Advocates Can Take Action To Increase Odds of Success

Why are consumer health advocates more successful at improving access to medical care in some states than they are in others?

That simple question was among the driving factors behind a first-of-its-kind study that looked at what factors affect the amount of funding that states commit to expanding or at least maintaining access of their residents to health care. The study's authors said it is an increasingly important question as states take on a growing share of the health care burden.

A report titled “Consumer Health Advocacy: A View From 16 States,” released last month by Community Catalyst Inc., a health-advocacy group based in Boston, concluded that the success of state-based consumer health groups largely depends on a combination of how organized the groups are, how much funding they have, and their state's political environment.

“Consumer advocacy has had a significant impact, both in promoting innovative new health policies and in defending against proposed cutbacks in health coverage and access,” according to the report.

The report was based on more than 200 interviews with advocates and policy-makers in 16 states, as well as reviews of research and health care databases.

Advocates said the report comes at a crucial time as significant aspects of public health policy decision making have shifted from the federal government to the states. In recent years states have taken the lead in tightening Medicaid eligibility and benefits, providing children's health insurance and hospital care for the indigent, and addressing other public-health access issues.

Additionally, the issue of publicly funded health coverage has become increasingly important, the advocates said, as the number of uninsured Americans rose to 46.6 million in 2005, an increase of 1.3 million people over 2004, according to U.S. Census Bureau statistics. Those changes come as efforts to expand health care coverage at the federal level have been stymied by financial constraints.

Focus Must Shift to States

“Taken together, these realities have prompted a focus on states as the place where health policy is most likely to be made,” wrote the report's authors.

Successful efforts to expand public access to health care at the state level are already under way. Recent passage of major public health care coverage expansions in Massachusetts, Colorado, and Illinois were signs that significant policy change is still possible when consumer advocates are actively involved. Health care advocates are also critical to preventing the loss of access to health coverage in states looking for financial savings, as evidenced by recent successful efforts to preserve public health benefits that had been under threat in Mississippi and Ohio.

The report determined that the success of local advocates in raising their own consistent funds is a crucial factor in the scope and success of consumer advocacy efforts in a given state.

“We can give state groups money for specific campaigns, but sustainability after that little bit of money is gone is very important,” Laura Galbreath, director of health care reform at the National Mental Health Association,told Psychiatric News.

Well-Trained Advocates Get Results

The report found that states with “sophisticated advocacy capacity,” such as Illinois and Massachusetts, expanded health coverage for hundreds of thousands of people in recent years. In Illinois, the report authors credited consumer health advocates with enabling 280,000 uninsured adults to obtain Medicaid coverage by getting the state to change eligibility limits. A three-year campaign by consumer health advocates in Massachusetts won affordable health coverage plans for 350,000 low- to middle-income people.

The study found that more people in southeastern states suffer disproportionately with health care access problems than those in other regions. These problems are largely the result of depressed economies, low rates of employer-sponsored health insurance, and strong political opposition to health policies that benefit the uninsured and underinsured, according to the report's authors.

When well organized, however, advocates have improved public health care access even in these states. In Mississippi, advocates mounted a successful campaign to stop an effort that would have terminated the Medicaid coverage of 65,000 low-income seniors and disabled individuals. The public pressure generated by advocates across the state led to a delay in the termination until most of the recipients were eligible for Medicare prescription drug coverage.

The report found that many of the 16 states had well-organized mental health advocacy groups, but, like other state health groups, many are wholly volunteer efforts with minimal budgets or are dependent on staffing and other resources contributed by large organizations or agencies.

Better organization also would benefit other, wealthier states where better public health services might be expected, such as Maryland, but that have“ piecemeal and uncoordinated” public mental health services, according to advocates interviewed in the report. The report cited Maryland's 1996 Medicaid waiver that allowed it to shift those beneficiaries into managed care, but did not include mental health services.

To develop strong and organized “systems of consumer advocacy” in all 50 states and ultimately to influence national health care debates, the report made four recommendations: build advocacy systems in each state based on an assessment of local needs, develop a national program to coordinate state efforts and deliver strategic support, organize issue campaigns within and across states to build momentum for reform, and develop a stronger resource base to support that advocacy.

“With more Americans losing or at risk of losing health security every day, creating strong consumer organizations on the ground level in each state would change the whole tenor and outcome of the health care debate,” said Rob Restuccia, executive director of Community Catalyst.

“Consumer Health Advocacy: A View From 16 States” is posted at<http://cohealthinitiative.org/consumerhealthadvocacy.pdf>.▪