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Consumer Engagement in Reform Implementation:
A Roadmap for Funders and Advocates
Preliminary Report
Susan SherryCommunity Catalyst
GIH Audioconference December 2009
Work Supported by the Public Welfare Foundation
Image: avecteatre.wikispaces.com
Passing Reform Legislation
Making Health Reform Work
© Community Catalyst 2009
Overview of Presentation
The Work Ahead Lessons from Prior Implementation Capacities Required Defining Reform to Public Policy and Regulatory Demands State Actions Key Success of Reform On-the-Ground Infrastructure Needs Role of Funders
© Community Catalyst 2009
The Work Ahead
Maintain and expand public support for national reform
Protecting existing coverage (Medicaid, CHIP, etc.)
Implementation
Making improvements in the law
New opportunities and unaddressed issues
© Community Catalyst 2009
What We Have to Do
Define reform to the public Policy and regulatory work
• Intensive and complex• New federal/state paradigm
Make it work on the ground • Grassroots infrastructure & systemic feedback• Health delivery system – quality and cost• Population health
© Community Catalyst 2009
Lessons from Prior Implementations – SCHIP, TN, FL, MA, ME and Others
Consumer feedback improves policies
Advocates encourage transparency and play unique intermediary role with public
Agency relationships are important
Documenting how reform is working is valuable
Implementation happens in many places and requires resources for a set of integrated core advocacy capacities.
© Community Catalyst 2009
Capacities Required
“Consumer Health Advocacy: A View from 16 States” (2006) found strong systems of advocacy make a difference in all environments
Effective advocacy requires coordination across state and local organizations of six core capacities
Grassroots organizing Policy analysis Coalition – stakeholder alliances Campaign Communications Resource development
© Community Catalyst 2009
Capacities Have Grown
Since 2006 – significant investment in building systems and learning community• CVC – RWJ - 18 states• SHP – PWF – 11 states• Many other national and local funders in above states and in NH,
MO, NM, and others
Advocates developed strong relations with both state and federal policymakers
State infrastructure and learning community in place
© Community Catalyst 2009
Defining Reform to the Public
Defending against attacks • 2010 elections – key battlegrounds in specific states• State referendum, “symbolic” legislation, linking state
budget crises and Medicaid with reform
Proactive engagement • Public education• Recognition of specific progress along the way• Acknowledging specific problems (and solutions)
© Community Catalyst 2009
Defining Reform to the Public: What is Needed
Coordinated national opinion research and messaging support including “rapid response” capacity
Ongoing public education
Build a grassroots base
Continued local communications with federal and state policymakers
Engage with referendum and legal attacks
Electoral support
© Community Catalyst 2009
Policy and Regulatory
Federal and state interaction – two-way street
States will have significant implementation role (see NASHP policy brief)
Issues include: • Medicaid/CHIP• Insurance reform and exchanges• Affordability• State fiscal and revenue issues• Safety net • Delivery system reform
© Community Catalyst 2009
Policy and Regulatory: What is Needed
Coordinated national consumer organizations to monitor, analyze and address consumer concerns at federal level
Build new state advocate policy expertise
State (and federal) governments under-resourced • states will rely on well-organized interests for policy development• state consumer advocates must be well-organized
Build stronger stakeholder relations at state level
© Community Catalyst 2009
States Will Influence Success of Reform in Different Ways
“Leader” (proactive) states will push envelope on cost/quality issues to move national agenda further
“Defensive” states (many southern) have largest access, quality and disparities issues – success here gives real meaning to national reform
“Intermediate” (purple) states have disproportionate influence on sustaining national political will
Individual states have specific significance (NV)
© Community Catalyst 2009
State Political Environments Vary Widely(2008 Electoral Map)
Image: dashboardinsight.com
© Community Catalyst 2009
Making It Work On the Ground
Consumer representation
Consumer assistance/feedback
New/unfinished business• Health equity• Delivery reform in proactive states – new models• Delivery issues in defensive states – low income• Community benefits – population health
Grassroots advocacy and mobilization
Strengthening stakeholder relations
© Community Catalyst 2009
Needs
Immediate need for both defense and implementation
Develop new expertise in new issue areas
Coordination among national organizations – division of labor
Collaboration and coordination between state-based and national organizations
Strengthen and build state systems of advocacy and campaigns
Resources from a variety of sources (c(3), c(4),and electoral activity)
© Community Catalyst 2009
Image: theyoungconservative.wordpress.com
© Community Catalyst 2009
Stay the Course!
Role of Funders
Mission not accomplished - - - - -
Role of Funders
Foster collaboration among national organizations
Support new expertise
Invest in state-based systems of advocacy
Engage in multiple arenas – state and federal, implementation, public education
Build new funding partnerships
© Community Catalyst 2009
Community Catalyst, Inc.
30 Winter Street, 10th Fl.
Boston, MA 02108
617-338-6035
Fax: 617-451-5838
www.communitycatalyst.org
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working in partnership with national, state and local consumer organizations, policymakers, and foundations to build the consumer and community leadership required to transform the American health system so it serves everyone—especially vulnerable members of society.
Our staff of experienced policy analysts, attorneys, community organizers, and communications specialists has worked with organizations in over 40 states. From Oregon to Orlando, Community Catalyst strengthens organized consumer voices wherever important decisions about the health system are made: in communities when hospitals go up for sale; in courtrooms where consumers challenge the illegal practices of drug companies; and in statehouses when advocates strive to win improvements in health care programs.
Presented by Susan Sherry
Electronic copies of this presentation are available by calling 617-338-6035.
Organizations seeking to distribute or otherwise make widespread use of this
publication are asked to notify Community Catalyst.
Work supported by the Public Welfare Foundation
© Community Catalyst 2009