unmc.coph.advocacy.2015
TRANSCRIPT
FACTS NEED ADVOCATES
Medicaid Expansion
• If states choose to opt in:– Most residents with income below 138% FPL will be eligible for
Medicaid – Expansion is almost completely paid for by the federal
government. States receive 100% funding from the federal government from 2014 to 2016. The federal share gradually drops to 90% in 2020 where it will remain.
• If states choose to opt out:– Nothing changes– Traditional Medicaid eligibility rules apply
• No expanded eligibility to non-disabled PLWH
Coverage If No Expansion
Very-low income individuals with income below $12,000 (100%
FPL)
Medicaid
Old eligibility rules apply
Very-low income individuals with income between 101-138% FPL
($12,000 - $15,000)
???????????
ACA has no specific guidance since it was
assumed the Medicaid Expansion would be
mandatory
Individuals earning between $15,000 and
$44,000 (138% to 400% FPL)
Purchase private insurance with premium tax credits and cost-sharing subsidies through health insurance
exchange
Exchange essential health benefits process will
determine what benefits they will receive from plans
Why Expand?:Uncompensated Care
What is it?• Health care services provided to patients who
are unable to pay – still must be paid for• Hospitals are forced to shift these costs to
other payers -- typically private insurance companies. - “Cost Shift”
• Increases the overall cost of healthcare• The annual cost of uncompensated care in
Nebraska is over $888 million dollars**Nebraska Hospitals Association
Nebraska Cannot Affordto Opt Out
• $2.3 to $2.7 billion would be returned to Nebraska’s economy*– All that federal money stays in Nebraska – Increase Local Health Jobs and Services– Can’t outsource healthcare
• 50,000 to 70,000 uninsured Nebraskans would gain coverage through this program under the ACA
• The number of uninsured Nebraskans below 138% FPL will be cut in HALF
*Kaiser Family Foundation. Medicaid Coverage and Spending in Health Reform. Online at http://www.kff.org/healthreform/upload/medicaid-coverage-and-spending-in-health-reform-national-and-state-by-state-results-for-adults-at-or-below-133-fpl.pdf
There’s a differenceCommunity Organizing
• Mass emails/letters• Rallies• Organized call days• Lobby Days• Media• Etc.
Government Affairs
• Advocating• Educating• Lobbying• Behind the scenes• Navigating the grey areas• Typically one on
one/small group
Advocacy Jujutsu
Get More vs. Let Me
Get More vs. Let Me
Get More vs. Let Me
Understanding Motivations
Q: What is the primary goal of an elected policy maker?
Understanding Motivations
A: Re-election
Targeting
• Probability of re-election improves with:– Claiming credit for positively perceived policy– Avoiding blame for negatively perceived policy
• Certain groups create electoral feedback– Value laden public images – political mobilization
• Policy Rationales– Rhetoric to define problems and characterize target populations
Donovan, M.C. (2000). Taking Aim: Target Populations and the Wars on AIDS and Drugs, Washington, DC: Georgetown University Press
Policy Windows
Kingdon, J. W. (1995). Agendas, Alternatives, and Public Policies (2nd edition) New York: Harper Collins
8 Rules
8 Rules
1. All Politics are Local– Or why no one can explain a bill like a
constituent
8 Rules
2. Capone Rule– You get more done with kind words and
a gun than with kind words alone
8 Rules
3. Machiavelli Rule– Don’t burn a bridge that you may need
to cross again
8 Rules
4. Bebe Robozo Rule– Always make your friends before you
need them
8 Rules
5. Ronald Reagan Rule– Or why a good story always beats the
facts
8 Rules
6. Animal Farm Rule– All legislators are equal; it is just that
some are more equal than others
8 Rules
7. Norman Schwarzkopf Rule– Make your friends your heroes and they
will fight for you like your heroes
8 Rules
8. Abraham Lincoln Rule– In the long run, legislative battles are
won not in the halls of the legislature, but in communities
Thanks!
Questions?Contact me– 402-552-9260– [email protected]
Visit us online www.nap.org
or on Facebook (Nebraska AIDS Project)