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Welcome to Day 2 of Health Action!


Health Action 2015
Friday, January 23, 2015

5:30 p.m.Competing Visions for the Future of Health Care

Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute
Judy Feder, Professor of Public Policy, Georgetown University

We just heard from two leading thinkers in health policy debate some of the most pressing issues related to access to affordable health care in America.

In a wide-ranging discussion that covered everything from Medicaid policy to children’s benefits on the exchanges to the ACA’s subsidies, these two feisty policy wonks hashed out their visions for the future while reflecting on the past year.

“I’ve been astounded with how successful the ACA has been,” Feder said. “We’ve covered 10 million new enrollees this year; that’s a damn high number.”

After some technical difficulties with last year’s rollout, “it became evident how much wanted health insurance and how far people will go to get it, even when you don’t make it easy.”

Feder has been pleased with the trend of premiums rising at a slower pacing as insurers compete in the market. She also focused on the determination of the consumers to get quality health care.

“I also thought we wouldn’t make as much progress with new enrollees,” Feder said. “I thought the market would be dominated by those who already had insurance renewing.”

Joseph Antos agreed that last year’s experience showed consumers who really wanted health coverage were willing to go through anything to get it. But he questioned whether the slowdown in health care costs could be attributed to the ACA.

The panelists also discussed Medicaid expansion and their hopes for the future. Feder believes that as the ACA becomes more widely accepted, it’s going to be harder for states to resist the money on the table.

“The reality is that getting all that federal money and getting people coverage just makes too much sense.”

When the conversation turned to the big Supreme Court case threatening the ACA subsidies, Joe Antos joked that this was “a classic case of the dog that caught the car.” Now that the conservatives that wanted this case caught the car “what are they going to do with it?” How will they deal with the new reality if the Court sides with the plaintiffs?

What does Feder think will happen if the Court rules against the government? “It’ll be a friggin’ disaster.”

4 p.m.Communications on a Dime: How organizations with tight budgets can reach consumers

Leah Barber-Heinz, Florida CHAIN
Justin Kolikof, Families USA
Jason Stevenson, Utah Health Policy Project

Advocates just got a chance to learn some tips for using social media to communicate their messages when there’s not a lot of time or money to spend.  Three presenters from health nonprofits discussed how to get the most out of social media when you don’t have a full-time staff person devoted to it.

Jason Stevenson of the Utah Health Policy Project (UHHP) shared a great breakdown of how groups should approach their digital communications.

First, define your audiences; every project has a primary audience (supporters, media, opposition, etc.).

Second, determine level of work you want to put into it. Does it have to be high quality or can it be produced quickly?

Third, figure out the timeline for the project.

He advised groups to follow some universal design concepts when producing content for social media.

UHPP has had success following these tips with its enrollment advertising. They’ve also started using infographics/infocharts when reporting new enrollment numbers. Stevenson said this approach is working better in engaging the media than the more conventional press releases they used to put out.

Families USA’s Justin Kolikof answered the question all organizations wrestle with: Is social media worth your effort? Yes. Kolikof shared data showing that social media increases traffic to organizations’ websites, among other benefits.

And the good news is that you don’t have to spend a lot of time on it. 3-5 posts a day are enough. To address capacity challenges, it’s important to plan a strategy where major issues like the purpose of social media, the target audience, etc. is all defined upfront. Determine voice and tone—are you going to be political, just the facts, etc.?

Kolikof shared some guiding tips:

  • Be timely, relevant, and engaging
  • Follow back and interact – RTs (retweets) can be part of your 3-5 tweets per day
  • Be visual
  • Address your audience’s needs
  • Visual content is powerful, resulting in an 85 percent increase in Facebook interaction and 35 percent increase in retweets.

Leah Barber-Heinz said that Florida CHAIN, a small nonprofit with 7 staff, decided a year ago to hire a digital organizer and it’s been terrific. The funders think all this online work is amazing.

CHAIN has been able to initiate campaigns around CHIP, Medicaid, and ACA enrollment.

“Investing in a digital organizer is an opportunity to explain to people quickly what this [complex health policy] all means,” said Heinz

Tips for creating content: build up a bank of photos to use (events are good source, as are friends and family), create design templates.

