| The latest news from and for state health care advocates |
May 2011 |
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In each edition, we'll feature an action, victory, campaign, or interesting tactic shared by a state advocate. Send us your updates. |
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In This Issue:
What’s Inside:
Buzz around the States
A new poll out of North Carolina reveals that voters oppose having insurers on the exchange board.
Health Care for All New York coalition sends state policy makers a letter to encourage them to get moving on exchange legislation.
Join Vermont advocates on a conference call to learn more about Vermont's New Health Care Reform Law on Wednesday, June 1, from 1 - 2 pm EDT (Call-in: 1-712-432-3066, passcode: 320217).
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States in Focus
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For Colorado advocates, passing an exchange bill that laid a reasonable foundation for them to build upon was a big win. By truly understanding state politics, advocates were able to look long-term and build support within the consumer health advocacy community to support a bipartisan bill.
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Colorado Passes a Truly Bipartisan Exchange Bill
State legislative sessions are coming to an end, but seven states have had success in passing exchange legislation. Colorado, in particular, stands out due to the very unlikely variety of groups that publicly supported their exchange bill.
Dede de Percin, executive director of the Colorado Consumer Health Initiative (CCHI), was proud to say that Colorado passed a bipartisan health insurance exchange bill that is supported by consumer advocates and business groups alike. She credits the bipartisan support in part to the unique independent spirit shared by Coloradans. This independence, which has been ingrained in Colorado culture since its very beginnings, allowed legislators to garner diverse support among legislators, advocacy groups and the public to at least consider a bill that no one deemed “perfect.”
Consumer advocates, who may have been disappointed with some of the provisions of the legislation that are supported by traditional foes, were willing to look beyond the surface and assess the actual impact of the legislation. Dede explained that the task was not easy and took a lot of forward thinking. Their coalition took a hard look at the details of the legislation and determined how they would be able to influence and improve it moving forward. For example, although consumer groups were not thrilled that there would be insurers on the board, they were pleased with the process of board appointments, conflict of interest protections, and opportunities for strong consumer representation.
Similarly, business groups came out strongly in support of the exchange legislation. The National Federation of Independent Businesses (NFIB) was perhaps the most publicly supportive group coming out strongly in the media, chastising tea party representatives for their opposition. Their support bucked the national NFIB’s strong opposition to any progress on implementation and proved a critical factor in getting the bill passed.
In the end, consumer groups view the legislation as an excellent starting point. For Dede and her Colorado colleagues, it will be critical to understand where to claim a win and where to compromise in order to make a long-term difference. Part of that understanding comes from a keen perception in Colorado that using and engaging the strong independent culture plays a key role in moving legislation forward to achieve higher-quality, more affordable health coverage for Coloradans. Other states that have passed exchange legislation so far this session include California, Maryland, Vermont, Washington, and West Virginia.
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Bringing representatives from multiple states together to discuss exchange policies can be helpful in implementation. Since exchange policy is a new area of work for many advocates, dialogue between states at different stages in the exchange process may help you learn best practices for implementation and solutions to potential obstacles. For more information about the CT-MD-NY meeting, please contact Jill Zorn at jzorn@universalhealthct.org.
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Three States Meet to Talk Exchanges
In this legislative session, health insurance exchanges are a hot-button issue for many advocacy groups. Exchange discussions in many states revolve around the political difficulty of passing legislation. However, Jill Zorn, senior program officer for the Universal Health Care Foundation of Connecticut, found the topic of exchanges to have a different tone in Connecticut, a state committed to implementing health care reform. Two other states in the region, Maryland and New York, are also moving forward with the implementation of their exchanges, and the Foundation thought they could learn more about exchange policies from these states. The Foundation enlisted the help of the regional HHS directors who cover the New England and Mid-Atlantic states to coordinate a meeting with Connecticut, Maryland, and New York. All three states are in different stages in their exchange implementation: Maryland passed legislation; Connecticut is currently moving bills; and New York hopes to introduce an exchange bill soon.
Regional HHS directors, state officials, legislators, and consumer and small business advocates participated in the day-long meeting. Two other sponsors, the Annie E. Casey Foundation, headquartered in Maryland, and the Greater New York Hospital Association were recruited to help defray the cost of the meeting.
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To avoid having a conversation dominated by the exchange landscape in each state, a panel of national experts led discussions on issues of interest to all three states. Topics ranged from boards and governance to the role of the exchange as an active purchaser and small business exchanges. By diving into a few specific policy topics, representatives from states in different stages of the process could learn from each other. Those attending also had the opportunity to hear from Joel Ario, HHS director of Health Insurance Exchanges in the Center for Consumer Information and Insurance Oversight, who discussed an updated timeline of impending exchange regulations; the grant process for exchange establishment grants; and policy issues, such as the role of navigators and brokers in exchanges.
Jill believes that the dialogue was very fruitful as advocates acquired a better understanding of implementation and legislative obstacles while state and federal officials got to hear the consumer perspective. She urges advocates to replicate this multi-state meeting in other states. For those interested, Jill advises advocates to first reach out to regional HHS directors who are willing to assist in organizing these meetings and add an attractive element to get advocates and officials to participate.
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Many states will conclude their legislative session without passing exchange legislation. Take Action Minnesota and the broader health advocacy community decided that is was not a bad thing. Advocates will use the coming year to build momentum and develop relationships, resources, and narrow their priorities so that they will be in the position to pass strong legislation or win particular policy decisions.
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Slow and Steady Wins the Race: Minnesota Moves forward without Passing Exchange Legislation
At the start of 2011 session, the Minnesota legislature introduced exchange legislation that would have undermined the state’s ability to regulate insurers. The legislation not only provided insurers seats on the board, but it also lacked conflict of interest protections. While advocates realized early that this legislation would not garner enough support to pass, they anticipated that the consumer-friendly legislation they helped draft would also fail.
Advocates were in limbo wondering how to move implementation of an exchange forward without wasting critically important time supporting or attacking bills that were dead on arrival. Together, the advocacy community decided that they would not dedicate time promoting a particular bill in the media or at the capitol. According to Liz Doyle, policy director of Take Action Minnesota, the advocacy community decided to devote their time to building the necessary groundwork to pass strong legislation during the next session instead.
To set the stage for exchange legislation next session, advocates attended stakeholder meetings initiated by the implementation council and had regular contact with the governor’s office and other allies. They informed these groups about policy priorities and told them that it was acceptable for the state to wait a year to pass exchange legislation. Throughout their conversations, advocates pointed to the exchange legislation they helped write as a way to show leaders that the advocacy community understands the policy choices and has ideas to bring to the table.
Despite the fact that Minnesota failed to pass exchange legislation when the state’s legislative session concluded earlier this month, advocates were pleased with their strategy and confident in their decision to build toward better legislation next session rather than settling for something they did not support this year.
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Beat of the Month
This month the theme of the Beat is “Rolling in the Deep” by Adele.
Advocate Tip: Tying it All Together
As there are attacks on the Affordable Care Act, Medicaid, Medicare, and other critical health care programs, it can seem challenging to have to fight on multiple fronts at once. On a recent conference call, Families USA Executive Director Ron Pollack advised advocates to keep telling consumer stories and use attacks on other programs (such as Medicaid and Medicare) to talk about the Affordable Care Act. In other words, this is an opportunity to show the extreme contrast between what opponents want to do—cut coverage and access, and what the Affordable Care Act does—increase coverage and access. Using consumer stories to show the effects of cuts in coverage and access adds a credible and personal touch.
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New Resources from Families USA and Stand Up for Health Care
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