Talking About Medicaid – Connecting with the Public

Professor writing on whiteboard in classroom

MEDICAID DEFENSE MESSAGE GUIDANCE

 Talking About Medicaid — Connecting with the Public

1.  Tell a Values-Based Narrative:

America thrives when we create shared prosperity, strengthen working families and treat all people with dignity and respect.

2.  Relate this Narrative to Health Care Security:

Access to secure and affordable health care for working families and small businesses helps  families stay strong, businesses grow, communities be more robust, and create a brighter future for our kids.

3.  Then Focus on Medicaid—First Put a Personal Face on Medicaid

Medicaid provides care for seniors, disabled people, children, and hardworking people who are facing difficult life transitions. (select one or two of the following)

  • Medicaid helps our parents and grandparents stay in their homes or cover them if they need to go into a nursing home.
  • Medicaid assists our loved ones and friends who are disabled live independent lives.
  • Medicaid means all children can see a doctor when they need to.
  • Medicaid means hardworking people don’t have to worry about falling through the gap.

4. Then Describe Medicaid as Successful

Medicaid is a smart investment. (select one or two of the following)

  • Cuts to Medicaid will hurt our economy and the health and security of working families.
  • States with expanded Medicaid show a striking decline in mortality. Having access to healthcare does make people healthier and more productive.
  • Medicaid is less costly – 20% less – than private insurance due to less administrative costs and effective bargaining.
  • Medicaid spending grew slower (2007-2010) than private health insurance premiums.
  • Medicaid enables families and small businesses to afford health care.

5. Concluding Remarks/Response to Budget Cut Attacks

Americans living paycheck to paycheck while striving to build a better life for themselves and a brighter future for their children want leaders who represent all people, not just the wealthiest few. No hardworking American should fall through the gap. Don’t cut Medicaid so high income people can get a tax break.

6. Two Key Public Audiences

Latinos:  While supportive of Medicaid and the ACA, Latinos (especially Spanish-speaking and non-college educated women under 50), become much more supportive once informed on how it affects them, their families, and their community. Example of language to use:

We want to make sure our young people have a fair start in their work lives, people working in jobs without insurance have the availability of affordable insurance, and older people have care for their health conditions before they’re eligible for Medicare.  Medicaid helps our community and families to be stronger and our kids to grow up healthier. Soon new Medicaid coverage will be available in (State) that will provide affordable care for many who don’t now have access.  Young and old people will be able to get preventive services, care for chronic conditions, and medicine. We’ll be able to get coverage when between jobs or starting a small business.

Single Women: Single women are uniquely vulnerable to economic challenges and worry about falling through the ‘gap.’  About a quarter of single women are uninsured; unemployed single women increased by 40% last year. Example of language to use:

Our country and our families thrive when we have a strong middle-class. But today working people, especially women, are being crushed financially and worry that they will fall through the gap. Health care costs and security are a big part of the problem. Medicaid gives Americans an opportunity to get affordable coverage, preventive services, and economic security against an accident, illness, or job loss. Budget cuts to Medicaid threaten seniors living in nursing homes, those with disabilities who receive care allowing them to live more independent lives, and children to see a doctor when they are sick. Governor [XXX’s] refusal to expand Medicaid would deny health coverage to millions of vulnerable families, many headed by women. It’s wrong when a country like the US denies decent, affordable healthcare to the hardworking people. It would be more effective and a better investment   to reduce health care costs by reducing the effects runaway greed has had at every level of our health economy.

NOTE: The defense of Medicaid needs to bridge to our Medicaid expansion discussion. This overlap is done by centering the discussion on working families and small businesses.

Community Catalyst Draft

Audiences: Supporters of Medicaid

 I.  Leadership

VALUE: Protecting Medicaid

We must protect Medicaid, a program that provides long-term care to millions of seniors, helps people with disabilities live independently, and enables children see a doctor.

  • Nationally, NUMBER Americans receive health care coverage and other vital services through Medicaid.
  • As you know, in STATE, that means NUMBER of your constituents get the health care they need, including NUMBER seniors, NUMBER people with disabilities, and NUMBER children.

BARRIER: Not worth the political capital

Without your leadership, opponents of Medicaid will use the debt debate to make cuts that will harm millions of Americans, including the residents of STATE, your constituents.

  • Reducing the deficit is important, but too many of the current proposals put the health and economic security of millions of Americans at risk.
  • [If ACA champion] – Federal cuts to Medicaid embolden our opposition in STATE and undermine our ability to make the case for effective ACA implementation, including Medicaid expansion.

ASK: Don’t cut Medicaid

We’re counting on you to stand against threats to Medicaid.

  • Voters are with us on this – a recent Quinnipiac Poll found that 70 percent oppose any cuts to Medicaid spending.
  • Medicaid is an extremely efficient health insurance provider: 96% of all money spent on Medicaid goes to actual care, not program administration. That means when Medicaid is cut, it’s not ‘overhead’ that’s cut, it’s the care STATE children, seniors, and people with disabilities rely on.

VISION:

By taking a stand today and protecting Medicaid, you’ll be caring for the most vulnerable among us.

II.  Don’t shift costs to states

VALUE: Fiscal health of their state

We need to safeguard STATE’s fiscal health during the fiscal cliff negotiations. At a time when state economies are fragile and slowly beginning to recover, drastic federal action would send the wrong message.

BARRIER: Belief that states won’t be affected

We are hearing from policymakers in our state – loud and clear – that any move to cut Medicaid will impact their ability to move forward on other key priorities, such as expanding the Medicaid program under the Affordable Care Act and protecting other important social services in STATE.

