Health Action in Depth

October 2003

2004 Brings a New Election Season:
Time to Strike While the Iron's Hot

A new election season has begun, and this one is exceptionally important because both the President and many members of Congress are up for re-election. And with the recent announcements that Ernest "Fritz" Hollings (D-SC) will retire at the end of this term and that John Edwards (D-NC) will forgo another run for the Senate to focus on the presidential race, the balance of power in the Senate is likely to remain precarious.

The upcoming elections are also particularly important because health care issues have become significant, high-priority issues among those running for President. One reason this is happening may be that polling data show that the public would prefer--by sizable margins--that Democrats set the country's policies in the areas of health care costs and prescription drug coverage for seniors.

Six of the presidential candidates--Howard Dean, John Edwards, Richard Gephardt, John Kerry, Dennis Kucinich, and Joseph Lieberman--have publicly released very detailed visions for expanding health coverage to the uninsured, and two of the three remaining candidates have expressed their points of view on a range of health care issues. These views, whether put forth in speeches, at forums, or at debates, have garnered considerable press attention. With health care issues receiving so much press, it's time to strike while the iron's hot by setting priorities and organizing for what will undoubtedly be an arduous election season.

Whether you work for a nonprofit organization, are a member of an advocacy group, or are just a concerned citizen, there are many inventive ways you can educate and energize your members or fellow citizens-and some ways you can get candidates to stake out their positions on health care issues and hold their feet to the fire when they make campaign promises.

However, if you work for a nonprofit organization, any work that you do on behalf of the organization--or on your own behalf while using the organization's phones, photocopiers, or other resources--that involves lobbying government officials or educating legislators, your members, and the public is governed by the tax code and by federal election law. To ensure that you are following these laws, your organization should consult with an attorney who is knowledgeable in this area of law.

For more advice on this topic, you can also see materials published by the group Charity Lobbying in the Public Interest, available at (www.independentsector.org/clpi/). They have published a booklet called Playing by the Rules, which is available online at (www. independentsector.org/programs/gr/Playing_by_the_Rules.pdf).

This article focuses only on why health care issues are generating so much heat--a situation that groups working on health care issues should take advantage of now.

Concerned about Health Care? This Election Season Offers Special Opportunities
Much of the time, it may seem like getting politicians or the press to focus on health care issues is like pulling teeth-for whatever reason, they don't think certain topics are worth addressing. But during election season, politicians running for office become acutely aware of the interests of both their broader audience and the special constituencies they may be courting, such as labor groups, gay rights groups, or groups of color. This need to connect with potential voters presents the perfect opportunity to introduce issues into the mix, make sure health care issues get talked about, and get additional press coverage. It is also an ideal time to ask candidates about their positions on your issues.

Now is an especially opportune time to hammer away at health care issues because of the confluence of four factors:

1. Health care costs keep rising by rates that are in the double digits, making health coverage unaffordable for an increasing number of payers (including employers, government programs, and consumers).
2. The labor market is softer than it has been in many years. This means that employers are more apt to pass health care costs on to their employees and to limit or cut health care benefits for retirees. In fact, health coverage has become one of the most important negotiating points for unions across the country.
3. The unemployment rate is the highest it's been in nine years. Most people under age 65 get their health coverage through their jobs; they lose that coverage when they lose their jobs. Because COBRA continuation coverage is so expensive (workers must pay 100 percent of the premiums plus at least a 2 percent administrative fee plus the out-of-pocket costs-such as copays-of any care they receive), it has done little to ameliorate the problem of the growing number of uninsured. For example, a Families USA report found that 74.7 million Americans-nearly one out of three of those under the age of 65-had no health coverage for all or part of the two-year period from 2001-2002.
4. Medicaid and the State Children's Health Insurance Program (SCHIP) have been able to offset some of the loss of employer-based coverage for low-income working families, but these programs are under increasing strain due to state budget crises and cannot make up for all of the losses in this area. The federal government needs to provide additional help for states to meet the growing need for public health insurance coverage.

For all of these reasons, concern about health care--particularly apprehension about health coverage--is an issue that has been transformed from one that was driven by altruistic motives to one that is driven by self-interest. A growing number of people are feeling the strain of health care costs and are worried about losing their coverage. But while the issue has been getting increasing amounts of attention, little of substance has been done about it.

Recently released data from the Census Bureau indicate that 43.6 million people lacked health coverage in 2002--the biggest jump in the number of uninsured in a decade. That report also showed that lack of health coverage is increasingly becoming a problem of working families and the middle class. As the issue of health coverage becomes more and more salient among the middle class, it gains more public attention, more attention from the candidates, and therefore presents more of an opportunity to inject health care issues into the political landscape. Time to put your plans into action!