Talking About Health Reform

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Talking About Health Reform

• a presentation by
• Herndon Alliance
• Columbia, Missouri
• June 13, 2008

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Why are we all here?We want guaranteed quality
affordable health care for all.
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Outline for today

• Introduction to Herndon Alliance (HA)
• Maximizing your impact
• Research and polling findings
• Communications strategies
• Practical applications

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Things to think about

• How can the findings influence your work to help
  move reform in Missouri?
• How can the findings influence your collective
  work around common strategies to move reform in
  Missouri?
• How can you apply this information (for example
  to specific plans such as in Cover Missouri)?
• Who are you/will you be speaking to (membership,
  public, legislators, media)?
• What are the challenges and opportunities in
  Missouri?
• What findings are most surprising or might be
  difficult to put into action?

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Introduction to HA
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Americans speak out

• More than 80 of American say we need a better
  health care system.
• More than 60 agree that health care is a
  fundamental human right.
• The issue of health care reform is a top domestic
  issue for voters.

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Health care plans erode support
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Why we began

• For years, the base of support for health reform
  has remained at about 15.
• Our need to broaden the reform base so we can
  consistently count on 50 support.
• One piece of the puzzle tied to our ability to
  talk about health reform in ways that would
  resonate with the public, rather than shut them
  down.

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What Herndon does doesnt do

• Provides findings on the values, attitudes and
  beliefs of the American voters relating to health
  care reform
• Provides communications and messaging strategies
  and resources
• 
  
• While it is easier to apply HA findings to some
  advocacy agendas, we dont advocate for specific
  policy initiatives. Local political realities and
  needs are fundamental issues determining which
  policies you decide to support. Our goal is to
  help you talk about all of the issues that the
  public might be engaged in and learn some ways to
  avoid barriers and build a broader base of
  support.

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Who is the Herndon Alliance?

• 150 national, state and local partners
• -Advocacy, faith, labor, minority, small business
  and provider groups
• All support vision and goal
• -Build a health care system that provides
  quality, affordable healthcare for all
• -A unified approach to talking about reform
• All support reframing the health reform
  discussion so that it speaks to the values and
  beliefs of the voting public.

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Our Work Research and Communications

• Research Understand values and beliefs about
  health care
• Opportunities and barriers
• National Communications Encourage partners to
  communicate and work together
• State Communication Support
• Best information available
• Strategy
• Skills

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Our research and process

• Identify and understand the values and beliefs
  about health care and reform held by American
  voters
• What helps people listen vs. closes them off
• What are the barriers to reform and how to
  overcome them
• Is there a reform concept that resonates with the
  public
• What stories and narratives connect with the
  public?

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Who are the voters?

• 94 of voters in 2006 were insured. Of those,
  15 are part of the health care base and 79 are
  swing voters.
• Women and seniors are the most attentive voters
  on the health issue.
• SEIU/AHC polling by Lake Research Partners,
  November 2006

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We started with the values of the health justice
base . . . . and found connections to swing
voters

Base(15) Support health care for all and taxes
to support it Its immoral not to insure
everyone. Values responsibility primacy of
the family and national pride
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The Moderate Middle an important constituency




Moderate Middle Americans (40 of electorate)
Values personal responsibility everyday
ethics and national pride In America,
we can do better but people have to take
personal responsibility.

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Marginalized Middle-Agersanother important
constituency

• (15 of electorate)
• looking for help and status

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Maximizing Your Impact
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ABCs of Communicating

• Know your audience
• Where they presently are in their thinking (not
  where you wish they were)
• What they believe, value, want, need, and fear
• Remember values and beliefs outweigh facts
• Connecting with people counts more than winning
  an argument

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Connecting with people vs. winning an argument

• What? TV interview with senatorial candidates
• Topic? taxes
• Democrat lengthy statement establishing a rock
  solid case for raising taxes
• Republican Heres the difference. You see
  taxes as a revenue stream. I see taxes as taking
  money out of hardworking constituents paychecks.

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Can be done effectively

• Jan 23, 2007
• Senator Jim Webbs (Virginia) response to
  President Bushs State of Union address
• When one looks at the health of our economy,
  it's almost as if we are
• living in two different countries. Some say that
  things have never been
• better. The stock market is at an all-time high,
  and so are corporate
• profits. But these benefits are not being fairly
  shared. When I graduated
• from college, the average corporate CEO made 20
  times what the
• average worker did today, it's nearly 400 times.
  In other words, it takes
• the average worker more than a year to make the
  money that his or her
• boss makes in one day.

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Raising the bar

• Opening the dialogue raises the bar for all.
• Americans want to do better you can help people
  expand their thinking by connecting to their
  values rather than shutting them down with fear
  based facts.

