INTRODUCTION

The American Medical Association (AMA), which convenes 190 + state and specialty medical societies, declared climate change a public health crisis in 2022, stating that “the Earth is undergoing adverse global climate change…[that has] adversely affected the physical and mental health of people…and that anthropogenic contributions are significant.”1

Health professionals view public policy as an important means to address climate change.2 One way the AMA influences policy is through its national bipartisan political action committee (PAC), the AMPAC. AMPAC donates to US legislators whose agendas align with the physicians and patients the AMA represents.

As climate is a topline priority in the US and for the AMA, we assessed AMPAC’s goal to support climate action by evaluating the climate policy positions of AMPAC-funded legislators in the 118th Congress.

METHODS

We identified AMPAC-funded voting members elected to the 118th Congress (term 1/3/2023–1/3/2025) by extracting AMPAC donation data from the Federal Election Committee website.3 We analyzed donations from 1/1/2022, one year prior to the start of the 118th Congress when legislators are likely to campaign for election, to 12/31/2023 to include donations made while the 118th Congress was in session.

To systematically evaluate the climate change policy positions of AMPAC-funded legislators, we consulted with three climate advocacy organizations: Climate Cabinet, Vote Climate US PAC, and the Environmental Voter Project. Their consensus was to use the publicly available League of Conservation Voters (LCV) National Environmental Scorecard, which provides “objective, factual information about the most important environmental legislation.”4

LCV identified 50 pieces of climate change-related legislation from 1/1/2020, prior to the 2020 US elections, to 12/31/2023. For each, LCV classified the pro- and anti-climate action vote through the consensus of experts from 20+ environmental organizations and provided a written justification.4 For example, the Inflation Reduction Act of 2022 that, in part, aims to reduce greenhouse gas emissions is pro-climate action legislation; thus, “yes” is the pro-climate action vote. Conversely, the Department of the Interior, Environment, and Related Agencies Appropriations Act of 2024, which includes a 40% cut to the Environmental Protection Agency, is anti-climate action legislation; thus, “no” is the pro-climate action vote.

We divided the number of pro-climate action votes by the total number of votes for each AMPAC-funded legislator. After observing the distribution of pro-climate action vote percentages, we classified those with > 90% pro-climate action votes as pro-, and < 10% as anti-climate action. All data was analyzed using R, version 4.4.0.

RESULTS

The AMPAC donated $1,095,900.00 from 1/1/2022 to 12/31/2023 to 244/535 (45.6%) voting members of the 118th Congress. Of the total donations, $952,900 (87.0%) went to the House, which considered 29 pieces of climate-related legislation, and $143,000 (13.0%) to the Senate, which considered 21 pieces of climate-related legislation. Democrats received $654,400 (59.7%), and Republicans received $441,500 (40.3%).

There was no statistical correlation (Spearman’s ρ = − 0.08, P = 0.24) between AMPAC contribution amount and the percentage of pro-climate votes made by the 244 legislators (Fig. 1). Of these legislators, 89 (36.5%) were classified as anti-climate action, while 147 (60.3%) were classified as pro-climate action. Eight (3.28%) legislators fell into neither category. Of its total contributions, the AMPAC donated $423,500 (38.6%) to anti-climate action legislators. This included $364,000 to anti-climate action Representatives, 38.2% of its total contribution to the House, and $59,500 to anti-climate action Senators, 41.6% of its total contribution to the Senate (Fig. 2).

figure 1

Pro-climate action vote percentages on climate-related legislation from 1/1/2020 to 12/31/2023 by AMPAC contribution amount to legislators of the 118th Congress. After observing this distribution of pro-climate action vote percentages, 10% and 90% thresholds were chosen for “pro” and “anti” climate action classifications to reflect the consistency of each legislator’s voting record while acknowledging the non-climate-related factors that may affect voting on bills that address multiple policies.

figure 2

AMPAC contributions by legislator office and position on climate action.

DISCUSSION

During our study period, over a third of AMPAC-funded federal legislators voted against climate action over 90% of the time, even as the AMA affirms that climate change “threatens the health and well-being of all individuals.”5 The AMPAC and other medical societies have previously had similar discordance between their policy positions and political contributions.6, 7 While the AMA assesses legislators’ positions on many issues, our findings suggest that climate change may not be a key consideration when making donations.

Study limitations include data that do not capture political funding to unsuccessful candidates or local/state legislators who shape climate policy. While the LCV Environmental Scorecard offers the most comprehensive review of legislators’ climate positions available, any classification of relevant climate legislation and policy stances is subjective.

As the impact of climate change exacerbates health inequities,1 medical organizations must prioritize funding legislators who support climate action that protects and advances human health.