Do research: figure out what’s working and who is reaching whom (analytics)

Breaking news: we have to always be prepared. Have a breaking news template that lets you share a headline and grab a quote. It’s an effective way to stand out.

Overcoming resistance to social media

Show people all the journalists who are on Twitter – it’s increasingly where journalists sniff out new stories.

When you’re just getting started, do a lot of listening, monitoring, and lurking – take the time to figure out who matters, who can spread the word, amplify your message

There’s no such thing as over-tweeting – because people aren’t on it all the time they don’t have a sense of saturation. Chance of someone being annoyed by seeing a tweet again is low compared with the possibility someone else is seeing it anew.

Measuring performance of your social media efforts

  • Establishing a baseline of how many followers you have
  • Monitor how your activity affects it
  • If I repeated a tweet, used an image, etc., what effect did it have?

1:30 p.m.Senator Sherrod Brown (D-OH)

We just heard from Senator Sherrod Brown (D-OH), a champion for health care, who goes way back with Executive Director Ron Pollack.

Brown assured advocates in the room and nationwide that our hard work has paid off. The passage of the ACA has brought peace of mind to families; no longer do they have to worry about their children getting health coverage.

“Too many kids are on the free-or-reduced breakfast or lunch plan at schools,” Brown said. “That really tells us something about sharing prosperity in our country.”

Brown reflected on the fact that passing both Social Security and Medicare wasn’t easy at the start.

“It’s always difficult to get buy-in,” Brown said. “That’s why it’s so important to see what we’ve done here. Seven hundred thousand people have insurance in Ohio who didn’t have it five years ago. A million seniors have gotten free screenings for osteoporosis and diabetes and other preventive care.”

Senator Brown shared how important where you live can be to your health.

“Your life expectancy is connected to your zip code,” Senator Brown said. This can affect if you have a better or worse chance at life, whether it’s health care, education, etc. Someday, he added, that won’t be the case.

Brown also encouraged advocates to keep up the good fight to extend CHIP funding.

“It’s the smart public policy thing to do, to extend CHIP,” Senator Brown said. “These kids will become healthy young adults who will contribute to society.”

10:45 a.m.The Future of Medicaid Expansions and the Children’s Health Insurance Program (CHIP)

Bruce Lesley, President, First Focus
Mike Perry, Partner, Perry Undem Research/Communication

Watch C-SPAN’s coverage of our Friday program on Medicaid expansion and CHIP.

We just left a fascinating discussion about what messaging works – and what messaging doesn’t work – in persuading conservative voters and lawmakers to support Medicaid and CHIP.

Mike Perry of Perry Undem

First up, Mike Perry shared what his firm is discovering through research in southern states. He talked with conservative voters — precisely the kind of voter and elected official we have to be better at reaching if we’re going to succeed in expanding Medicaid in all 50 states and in renewing CHIP funding. The focus groups definitely helped Perry’s firm improve its ability to persuade voters to support these programs.

Findings so far about Medicaid expansion:

Attitudes may be different in different states. Messaging may need to be different too. For example, in some states, mentioning Medicaid by name is not a good idea.

In these states, it’s hard to find trusted messengers. These voters don’t see the personal relevance of Medicaid to their lives, even when they actually were connected to the program through a family member who benefited.

Even though the debate in some of the states has been intense, most voters were unaware their state has turned down federal money or made a decision about Medicaid.

While there’s a desire to keep these conversations separate from the ACA, advocates must know that it’s difficult to decouple them.

This group is distrustful of the federal government, said Perry: “Whenever the detail was explained that the feds were giving the money to the states, we got into trouble with the voters.”

We must do a better job of educating voters. They still don’t understand Medicaid. More conservative voters think of it as a handout, think there’s a lot of abuse in the program. Bu they think it’s an important program when they learn who benefits from it. More than 70% think so. So these conflicted feelings are present whenever you talk about Medicaid.

They didn’t know how low the eligibility levels are — voters think their Medicaid programs are way more generous than they are. They were surprised to hear that a childless adult would not qualify in most states.

“Coverage gap” is a tough concept no one is familiar with. Lots of misperceptions about what this term means.

Tested “expanding Medicaid” vs. “covering more uninsured” — even though the opposition may be talking about Medicaid expansion, it’s important to talk about it more broadly.