  • Shifting costs to states is not the answer, and it will force state policymakers to make drastic and harmful cuts.
  • Instead of paying for their care in a cost-effective way, STATE will pay for it through more uncompensated care – like more costly emergency room visits for people who lose access to primary care providers. This causes economic stress for hospitals and providers who would normally be paid by Medicaid dollars.
  • [If ACA champion] – Federal cuts to Medicaid embolden our opponents in STATE and undermine our ability to make the case for effective ACA implementation.

ASK: Don’t cut Medicaid

We’re counting on you to stand against any threats to Medicaid.

  • Medicaid is an extremely efficient health insurance provider: 96% of all money spent on Medicaid goes to actual care, not program administration. That means when Medicaid is cut, it’s not ‘overhead’ that’s cut, it’s the care STATE children, seniors, and people with disabilities rely on.
  • Voters are with us on this – a recent Quinnipiac Poll (December 2012) found that 70 percent oppose any cuts to Medicaid spending.

http://www.quinnipiac.edu/institutes-centers/polling-institute/national/release-detail?ReleaseID=1821

VISION:

When we protect Medicaid, we protect STATE’s budget and states will know that they have a strong partner in the federal government.

Federal Medicaid Defense Messaging

Audience: Proponents of cutting Medicaid as part of fiscal cliff/deficit reduction plans

I.  ECONOMIC/WORKER FRAME

VALUE: Healthy people are productive people 

A strong economy depends on a productive workforce. When people have health care coverage they can stay healthy and be more productive on the job.

  • Access to health care coverage keeps businesses strong and working STATEians healthy by ensuring that they can see a doctor when they get sick.
  • Health security and economic security go hand in hand

BARRIER: Cutting Medicaid won’t affect our economy/is viable solution to deficit

When your constituents can’t get health care coverage through their jobs, they need a proven solution like Medicaid. Cutting Medicaid would threaten the economic security of thousands of STATEians, leaving them one accident or illness away from financial catastrophe or losing their job because they can’t afford medical care when they need it.

  • In STATE, NUMBER people receive health care coverage through Medicaid, including working families, seniors, and children with special health care needs.
  • Stats on the connection between medical debt and financial crises (credit card debt, foreclosures and bankruptcies)
  1. Forgoing recommended follow-up care, not filling prescriptions, and delaying physician or specialist care when medical problems arise are all commonly reported behaviors among families carrying credit card debt; also, just under 75 percent of families that lost coverage due to unemployment reported using one of these strategies to keep costs down. M. Doty, S. Collins, R. Robertson, and T. Garber. “Realizing Health Reform’s Potential: When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help.” The Commonwealth Fund, August 2011.
  2. A survey found that medical bills and unemployment were among the leading contributors to credit card debt for low- and middle-income families, with 55 percent of survey respondents with poor credit citing medical debt as a contributing factor. A. Traub and C. Ruetschlin, “The Plastic Safety Net: Findings from the 2012 National Survey on Credit Card Debt of Low- and Middle-Income Households,” Demos, May 22, 2012.
  3. Carrns, “Medical Debt Cited More often in Bankruptcies,” New York Times, Aug. 8, 2011. See also D. Himmelstein, E. Warren, D. Thorne, & S. Woolhandler, “Illness and Injury as Contributors to Bankruptcy” Health Affairs Web Exclusive, Feb. 2, 2005; and Christopher Robertson, Richard Egelhof, & Michael Hoke, Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures, Harvard Law School, Aug. 2007.

ASK: Don’t cut Medicaid

Don’t cut Medicaid. Protect Medicaid and the health and economic security it provides to many of your constituents.

  • We need you to protect Medicaid so STATEians who work hard but don’t get health coverage through their jobs can get the consistent, comprehensive care they need to stay healthy and productive.

VISION:

By protecting Medicaid, we keep STATE’s workforce healthy and productive, helping businesses grow and communities thrive.  

II.  CUTS SHIFT CARE TO THE ER

VALUE: Comprehensive care is the most cost-effective care

Americans are healthier and more productive when they can see a doctor when they get sick, maintain their health through regular check-ups, and prevent small issues from becoming major medical problems.

BARRIER: People can get care they need in the ER

Medicaid provides more stable cost-effective care for your constituents than the emergency room. The ER is for emergencies. Cancer patients can’t go there for chemotherapy. A child can’t get a hearing aid to help her learn in school in the emergency room. Women can’t get routine mammograms in an ER.

  • Medicaid is an extremely efficient health insurance provider: 96% of all money spent on Medicaid goes to actual care, not program administration.
  • ER care is more costly:
  1. The average emergency department visit cost $922 in 2008. The average office visit, meanwhile, came in at $199. Emergency room visits accounted for 4.4 percent of doctor visits but 14.4 percent of doctor visit costs. Source: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/09/24/romney-was-against-emergency-room-care-before-he-was-for-it/
  2. http://meps.ahrq.gov/mepsweb/data_files/publications/st318/stat318.pdf

ASK: Don’t cut Medicaid

We need you to protect Medicaid so your constituents who work hard but don’t get health coverage through their jobs can get the consistent, comprehensive care they need for their health and economic security.

or

We need you to protect Medicaid so Americans who work hard but don’t get health coverage through their jobs don’t end up seeking inadequate, inefficient and costly care in the ER.

VISION:

By protecting Medicaid, we ensure Americans have access to consistent and adequate health care coverage. This keeps Americans healthy and out of the ER for routine care, which reduces health care costs for all of us.