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What the Research Tells Us The Values Beliefs
of the American Public
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Health care is a core value

• Linked to
• The pursuit of the American Dream and middle
  class aspirations
• Our countrys destiny
• Our familys well-being and future
• Voters talk about health care in moral terms yet
• reform as a moral issue is insufficient to move
• voters.

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Health care is personal

• Voting America is largely insured. With any
  health reform package, voters are fearful and
  worry about what they might lose.
• Cost and affordability Who will pay?
• Quality What will I lose? Will I get less for
  more?
• They see a role for something beyond market
  forces to ensure affordable access.

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Choice control

• Voters need to be reassured that they will have
• Choice of plans they can afford
• Choice of their doctors
• Guaranteed health coverage
• A plan (public or private) that will provide a
  standard comprehensive package of benefits.

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Security peace of mind

• Voters, especially women, want affordable health
• care they can count on and that mirrors both
  lifes
• transitions (birth of children, job changes,
  part-time
• and full time work, major illness, divorce,
  relocation,
• early retirement) and economic transitions
• (outsourcing, mergers, buyouts).

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Channel publics anger not fear

• Fear makes voters more self-protective and less
  willing to support change
• Anger moves people to action
• To reassure voters
• - keep doctors
• - have more control over health care
• - affordable coverage with guarantees and
• choice of coverage

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What angers voters

• Denials of coverage for pre-existing conditions.
• Voters want to rein in the greed of insurance
  companies, force them to treat people fairly, and
  hold them accountable.
• High costs, lack of affordability drug costs,
  rising co-pays, higher premiums

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Personal shared responsibility

• Voters believe everyone should have access to
  quality, affordable health care, but dont want
  to pay for those they perceive as being
  undeserving.
• Government, providers, employers, individuals
  should all be part of the solution

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Voters want an American solution

• See a role for something beyond market forces to
  ensure affordable health care access.
• Skeptical of a government run program, even as
  they acknowledge the failures of the private
  insurance model.
• See a role for government as watchdog.
• See a role for a non-profit agency to administer
  a public plan.
• Believe Medicare has problems, even though they
  support it, and are wary of using it as a model
  for future reform.

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Small business--an American icon

• Concerned about impact of health care reform on
  small business.
• Support discounts and sliding scales to help
  small businesses afford coverage.
• Want to hear directly from small business owners.

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Issues that block voters support of health
reform

• Cynicism about government bureaucracy.
• Higher costs and higher taxes.
• Scarcity loss of quality.
• Undeserving people.
• Impact on small business.
• Ability of powerful interests to block action.

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What the Research Tells Us Moving Beyond the
Barriers
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Speak directly to the beliefs and values of
Americans

• Take the offense take ownership of debate.
• Develop a health narrative that fits in with an
  overarching progressive narrative.
• Unblock altruism.
• Emphasize security, peace of mind, choice, and
  control.

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Personal responsibility

• Voters must clearly hear a central place for
  personal responsibility in a plan
  corporations, parents, individuals taking
  responsibility.
• Sliding scale works everyone pays something.
• People who work hard, play by the rules and pay
  taxes should have access to quality health care.
• Once their need for others to demonstrate
  personal responsibility is met, people become
  more generous.

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Choice, control, quality

• People want to make their own choices of doctors,
  tests, specialists, drugs, second opinions. They
  believe that choices are being reduced by
  employers, HMOs, and insurance companies. Keeping
  your doctor and the option of keeping your
  current plan is important, especially to women.
• People want more control over what they perceive
  to be an increasingly arbitrary system driven by
  greed.
• People are concerned that the public plan will
  be lower quality. They should decide plan not
  employer.

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Preventive care as stepping stone

• Common sense investment.
• Prevention encourages personal responsibility.
• A potential escalator when included people often
  embrace offering treatment.
• Provides acceptable role for government.
• Wellness does not test well.

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Emphasize an American solution

• Americans feel their needs are being neglected.
• They want a uniquely American solution to reform
  our health care system.
• They believe American ingenuity will produce the
  best approaches and model.
• Voters want concrete solutions with doable steps
  to make health care affordable and available.

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Give voice to small business

• Voters want to hear directly from small business
  owners and hear how reforms will impact them
• Needs to be a voice they can connect with and
  believe

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Address concerns about scarcity

• Voters are concerned that if everyone has access
  to health care, there simply wont be enough to
  go around. Doctors, support staff, hospitals, and
  clinics will be overwhelmed and quality will
  suffer.
• It is important to communicate that a reform will
  actually relieve the burden on emergency rooms,
  will simplify and standardize insurance coverage,
  and make it easier for people to get the
  preventative care they need, reducing more
  extensive/expensive treatment.
• System changes

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The role of government

• Embrace government as a watchdog and regulator.
• Worry about the bureaucracy and costs associated
  with government run programs.
• Prefer a choice for coverage be an independent
  public plan.
• Remind people of the bureaucracy, greed and
  profits, and high costs of our current private
  insurance system.
• Redirect concerns about government back to anger
  at the status quo.

