Effective Advocacy for Medicaid

1
Effective Advocacy for Medicaid

• Community CatalystPresentation to
• Association for Community Affiliated Plans
• 2005 CEO Summit, November 15-16, 2005

2
Medicaid Challenges

• Number of uninsured rising employers dropping
  coverage, low wage jobs with no coverage,
  increase in poverty
• Medicaid and SCHIP enrollment have increased to
  address uninsurance
• Increased costs due to
• Enrollment increases
• General health system increases

3
Threats to Medicaid

• Proposed FY06 federal budget cuts and structural
  changes threaten beneficiary eligibility,
  benefits and affordability
• State budget cuts in eligibility and benefits
  have left hundreds of thousands uninsured
• State and federal cuts threaten provider
  stability
• Constituents difficult to organize voice is not
  heard by press and policymakers

4
Lack of public information on Medicaid

• Limited coverage in press, particularly of
  federal budget impact
• State advocacy focused on state cuts and policy,
  less on federal
• Lack of tested, accessible messages for public
• Federal consumer and provider advocacy focused on
  policy and lobbying, not popular education
• State advocacy groups have limited resources
  (some policy and organizing, little
  communications capacity)

5
Support for Medicaid not well communicated

• Polls (e.g. Kaiser national poll Ohio foundation
  poll Missouri hospital poll) show broad support
  of Medicaid
• Policy makers unaware of polls or unconvinced of
  voter support
• Those affected by cuts not well organizedtheir
  stories are not widely communicated
• Ideological opposition to entitlements Medicaid
  described as budget buster in states

6
Medicaid Matters Goals

• Provide more effective materials and messages for
  Medicaid advocacy
• Enhance collaboration among national consumer
  advocates and providers
• Coordination of partners state level advocacy
  for federal Medicaid
• Unify the public messages in support of Medicaid
  

7
Medicaid Matters Communication Strategy

• Messages Understandable, persuasive to general
  public, tested by polling
• Materials high quality graphics not easily
  developed by local groups
• Website to disseminate materials to national
  networks, state groups, providers

8
Medicaid Matters Materials available on Website

• Flyers, postcards, posters, banners, hero
  awards in PDF printer-ready format or in WORD
  for customization
• E-cards to send to elected officials
• Letter to the Editor function
• Dissemination of models
• Advocacy tools
• Medicaid innovations and expansions Use Democracy
  in America service

9
Medicaid 40th Birthday Events

• Opportunity for visibility after federal budget
  reconciliation vote
• 17 states organized events 5000 cards
  distributed
• Medicaid Matters partners assisted state
  advocates with strategy and materials
• Focus on states with moderate Republicans (e.g.
  Oregon, Rhode Island, Maine, Pennsylvania)

10
Medicaid Birthday Event Oregon

• Press conference at Rehab center
• Sponsors CareOregon , Oregon Center for Public
  Policy, Oregonians for Health Security, United
  Seniors of Oregon, Oregon Association for Retired
  Citizens, and Save Oregon Seniors
• Celebrated Medicaid
• Distributed birthday postcards for Senators

11
Other Medicaid Matters support for state advocacy

• Regular alerts and updates on federal budget
• Flyers, cards and banners customized for specific
  states
• Publicize highlights on Medicaid Matters in
  Action page
• Medicaid Matters Hero award to Senator Ted
  Kennedy
• Public news service stories on Medicaid initiated
  by advocates in Colorado, Minnesota, Iowa,
  Washington
• Op Eds and Letters to the Editor examples
• Oregon customized Medicaid Matters materials

12
Future Opportunities for Medicaid Matters project

• Targets
• Katrina disaster relief support
• Impact of final FY06 federal budget on next state
  budget cycle
• Collaboration Expand opportunities for advocates
  in states with progressive delegations to impact
  federal decisions
• New Methods
• ACAP members engage members and provider networks
  (health centers and physicians)

13
Massachusetts Advocacy for Medicaid and Health
Reform 05

• KEY POINTS
• Big Picture 3 Problems
• Access, Costs, Quality
• MassHealth Significant Holes
• Health Reform 4 plans
• Governor Romney
• Senate President Travaglini
• Speaker of the House DiMasi
• MassACT! (Affordable Care Today coalition)

14
MassHealth Problems

• MassHealth Essential capped
• 9000 on waiting list
• Potential caps for HIV, CommonHealth,
• 7,000 legal immigrant adults dropped
• Adult Dental Care, Dentures, Eyeglasses still not
  available
• Restoration for pregnant women and new moms not
  implemented
• Limited eligibility for childless adults

15
Fixing MassHealth MassHealth Defense Group
Goals

• Repeal caps, open enrollment
• Requires state appropriation, federal permission
• Restore Immigrant Eligibility
• Restore Benefits
• Expand Eligibility
• Pool concerns, also

16
MA Senate Health Reform Proposal 05

• Lower individual coverage costs through
  reinsurance, less mandates
• Lower small group costs through expanding
  Insurance Partnership
• Free Rider Surcharge - assess firms who dont
  offer coverage when workers use Pool
• No new revenue

17
Governor Romney Plan 05

• Commonwealth Care Reduced-cost (reduced
  benefits) insurance for individuals and workers
  in small businesses above 300 of poverty
• Safety Net Care sliding subsidies for those
  below 300 of poverty.
• Individual Mandate everyone must have coverage,
  or face tax penalties
• No new revenue

18
MA House Plan 05

• Insurance Market Reforms
• Subsidized insurance for those under 300 FPL.
• MassHealth Expansion
• Enhanced MassHealth provider rate payments
• Individual mandate
• Employer contributions
• Reduction of Racial and Ethnic Health
  Disparities
• Health Safety Net Fund.
• Funding Federal matching dollars employer
  contributions tobacco settlement funds

19
MassACT! Plan

• Access
• MassHealth eligibility increase (200 adults,
  300 kids)
• Moderate income subsidy (200 - 400)
• Employer responsibility assessment for workers
• Costs MassHealth provider increase
  small/non-group reform small business subsidies
  increase
• Quality State Cost/Quality Council chaired by
  Governor
• Financing
• Existing public resources (1.1 billion)
• New federal revenues
• Employer/employee payments
• New tobacco tax 50 cents other taxes