Advocacy and the Repeal of the ACA: Are You Ready to Mobilize?
By the end of 2015, $1billion had been spent on advocacy involving the Affordable Care Act. Now, it’s about to happen all over again.
Unless you’ve been sleeping under a rock these past couple of weeks, you’ll be aware the largest legislative repeal of the decade – possibly ever – is about to take place with the dismantling of the Affordable Care Act.
Here’s what’s happening right now
Early Thursday morning, Senators voted 51-48 to adopt the budget resolution that sets up the repeal of the health care law through the budget reconciliation process.
With that comes a game-changing field for advocacy, and the thousands of insurance, service, employer and healthcare-related associations, corporations and organizations directly or indirectly affected by it.
To get some grasp on the expected volume of advocacy action and the associated spend likely with this repeal, we only have to look back a few short years to the early soft whispers of its inception eight years ago.
From the very first spots about the ACA in 2009 through June 2013, more than $500 million had been spent on advocacy and campaign advertising referencing healthcare reform, according to media giant Kantar.
By the end of 2015, that sum was hovering at $1 billion – the last time numbers were reported.
That made it the largest cumulative advocacy budget since Medicare and Social Security, both of which have been around for 40+ years.
Based on those numbers it’s fair to estimate that at least the same amount will be spent all over again, by those for and against it’s disestablishment.
Ironically, spending on ACA advocacy up to the end 2013 was heavily in favor of those against all or various parts of the act, at a rate of 5:1.
Why this is such a big deal for advocacy
The juggernaut of campaign mobilization, some already in place, and the resources being put behind it is not surprising. Healthcare makes up close to one fifth of the national economy, accounting for almost 18 percent of the nation’s Gross Domestic Product. That resulted in $3.2 trillion dollars, or $9,990 spent per person in 2015. Significantly ahead of education and defense spending.
A study by the Milken Institute School of Public Health at George Washington University study found that a straight repeal of the law could eliminate three million jobs over the next four years and that total business output could be cut by as much of $2.6 billion. It also identified Florida, California and Texas as the states that would be most affected.
That leaves a whole lot of keenly interested organizations watching with bated breath to see what happens next, all the while arming themselves for long and protracted advocacy battles.
The battle has already commenced in multiple quarters. Has yours?
Many organizations aren’t waiting, having already gone on the offensive against disestablishment.
Those include insurance, hospital, physician, patient advocate groups, and multiple other stakeholders already launching advocacy campaigns, writing letters, press releases and advertising demanding to see a replacement for the ACA firmly in place before Congress repeals it.
While many groups initially opposed certain aspects of the ACA from the outset, most are now worried about potentially large disruptive measures to the established law and the repercussions that might bring.
Among those leading the advocacy charge are coalitions. Once such, calling itself the Alliance for Healthcare Security, has already pulled together a broad coalition of 21 doctor, nurse and patients advocacy groups and launched an alleged seven figure print and digital ad buy, targeted mostly in Alaska, Arizona, Maine, Nevada, Tennessee and Washington, D.C. warning against getting rid of the ACA without a replacement in place.
Families USA, one of the coalition’s members, is also running their own advocacy program urging advocates to sign up and take action. They started their efforts immediately after the election.
“It was pretty clear we were going to have a battle on our hands given that during the campaign they were saying they were going to repeal the Affordable Care Act,” says Craig Obey, deputy executive director of Families USA.
“Right after the election we started pulling together organizations, and rallying them to get motivated to act. When I think back to different times, when you’ve had changes in control, and different challenges for folks, it takes a while for it to sink in. When you’ve been through that before, you realize one of the most important things to do is to model the behavior that people need to have, and to say this is not a time to agonize, it’s a time to organize.”
Obey and his team wasted no time. The day after the election they held a conference call for advocates throughout the states. “We had more than 500 hundred participants,” he says.
Those with an established voice are planning to use it
CEO Mike Thompson at the National Alliance of Healthcare Purchaser Coalitions (National Alliance) an organization dedicated to value-based purchasing of healthcare through collective action says they are on full alert and ready to convey “the point of view of major purchasers” to lawmakers at federal and state levels.
Given that there are as many as 50 coalitions already within the National Alliance, they have a ready-made voice with 12,000 mid- and large-sized employers in both the private and public sectors covering 41 million Americans.
“Our primary concern is that the baby doesn’t get thrown out with the bathwater,” Thompson says.
“The danger is that we start over completely” and end up with “a patchwork of state-based reforms.”
Thompson says members are “anxious to be engaged and that the message is simple: “Make it better. Make it right.”
The Act with many advocacy scenes
Other groups are concerned with specific parts of the ACA that if repealed they say will have far reaching consequences for their organizations, and ultimately, patients.
The National Hospice and Palliative Care Organization (NHPCO) is one such group, and they have already been in touch with the Trump transition team.
In addition to engaging in grassroots advocacy through its Hospice Action Network (HAN), the national office maintains a presence in Washington D.C. to lobby on behalf of its members, more than 6,100 hospice programs nationwide.
“Deep in the Affordable Care Act is a provision that allows terminally ill children to receive hospice care – pain and symptom relief, spiritual support, emotional and family support – without having to forgo curative treatments,” says senior vice president of health policy, Jonathan Keyserling.
“NHPCO encourages Congress to preserve these important provisions, which allow some of our most vulnerable citizens — sick and dying children, and adults and their families — to access the full range of care and services that they need.”
As well as podcasts with HAN to update members, they regularly write letters and statements to target legislators and decision makers, and have sent a letter to President-elect Trump’s transition team. Here it is:
Is watching and waiting an option?
Community Health Charities (CHC) who represents some 2,000-member charities including St. Jude Children’s Hospital, and the American Heart Association, have also reached out to the transition team – but are taking a more watchful-waiting approach.