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Cost affordability

• Main concern is affordability for me and my
  family
• Cost control will result in my care being cut
• Believe there is waste in the system, but worry
  about plans to reduce waste. Unsure if
  competition will help.

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Guaranteed Affordable Choice

• Guaranteed affordable health insurance
  coverage for all with a choice of private or
  public plans that cover all necessary medical
  services, paid for by payroll taxes on employers
  and individuals on a sliding scale based on
  income.

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Guaranteed Affordable Choice Focus Group
Language

• Americans guaranteed to have a choice of health
  plans they can afford, either from a private
  insurer, or from a public plan offered at a
  sliding scale cost based on income.
• To maintain quality and allow fair cost
  comparisons, health insurance companies and the
  public plan would be required to provide a
  standard, comprehensive package of benefits,
  including preventive care and all needed medical
  care.
• Employers would be required to offer a choice of
  the public plan and at least one private plan to
  all employees, including part-time employees.
• Employers and individuals could choose to keep
  their current health plans or one that offers
  more coverage beyond the standard plan, but all
  plans private or publicwould have to cover at
  least the standard package of benefits.
• The cost to employers would be 8 of payroll,
  with discounts for small businesses. Employees
  would pay 4 of their paycheck through a payroll
  deduction. This would pay for all of their
  health care, including their dependents, with no
  additional premiums and no deductibles.
• No private or public insurer could deny coverage
  or charge higher premiums to people with
  pre-existing conditions.
• Illegal immigrants would not be eligible for the
  plan.
• Costs would be controlled by competition between
  the plans, and by using a nationwide pool to
  negotiate lower prices within the public plan.

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Guaranteed Affordable Choice Focus Group Insights

• Generally speaking, voters like the concept of
  Guaranteed Affordable Choice. They are upset
  about the greed of private insurance and
  pharmaceutical companies and they are ready for
  an alternative, even as they fear losing what
  they have.
• Voters think the 4 payroll deduction and sliding
  scale to pay for the plan are fair and
  reasonable. They want employers to pay more than
  employees.
• People are concerned about the impact on small
  business discounts are important and some are
  confused about coverage for multiple family
  members.
• Voters tend to perceive a public plan as inferior
  and need reassurance that they will have a choice
  and wont be dumped into a public plan. Once
  they have that reassurance, they like the
  guarantee that they will always have health
  coverage, and knowing that all plans have to
  provide a comprehensive package of benefits.
• Voters like the idea of having the public plan
  administered by a more independent agency rather
  than the government.

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Key Survey Findings

• Voters continue to support providing affordable,
  quality health care for all Americans even if it
  means raising taxes or a major role for the
  federal government.
• A strong majority of voters favor Guaranteed
  Affordable Choice (GAC), and voters prefer it to
  other health care reform alternatives tested like
  HSAs or a single payer plan.
• That insurance companies couldnt deny coverage
  to people with pre-existing conditions is the
  strongest-testing component of GAC.
• However, voters believe their taxes and costs
  will go up regardless of what is proposed.
• In head-to-head debates on key aspects of GAC,
  including costs, bureaucracy, and insuring the
  illegal immigrants, a plurality side with the
  opponents arguments over those defending GAC.
• Despite this, voters consistently and strongly
  support GACeven after they hear tough criticisms
  of the plan.
• Voters prefer paying for health care through
  their employers, with
• an employer contribution or through a very
  progressive income tax

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When asked head-to-head, voters prefer Guaranteed
Affordable Choice to other plans by about 3 to 1
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Text of GAC, HSA, Tax Credits, and Single Payer
Plan

• Guaranteed Affordable Choice language
• An approach that would guarantee affordable
  health insurance coverage for every American with
  a choice of private or public plans that cover
  all necessary medical services, paid for by
  employers and individuals on a sliding scale.
• Health Savings Account language
• A Health Savings Account program that would
  provide tax-deductible savings accounts to all
  Americans if they purchase a private insurance
  plan with at least a thousand dollar deductible.
• Tax Credits language
• An approach that would provide tax credits that
  will reimburse individuals and families for 25 to
  50 percent of the cost of their private health
  insurance policies.
• Single Payer language
• A single government-financed health insurance
  plan for all Americans financed by tax dollars
  that would pay private health care providers for
  a comprehensive set of medical services.

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NarrativesTelling the story

• These messages represent ways of turning the
  language of policy experts and think tanks into
  the language of the kitchen table, so you can
  talk with people in an honest, emotionally
  compelling way about the choices they have as we
  reform our health care system.

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Narratives that work

• We are all in this together
• I believe that people who work for a living
  ought to be able to take their kids to a doctor,
  and people who are retired, ill, or temporarily
  out of work shouldnt risk losing their life
  savings because of an illness.