“I’m becoming anti-message the more I do this work. They really want facts. I’m leaving behind value-based messaging and giving them facts.—Mike Perry”

Obstacles to effective messaging

  • Federal government involvement
  • The 10% state share – biggest obstacle
  • Believe their taxes will go up
  • Explaining the 100% federal government funding – voters want to know where the money is coming from in the federal government
  • Do not know Medicaid levels are so low
  • Unaware people have fallen into the coverage gap
  • Do not want another government “handout” program
  • There are few trusted messengers – hospitals not trusted, even governors not trusted in some states (e.g., Virginia)

Opportunities for effective messaging

  • Want to help working families
  • Are surprised Medicaid levels are so low
  • Can be educated about the coverage gap
  • Hearing the money is already earmarked makes them feel they would be foolish to turn it down – use it or lose it. This idea worked well!
  • A hospital fee to cover 10% works well
  • Hearing the expansion could be “cost-neutral” is effective
  • University researchers/economists are considered very trustworthy messengers
  • Talking about economic benefits to the state could help
  • Give sample income ranges of those who are eligible
  • Describe industries they work in
  • Define the coverage gap
  • Noting that states can opt out at any time, that it’s a pilot program, that the money has been set aside by ACA
  • If we do nothing, these individuals will still go to the ER, still get sick, still cost money

Bruce Lesley

While Mike talked about offense, Lesley talked about defense. We’re going to see some budget reconciliation efforts to cut Medicaid.

Medicaid covers immunizations, cancer screenings, and nursing home care. When people hear that these are the types of care that Medicaid covers, they are more supportive.

People are still very populist. As we go into this debate over Medicaid, we have some messages that will resonate.


When you tell people how low the uninsured rate is for kids, they are impressed, and it’s attributable to Medicaid and CHIP.

There are three important dates in advocacy for CHIP: “express lane” eligibility expires in March 2015; we need to extend funding through 2019 by September 30, 2015; provide maintenance of effort (MOE) that protects both CHIP and Medicaid (this expires in September 2019).

Why continue CHIP? Lesley explained that the ACA was designed to sit on top of CHIP and Medicaid. The out-of-pocket costs for kids would go up dramatically if CHIP disappeared.

Once people understand CHIP, support for it grows. The problem is that people don’t really understand it or recognize the name.

Even Tea Party Supporters like it: 66% supported it in one poll.

There’s a gender gap among older voters in terms of supporting CHIP. But among younger people, men support it and even in greater numbers.

In terms of messaging:


  • “economic lifeline” really resonates with people
  • testimonials work
  • target moms, younger women, and Dems


  • compare it to Medicare
  • focus on the government’s balance sheet
  • lump it in with Obamacare

In psychology, if you have people play a game where they can get money or possibly lose money, they are always loss-averse. One powerful message is “don’t gamble with children’s health.”

Immigrant children

The law known as ICHIA (the Immigrant Children’s Health Insurance Act) gives states the option of covering immigrant children and pregnant women through Medicaid or CHIP without having to wait 5 years. This provision may be targeted for repeal.

Best message for defending this provision: Nobody should have to wait 5 years for health care, especially kids and pregnant women.

Q&A Session

What, if any, messaging testing did you do around lawmakers? For Congress, similar messages work. For a lot of these members, they weren’t around for the passage of the ACA or reauthorization of CHIP. They’ve only voted “no” and tried to repeal the ACA. They need to be educated about Medicaid and CHIP and their bipartisan history.

“Don’t assume the lawmakers are that different than voters and know a lot about CHIP and Medicaid. Mike Perry”

How do red state conservatives respond to messaging about the need to keep funds to prevent closure of rural hospitals? Perry said they did discuss this with voters.

It was sort of unbelievable to them that hospitals could fail. “We didn’t have luck talking about hospitals closing their doors,” said Perry.

What are we asking lawmakers to do? We are not in favor of a two-year extension, we want four years (though would love a permanent extension). In 2019, we will have a complete debate about the future of CHIP. There’s some thought there will be some improvements to the ACA by that time, fixing the family glitch, etc. that will enable kids currently covered under CHIP to move to ACA.

8 a.m.Good morning! Welcome to Day 2 of Health Action! We hear some early birds got up and ran around the National Mall this morning.