Accessing care: Advocating for change

Click here to view a general explanation of Advocating for Change

 
Insurance coverage is one of the most important factors in determining whether people can access care or not and yet an estimated 46.6 million Americans are uninsured. 

Reducing the nation's uninsured population and improving access to health care services will require significant health care reform.  There are many groups working at state and national levels that are focused on changing health care policies to improve the health of communities. 

Advocates working on health insurance and other access issues often work on an array of policies.  Such policies may serve to:

• Protect and expand essential programs and services, such as Medicaid and the State Children's Health Insurance Program (S-CHIP),
• Create new programs that can cover populations ineligible for Medicaid or S-CHIP, such as adults without dependent children, and
• Improve the overall functioning and responsiveness of the various public health and health care systems that are involved in providing coverage and care to low-income and working poor populations.

Many advocacy groups focus on preserving health programs for the poor, but maintain an ultimate goal of universal health insurance coverage for all Americans. 

Most efforts toward universal coverage have taken place on the state level, where innovative models of coverage are being tested.

Families USA is a national advocacy organization based in Washington, D.C. that works on behalf of health care consumers to improve access to quality health care. Families USA has been active in efforts to protect and strengthen the Medicaid program by serving as a watchdog over government actions affecting health care.  Families USA has developed detailed reports describing the problems facing health care consumers and possible solutions.  The group also conducts public information campaigns and serves as a clearinghouse for resources, reports, and other information.  Its perspective and access to data can be extremely useful to community-based organizations beginning to tackle local health care issues.

The Children's Defense Fund (CDF) is a national nonprofit organization dedicated to protecting and advancing the overall health and well-being of the nation's children.  With its national office in Washington D.C. and state offices throughout the country, CDF is an important voice advocating for expanded coverage and enhanced services for poor and disabled children and their families. 

CDF's New York office has developed several initiatives to improve access to health care including “Making the Connections.” This effort acknowledges that enrollment in health insurance, while important, does not guarantee that families will get the care they need when they need it. 

Making Connections attempts to document what it takes to actually connect families to health care.  This information is used to inform public policy, so families experience fewer barriers to care. 

In addition to informing and shaping policy decisions, national and statewide advocacy organizations serve a key role by connecting local service providers to important policy debates. 

As mentioned above, these organizations can provide community groups with important data, reports, and other resources that influence local services. 

Since many direct-service organizations lack the capacity to be engage in public policy advocacy directly, connections to national advocacy organizations serve a vital function.

The Asian Pacific Islander American Health Forum (APIAHF) is one example of an organization that works closely with local health care providers to inform both policy and practice at the national and statewide levels.  With offices in both San Francisco and Washington, D.C., APIAHF staff closely monitors legislation and mobilizes constituencies to advocate for the needs of their community.  

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Before you give...  Advocacy aimed at influencing public policy is a challenging approach to health care issues, but can often lead to long-term impact.  It involves conducting research and analysis, forming coalitions and alliances, and creating media and other strategies to draw attention to an issue.  Advocacy also requires careful political analysis to identify potential allies, convincing arguments, and good opportunities for progress, while also clarifying possible objections to reform. 

Policy research and data collection are often the cornerstone of advocacy efforts.  Advocacy organizations can provide donors with helpful data and insight into your own community's health care issues.

Questions to consider before you give:

1. In the case of advocacy efforts, does the group soliciting funds have tax-exempt status? Will the grant conform to IRS rules regarding foundation support? 
2. Does the group have a clear grasp of the issue, the context and possible solutions?
3. Does the group have the facts and other information necessary to advocate for a policy or opinion change?
4. Or will the group be using your support to conduct research and develop a case? 
5. Does the group have a strategy which seems likely to succeed in winning reforms?  Will it have sufficient allies and power?
6. Is the group involving individuals directly affected by the issue(s) in their advocacy or research plans? 
7. Will the effort help to organize, build skills and improve the conditions among those directly affected?
8. What specific outcomes do you believe will result from your contribution?
9. Does the group truly have the skills to organize, market, disseminate findings, speak or testify to policymakers? 
10. What is the group's timeline?  Is it realistic?
11. Having considered the other questions, what is the likelihood of success for the group? Will failure on a particular cause curse the entire venture or might the leadership skills and experience gained make empower the group for the next cause?
12. In addition to grant money, are there other ways you can assist the group in meeting their goals?

You may find some questions irrelevant or have a few questions of your own, not listed here. This list is not meant to be exhaustive. 

Try using the questions as a springboard for lively and respectful conversation between you and a potential grantee. Or as a way of discussing a grant proposal with your fellow trustees, your family or other board members.

Related Reading

Other Ways to Take Action in Accessing care

• 2010 Health Care Reform: SmartLink Breaks It Down

  As a donor, you may be wondering how health care reform will affect individuals and families served by nonprofit health care providers, as well its impact on nonprofit organizations themselves. SmartLink has developed an overview of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act. Consider this summary a starting point. Over time, we will learn much more about how donors and communities can influence the health care for low-income communities.

• A FEW WORDS WITH Atum Azzahir

• Developing new programs

• Organizing for change

• Strengthening community groups

• Tackling immediate needs