Saving the Affordable Care Act
April 21, 2017
That was a close one. Twenty-four million Americans get to keep their health coverage — for now. Grassroots pressure undoubtedly influenced the decision of Speaker of the House Paul Ryan and the White House to pull the Obamacare repeal bill, but winning the first round of this battle is not grounds for complacency. Indeed, now more than ever, Americans need a robust political movement in support of affordable health care for all.
In the end, the American Health Care Act (AHCA), as the bill was called, failed because Republican members of the House who wanted to dismember the Affordable Care Act (ACA) could not agree among themselves how to do that. Ordinary Americans also were fortunate to have powerful stakeholders such as the American Hospital Association and American Medical Association on their side. There is no escaping the fact, however, that Republicans gained control of both chambers of Congress and the White House in the 2016 election by promising to repeal the ACA.
This makes the conspicuous lack of consumer-focused nonprofit organizations focused on health and policy all the more troubling. The situation is in stark contrast to the corporate healthcare sector, which spent $509 million in 2016 lobbying the federal government on behalf of drug makers, hospitals, providers, and insurance companies. In addition, most health nonprofits focus on a particular area of health care, such as insurance coverage or wellness or mental health, which contributes to the field's inability to build a unified movement for more affordable and accessible care.
Against this backdrop, foundations have an opportunity to tilt the scales. In Colorado, thanks to the foresight and funding of a large foundation, we have a model that's working for residents of the state — and could, I believe, work for all Americans. Among other things, it recognizes that legislative battles are won by numbers — especially, dollars and votes. And while to date there hasn't been a funded mechanism to unify ordinary consumers of health care around an overarching goal (leaving corporate lobbyists in the driver's seat when it comes to debates about access and affordability), there is hope.
Healthier Colorado was seeded by the Colorado Health Foundation and launched nearly three years ago as a 501(c)(4) organization with the belief that improvements in public health depend, to a significant degree, on robust investment in public policy advocacy. To that end, we hired professionals with grassroots organizing, political fundraising, and lobbying experience. Our investment has paid off. In just over two years, Healthier Colorado has mobilized an unprecedented seventy-five thousand supporters, who in turn have influenced policy makers to:
- include more robust physical activity and nutrition standards in the state's childcare centers;
- adopt new rules that promote vaccinations in schools; and
- secure the second voter-approved sugary drinks tax in the nation.
Two key strategies have been critical to that success:
- deploying the full range of legally available advocacy tools to engage with policy makers on health policy issues; and
- strengthening the position of health advocates in the state by working alongside and supporting them with collaborative outreach campaigns.
We can accomplish only so much, however, within the confines of a relatively small state like Colorado. What we really would like to do is to combine forces with organizations across the country that have a similar orientation and capabilities. As outlined in our recent white paper, here's what that might look like:
Eliminate issue silos. People who work in the field of health policy know how interconnected the various factors and determinants affecting Americans' health are. And yet, people who work in the health policy field tend not collaborate as much as they could, or should. Few of us talk about the work of our colleagues collectively as constituting a movement. Yes, the Robert Wood Johnson Foundation has made a great start with its "Culture of Health" initiative, but it's up to the rest of us to take it to the next level.
Figure out how to communicate with the public. "Liberating" our colleagues from their "issue silos" will require lots of hard work. But so, too, will communicating those efforts to the public. Connecting issues as disparate as pedestrian infrastructure and Medicaid policy for the average American is neither straightforward nor simple. We need a bigger investment in communications research and outreach if we are to successfully convey how health and well-being are linked to food deserts, criminal justice policies, and built environments and physical infrastructure.
Create opportunities for activism and expression. By definition, movements are participatory and experiential. (Think Melissa McCarthy trying to save the world in Kia's Super Bowl commercial). And forums for expression are the oxygen of movements. We need to create more ways for Americans to participate in this movement for health.
Build an infrastructure that gives ordinary Americans an effective advocacy voice. Healthier Colorado is actively working with foundations and nonprofits in other states interested in adopting and adapting our model. We also are engaged in conversations to create a national organization. This is no small project. It will require intra-organizational cooperation and a willingness to step outside one's cultural comfort zones. However, there is experience from which we can draw in taking on these tasks. Many lessons were learned from the creation and early life stages of Healthier Colorado, and practices from other issue sectors can be applied to the effort as well. Many of these lessons are shared in our white paper, as well as in a forthcoming white paper from the Colorado Health Foundation.
The American public rarely has been as focused on the details of health policy as they are today, making this an opportune moment to mobilize a movement around the belief that every American deserves the chance to lead a healthy life. Funders nationwide control the resources that can turn this opportunity into reality. It is time to give regular Americans a seat at the table in shaping health policy.
Jake Williams is executive director of Healthier Colorado.