“We’re no different than anyone else. There is a lot of apprehension,” says CEO Tom Bognanno, adding that the organization will speak in two voices, that of the individual patient, and the business community.
From the business perspective they’re hoping Trump’s background in business bodes well, but for now they’ll withhold advocacy until the message is clearer. “We don’t want to overreact to speculation. We don’t want to contribute to the noise right now,” says Bognanno.
State advocacy coalitions are not being left behind
State organizations are also getting together to make their voices heard. More than 20 organizations in Massachusetts have formed a new coalition called the Massachusetts Coalition for Coverage & Care to fight back against repeal. The effort is being led by advocacy group Health Care for All and the Blue Cross Blue Shield of Massachusetts Foundation, which studies health coverage.
It includes groups such as the Massachusetts Health and Hospital Association, Boston Children’s Hospital of Health Plans, the Service Employees International Union, the Massachusetts Medical Society, and Partners HealthCare, to name but a few. They will meet twice a month to strategize on how they respond to repeal.
Large state organizations getting ready to mobilize
The Texas Medical Association, the largest state medical society in the US, representing almost 50,000 physicians and medical students, says it’s got all kinds of plans afoot.
“There’s a little bit of anxiety,” says Dr. Douglas Curran, chairman of the organization’s board of trustees. “But a lot of times change offers great opportunity. From the beginning we wanted to keep what was working with the ACA, and fix what was broken, and that’s still our hope. We’re trying to keep optimistic.
We just want to do what’s right by our patients, and right now there are a lot of people out there in the middle of cancer, or some such treatments, worrying about losing their healthcare. Hopefully legislators think of that as they transition.”
Curran says being a state organization doesn’t mean their voices are any less important or well heard in Washington.
“We’ve got national representatives and we’re encouraging them to stay focused. We’re of the opinion that [Washington] may not want to hear what we have to say, but we need to tell them. If I can tell a patient they’ve got cancer, I can certainly tell a lawmaker what they may not want to hear. We speak for our doctors and they speak for their patients, and when we can do that, we do our jobs.”
The push from inside Congress
Advocacy campaigns are also taking place within the halls of Congress, with Democratic senators rallying advocates in defense of the ACA.
At least 40 “Rally to Save Our Healthcare” events are planned around the country January 13-15 with senators from multiple states calling to on supporters to show up and stand with them against repeal.
Several, including presidential candidate, Bernie Sanders have also launched a full scale social media campaign to their supporters urging them to share images such as these below.
Part II: What Should You Be Doing Right Now?
Matt Duckworth, vice president of government relations for Hart Health Strategies, a Washington, D.C. bipartisan consulting and lobbying firm specializing in legislative and regulatory healthcare issues, offers these six advocacy tips.
Decide on your priorities
“I think if someone tells you they know exactly what’s going to happen, they’re probably jumping the gun a little bit. With this issue so important to so many groups, having a thorough understanding of what your priorities are in the legislative arena for the repeal and replacement of the ACA is important. Both in terms of things that are part of the ACA now that you might want to keep, and things you’ve looked to eliminate.”
Get your communication ducks in a row
“There are so many parts to this that you don’t want your organization talking out of more than one mouthpiece, or with competing priorities or having different views on the same issue. Where you can, make sure the stakeholders in your organization know how to effectively communicate when they’re called upon as experts, whether on Capitol Hill or on the news, or even talking with their patients or hospital administrators. Help them understand that as an organization this is what we’re pushing for.”
Be agile and ready to act at a moment’s notice
“I think it’s more important right to gear up your organization in a way it can respond effectively and quickly. Being agile comes down to a few things: Being able to deploy a grassroots campaign, and having the consensus of your membership, board or advocacy committee, and then the process of being able to move fast on without getting slowed down.
That could be something as simple as being able to submit a comment letter or a letter of support about a certain provision to committee or members of Congress as they begin to roll out their plans for replacement.
Many organizations are not able to be agile and the structure they’ve set up for those decisions can really hurt their place at the table. If you’re not able to respond fast when something you’ve prioritized comes up, say a committee or Congressional office reaches out and says we really need support here, it can hurt you as a resource to those people.
Work on your agility. Have your tools sharpened and ready to go.”
Keep your voice active
“At this point I think it’s OK to be reminding your champions on the Hill, as well as others who are going to be a part of the repeal and replace process, what your priorities are.
The main thing about a new Congress as it pertains to any issue, and with a new administration, is that it’s real opportunity to educate people on your priorities, and why they’re important to you and what the issues are.
So, from that end it’s important to start advocating immediately. It doesn’t mean you’re going full out, but once the replacement plan is kicked into gear you don’t want there to be any question on your position in the minds of those who make decisions when it comes to your issues.”
Get your advocates up to speed – before you need them
“Informing your members at this point can be a really important first step. The ACA is an issue that people feel personally about. Being able to come to a consensus with your membership from the top down early on, in terms of the message you’re going to be putting forward, is incredibly important.
The classic battle many organizations have is personal views about a political or policy topic, versus the organization’s views, and separating those effectively. That takes fully communicating how the organization plans to react, and taking members and advocates opinions into account and listening to them so you can be effective.
If you just take it as a top down approach, whether that’s the CEO, or the board or the advocacy committee, and you haven’t listened well enough to your actual membership, you’re not going to get the back up you need when it comes to grassroots campaigns and fly-ins. You want people to feel passionate about why they’re going to bat for the organization.”
Unification will be key
“Never underestimate the power of a coalition in Washington, D.C. and never underestimate the ability and willingness of government relations professionals to form coalitions. For something like the ACA, which is so public in nature, and for which there’s going to be real public pressure on the Hill, coalitions, issue by issue, are going to be very important.”