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Wednesday, November 26, 2014

Advocacy Tips for Basic Health Programs

This month, Minnesota will be the first state to submit its blueprint for a Basic Health program to the federal government for approval. This is the final blog in our series encouraging states to consider Basic Health as a strategy for providing health coverage to low-income residents. Previous blogs in this series: 

  1. Why Minnesota and New York are pursuing Basic Health programs
  2. Key policy decisions in Minnesota’s Basic Health program 

Here, state advocates share the main factors that contributed to their success in moving Basic Health forward in Minnesota and New York. 

While every state will have its own process and unique political environment, many aspects of advocating for Basic Health will be similar across the states. Advocates in Minnesota and New York – two states on their way to implementing Basic Health programs—told us about the tactics and strategies that were especially effective in generating support for Basic Health in their states. Contributing to this list were Liz Doyle, Take Action Minnesota, Elisabeth Benjamin, Health Care for All New York, and the New York-based Community Service Society

1. Start advocating for Basic Health Plans as soon as possible. This may be a long campaign. 

Other states may have a shorter path to implementing Basic Health programs now that federal rules are in place. However, advocates emphasize that campaigning for these programs takes considerable time and advocacy for each step of the process. 

Steps to state implementation of Basic Health include: 

  • planning a program
  • obtaining state budgetary and/or legislative authority
  • securing the governor’s sign-off and federal approval
  • contracting with plans to provide Basic Health  

Minnesota advocates and officials spent a year getting MinnesotaCare—the existing public coverage program funded by the state—in line with requirements for the Basic Health program. This involved changes to MinnesotaCare, such as modifying the eligibility procedures and health benefits covered by the program. 

Advocates worked continually with the public, state agencies, and state legislators to make sure the program would have broad support. Minnesota will begin operating its Basic Health program in 2015.

In New York, advocates have been working since 2010. Part of their efforts involved urging their state to form an official workgroup. This year, New York’s state budget authorized the creation of a Basic Health program, which will launch in January of 2016.

2. Consider producing feasibility studies that document the financial benefits of a Basic Health program.

In New York, Community Service Society secured funding from the New York State Health Foundation to perform its own actuarial analysis of the feasibility and benefits and costs of a Basic Health program. Subsequently, the state contracted directly with the Urban Institute – a nationally focused group which had been studying the Affordable Care Act’s impact on New York– to produce a second analysis. Both studies emphasized the financial benefit to the state of obtaining federal funding to provide health care to recent immigrants, for whose health care New York spends a significant amount.

In Minnesota, the Department of Commerce commissioned a broad study of the Affordable Care Act’s impact on the state—one that included the possible benefits of Basic Health. The state also formed two stakeholder task forces. One task force concluded that Basic Health program was the best way to meet the needs of a segment of the population, which fueled the conversation around Basic Health in the with state legislators.

3. Organize a strong, focused core of organizations committed advocating for a Basic Health program.  

A small, dedicated group of organizations is as important as a larger coalition. Pull together a core group of dedicated organizations that can contribute to each component of the advocacy process in developing a Basic Health program. Recruit members from organizations with a special interest in programs that both make health care more affordable and help provide families with financial stability regardless of their health needs and status. Potential member groups include: state consumer health coalitions, legal services programs that advocate for low-income people, immigrant organizations, and safety net providers.  

If your state might cover any benefits in a Basic Health Plan, in addition to those included in the essential health benefit package, consider allying with patient or provider groups that also care about those services.  When looking at the total cost of a Basic Health program, however, remember that adding benefits costs the state money. 

Reach out to other organizations for their help with sign-on letters and other types of advocacy. Having a core group of trusted organizations can help you earn broader endorsements. Hospitals and unions are likely allies for a Basic Health program. Both Minnesota and New York worked with a diverse group of advocates, providers, and industry players to build support for their programs. In New York, strange bedfellow advocates  included hospitals and insurance carriers.

Finally, make the most of the expertise within your own coalition and build on its strengths and access to information. Different organizations and associations can help craft a message that strengthens the various arguments for Basic Health. Hospitals, for example, can create the picture of the need to reduce uncompensated care costs in a state and supply real numbers. Advocates can collect stories to help humanize the tragic consequences when low-income families lack access to affordable health care –from disease to financial hardships like medical bankruptcy.

4.  Dedicate staff to support your advocacy coalition for a Basic Health program.

Hiring or assigning staff to the Basic Health effort can be very helpful. Staff can perform the time-consuming legwork of nurturing essential support among state and industry players. Take Action Minnesota hired a consultant to work on the Basic Health initiative. Dedicated staff helped to pursue the goal with state agencies and legislators and kept coalition members and the broader public informed.

5. Connect with partners outside of your advocacy coalition as well. 

Take Action Minnesota’s Liz Doyle advises, “build a dream team.” You’ll need legislative and administrative champions and friendly reporters in addition to your own staff. You’ll also need a trusted coalition, and grassroots leaders. Your staff and coalition will need to nourish relationships with these other partners. Take Action Minnesota stresses that players outside and inside the state capital were critical to its success: 

  • Outside the capital—the campaign used organizers, communication with traditional and new media, and coalition staff whose job it was to act as liaisons and connect with the inside-the-capital team. 
  • Inside the capital—the coalition used substantive experts who could discuss policy choices with legislators, review drafts of bills, and write fact sheets so that outside organizations could be involved. Budget and financing expertise provided by these experts enabled the coalition to respond to changing budget issues and write about them for outside groups. Communications and lobbying expertise were also critical. 

Talk with foundations about the need to support all parts of your dream team team, including the liaison and substantive experts.

Work with the relevant state agencies. Join a stakeholders’ workgroup or advisory committee with the appropriate agency.

Deploy consumer-friendly messages across social media channels. 

In Minnesota, the Basic Health program will build on the popular existing program, MinnesotaCare. To gain traction with the public, advocates first had to raise basic awareness about the program. To gain support, they took to social media to build on the popularity of MinnesotaCare, using messages such as “Will Minnesota keep and improve MinnesotaCare or eliminate it?” “The next generation of MinnesotaCare” and “Affordable Health Care vs. The Bronze Trap.” For more on messaging and framing, view their helpful PowerPoint presentation.

Take Action Minnesota also encouraged people to post personal messages in their church or organizations’ newsletters and on social media (for example, “I’m thankful to MNCare because….”).

In its messaging, Health Care For All New York (HCFANY) sought to help the public understand the challenges facing consumers who fall into the “coverage gap”—making too much to qualify for public insurance, but unable to afford marketplace coverage. HCFANY sent this action alert describing the need for Basic Health: 

“Thousands of working New Yorkers earn too much to qualify for public health insurance (like Medicaid), but not enough to afford private health plans. Even the financial aid available through NY State of Health (the state’s new health plan marketplace) isn’t quite enough to make health insurance affordable for some lower and moderate-income hardworking families, who are struggling to pay rent, utilities, groceries and other expenses in our high-cost state.”

In another post, HCFANY overcame messaging challenges by noting that the Basic Health Plan is more generous than its title implies: 

“Don’t be fooled by the name though - there is nothing “basic” about it.  According to the ACA, BHP coverage must be as affordable and comprehensive as what these adults would have gotten on the Exchange.  In New York, coverage would likely resemble that of the Family Health Plus program.” 

7. See the advocacy process through, commenting on drafts as they are released to the public—and urge other advocates to do the same. 

Basic Health plans may go through many iterations before policy decisions are final. It’s important to follow each step of the process to make sure that the final program will best meet consumers’ needs. 

Major decisions that can affect consumers can occur at any time in the process, making coalition involvement critical each step of the way.
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