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Narratives that work

• Wont this create a big bureaucracy?
• Channel everyones shared anger over everyday
  issues relating to health care
• If you want to see what bureaucracy and red tape
  look like, try reaching a person on the phone the
  next time you call your own insurance company,
  and try getting them to explain why they wont
  pay 800 of some medical treatment your doctor
  ordered. We need leaders willing to take on the
  insurance companies, by setting clear, high
  standards for whats covered, preventing them
  from requiring patients to jump through hoops
  just to get insured, and saving billions by
  cutting administrative costs and moving to
  electronic medical records. We need leaders who
  will hold insurance companies accountable,
  guaranteeing us all more choices, better care,
  and no more of those 45-minute phone-calls to the
  insurance company. And if we stopped wasting
  doctors time with paperwork so they had more
  time for patients, and stopped forcing people who
  used to have insurance into emergency rooms for
  basic care, we wouldnt have to worry about
  overloading our system.
• Mean rating 68
• Real reform means putting government to work
  for taxpayers again, not for special interests,
  by requiring insurance companies to put more
  money into patient care and less into efforts to
  deny it. It means preventing insurance companies
  from excluding patients because of pre-existing
  conditions and overriding doctors decisions
  about what their patients need.

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Narratives that work

• Wont this cost me too much?
• Middle class Americans are having a harder time
  making ends meet, and we need to cut both their
  taxes and their health care costs. If that means
  cutting the profits of insurance companies and
  requiring big businesses to contribute to the
  health insurance of their employees, my sympathy
  is with people who work for a living. Health
  care premiums have nearly doubled for the average
  family in the last seven years at the same time
  as insurance company profits have more than
  doubled, and if we dont do something now, our
  costs will double again. And thats not even
  counting the billions we already pay in federal
  and state taxes for expensive emergency room
  visits for people with no insurance who end up
  driving up costs because they dont get
  preventive care. Its time to put some money back
  in the pockets of working Americans and give them
  peace of mind about the health of their families.
  Mean rating 71

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Immigration health reform

• The illegal immigrant question in relation to
  health reform raises some or serious doubt with
  69 of voters.
• The reach of the attack is broad. Voters in the
  South and Mountain regions, women, and those with
  Medicare most likely to respond to this issue.
• Angry that those they perceive as illegal
  immigrants have broken the law and dont deserve
  services.
• Side-tracks focus from reform

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Messaging on immigration health reform

• Voters see the health care problem as more urgent
  that the immigration issue.
• Immigration is an important issue and there
  are a lot of questions about the best way to
  approach it. But health care is a big problem for
  us now. We cant let the immigration issue divert
  us. We need to make sure you and I are getting
  quality, affordable health care.
• Messages on the public health theme and
  compassion do not resonate as well with voters.
• Need more research on how to bring all immigrants
  into a health reform plan.

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Economic downturn and health reform

• Health care and the economy are linked in voters
  minds
• Americans believe there is a strong and direct
  link between improving the current economic
  situation and health care. In fact, Americans say
  making health care more affordable should be
  the number one priority to help improve the
  current economic situation for the average
  American.
• (Robert Wood Johnson Foundation National Survey
  Results, April 2008)

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Economic downturn and health reform

• Paying for health care is a top economic concern
  for American families and is affecting their
  ability to pay other bills.
• When asked what types of problems they were
  experiencing as a result of the economic
  downturn, paying for health care health
  insurance ranked in a statistical tie for second
  along with job issues, behind paying for gas.
  More people reported serious problems paying for
  health than paying for food, rent or mortgage,
  credit card debt, or stock market loses.
• (Kaiser Health Tracking Poll, May 2008)

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Economic downturn and health reform

• Voters (especially independents) are more
  interested in reducing costs than expanding
  coverage.
• In reforming the health care system, nearly 7
  out of 10 Americans think making health care
  more affordable is the priority the country
  should focus on first, over covering more of the
  uninsured (nearly 3 out of 10).
• (RWJ Foundation, National Survey Results April
  2008)

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Economic downturn and health reform

• The health care crisis is affecting working
  people like them.
• For roughly a decade, a majority of Americans
  believed the uninsured to be unemployed people.
  In contrast, for the past two years a majority or
  plurality of Americans believe the uninsured are
  employed people.
• (RWJ Foundation, National Survey Results April
  2008

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Messaging on economic downturn health reform

• Health care costs are second only to gas prices
  when it comes to what we worry about most when
  paying our monthly bills. We want and deserve a
  health care system that allows hard working
  people who pay taxes the security and peace of
  mind to provide quality and affordable health
  care for themselves and their families.

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What next?

• Deeper dive into immigration
• -Now have strategy to divert attention
• -Need strategy to include all people
• Economic downturn and health more messaging
• Making health system more efficient and
  effective.
• The importance of state work on national health
  reform

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