cancer Council and dental practice. It begins there; the dentists on those councils have that conversation. They go, “This is good. We got to do something about this.” Then, they act. It can begin with one person. It can begin with some outside influence that suggests dentistry needs to do something in this area.”
Mike Graham: We’re bringing to the House of Delegates, which will be held virtually this year in October. The first resolution will deal with veterans’ care. We have 600 fantastically dedicated dentists who worked in the VA system. However, only a small percentage of veterans are eligible for VA dental care because of how the laws are written for the VA. I’m a veteran myself, and I’m not eligible for VA dental care because I don’t have a service-connected disability with regard to the oral cavity. But the guidelines are written very narrowly. Our dentists in the VA do a terrific job in representing those dentists and taking care of those dentists who were eligible. But there’s another 90 percent of veterans who don’t get that care in. Many [inaudible] need it very badly, but they don’t have the money to pay for it. So, there’s a policy coming to the House of Delegates that’s going to address that. (It) came from a groundswell of just dentists saying, “Yeah, we need to do something about that.” We’re working with our good friends and dental lifeline network who you (might) know, I think.
Chuck Cohen: Very much. I’m on the board.
Mike Graham: Yes, you are.
Chuck Cohen: Very happy to be; very proud to be.
Mike Graham: Yeah, you should be. So they’re doing some good things. We hope to partner with organizations like that moving forward (to) improve access to care for folks who may not normally be able to get that on their own.
Chuck Cohen: Excellent. So, magic wand kind of question. As an influencer, if you could change one or two things about the profession or your impact on the profession or how you do what you do, what would you change going forward? Like what would you say, “if I had a magic wand, this is the change I would make . . . “
Mike Graham: In dentistry?
Chuck Cohen: Yeah.
Mike Graham: I thought you were saying in lobbying, which case that there’s a lot (for) lobbying.
Chuck Cohen: [Inaudible] to the first dentistry.
Mike Graham: Well, I wouldn’t have stuck around for 25 years if I didn’t think that the dentists were doing it right. Members of Congress stopped me all the time and (said), “We got to protect dentistry.” It’s the last bastion of a profession that really represents competition, small business, ingenuity, and all those great things. So there’s not a whole lot I would change.
Mike Graham: I would say this, having been in the Navy for 21 years. You’ve heard the term, “It’s like turning an aircraft carrier around.” It takes time. There are probably some things that I think we could eliminate, some steps that take to get things approved so we can move a little bit quicker. But there’s a benefit in taking a hard look at things as well.
Mike Graham: But we’ve done a lot of things right. It’s probably why we have a great membership, and we have great leadership that consistently gets us through tough times. Obviously, we’re getting through COVID. We’re getting through COVID better than almost any profession that I know of that’s out there. It’s because of all the things that have come together over the years. But, it’s hard to move a lot of people in the same direction sometimes. Maybe if I had to say, “I’d like to see that,” that might be the one thing that I would see if we could improve on it.
Chuck Cohen: Excellent. Well, let’s do the last question. I think you’re not going to be surprised when you hear what it is. So it seems like the caustic politics between the parties actually across the United States. Since you’re a political observer and a participant in the process, can you talk a little bit about a sort of “what’s right, what’s wrong” about the way things are done today and what you foresee happening? Where do you see things going today and into the future?
Mike Graham: When I was working on the Hill in the early 80s, one congressman and his staff would roll a piano out of his office to the fourth floor of the Rayburn House Office Building. We usually worked from eight to six, Monday through Friday. But he’d roll that out about 6 o’clock on Friday afternoon. Republican and Democrat members and staff, if they were in town, would sit around that piano and sing songs. It was something right out of a Mickey Rooney’s Judy Garland movie.
Mike Graham: And then we’d all go out and have drinks and dinner, and we did it together. We had great relationships, and we could differ on the policy as staff and with members. But we had great respect for each other and the work we were doing—representing the folks in America.
Mike Graham: If I could see any change, I would hope that we would turn back to the purpose (of) representing the people in America in a civil and productive way. I’m still very hopeful. I’m a believer that history is cyclical, and we may very well come back to that. I don’t know if we’ll ever be singing songs in the halls of the Rayburn House Office Building again, but I’m very hopeful that will come back to some level of civility.
Mike Graham: Very often, a crisis like this brings people together, and we get a little bit smarter, so I’m very hopeful that will happen. But there’s a lot of work that we have to do in America. I think we’re just going to roll up our sleeves, and dentistry is going to do its part. Dentistry is going to keep pressing the state to improve access to care, to take care of the people who need help, while at the same time producing quality services for the patients that we see everyday.
Mike Graham: The new generation of dental students coming up. They are sharp. They are a diverse population of young people who understand the importance of oral health. Also, I think they understand the importance of being a profession that has a real purpose in delivering world-class oral health care to their patients. So, I’m very heartened by the dentists that I meet every day that are graduating from dental school. They’re a a terrific bunch of people.
Chuck Cohen: Excellent. Mike, thank you very much for being here today. I want to close by saying, although I’m not a dentist and you don’t technically represent me as a member of the profession and the industry—I want to say we are lucky to have you working for us on Capitol Hill. Your team has done an amazing job of helping dentistry get through COVID. It’s clear from today’s talk; it’s not an accident. You really know what you’re doing, and you bring a very high level of professionalism and trust to a job that’s very important. So, thank you very much. Thank you for being here today and for sharing a little bit of your wisdom with us. We appreciate everything you do for us.
Mike Graham: Thank you, Chuck. Thank you for giving me this opportunity, and thank you for everything you do as well.
Chuck Cohen: Well, good. Well, thanks very much. Thanks, Mike.