Advocacy 101

1. Advocacy 101 Getting started, making a difference!

2. Outline • Overview of Congress & Process • Introduction to Advocacy • Specific Issues • Title VII • SCHIP • Others • Conclusions

3. Overview -110th (first session)Congress at a glance -Why your advocacy is important - Ensuring your voice is heard -phone calls -letters and leave behinds -in-person visits -Title VII and SCHIP -APA Resources

4. 110th Congress

5. 110th Congress Makeup Senate 49 Democrats, 49 Republicans, 2 Independents House 232 Democrats, 201 Republicans, 2 Vacancies

6. Congressional Leadership Senate Majority Leader: Harry Reid (D-NV) Minority Leader: Mitch McConnell (R-KY) House Speaker of the House: Nancy Pelosi (D-CA)Minority Leader: John Boehner (R-OH)

7. Important Committees House: Energy & Commerce- Dingell (D-MI) and Barton (R-TX) Appropriations- Obey (D-WI) and Lewis (R-CA) Ways & Means- Rangel (D-NY) and McCrery (R-LA) Senate: “HELP”- Kennedy (D-MA) and Enzi (R-MY) Appropriations- Byrd (D-WV) and Cochran (R-MS) Finance- Baucus (D-MT) and Grassley (R-IA)

8. Appropriationsvs. Authorizations • AUTHORIZATION BILL - provides the authority for a program or agency to exist and determines its policy. It also recommends spending levels to carry out the defined policy, but these levels are not binding. Authorizations may be annual, multi-year, or permanent. Expiring programs require re-authorization. House and Senate rules require that authorizations be in place before final funding decisions are made. • APPROPRIATIONS BILL - provides the legal authority needed to spend or obligate U.S. Treasury funds. There are 12annual appropriations bills that together fund the entire federal government. These 12 bills must all be enacted prior to the start of a new fiscal year, designated as October 1. Failure to meet this deadline causes the need for temporary short-term funding or results in a shutdown

9. How A Bill Becomes Law 1. Bill introduction 2. Referral to committee (s) 3. Committee hearings 4. Committee mark-up 5. Committee report 6. Scheduling legislation 7. House: special rules, suspension of the rules, or privileged matter 8. Senate: unanimous consent agreements or motions to proceed 9. Floor debate

10. How A Bill Becomes Law 10. Floor amendment 11. Vote on final passage 12. Reconciling differences between the house and senate 13. Amendments between the houses, or 14. Conference committee negotiations 15. Floor debate on conference report 16. Floor vote on conference report 17. Conference version presented to the president

11. How A Bill Becomes Law 18. President signs into law or allows bill to become law without signature 19. President vetoes bill 20. First chamber vote on overriding veto 21. Second chamber vote on overriding veto 22. Bill becomes law if 2/3 vote to override is achieved in both chambers 23. Bill fails to become law if one chamber fails to

12. Outline • Overview of Congress & Process • Introduction to Advocacy

13. Why your Advocacy is Important • Members of Congress want to be reelected They want your vote and the votes of your family, your patients, your colleagues, your community members, etc. • You are the expert No member of Congress (or their staff) can possibly know everything about every subject they vote on. Therefore, they must rely on experts to inform them about issues.

14. Know the subject Know the decision-maker Know the community Know the political situation Know how to anticipate problems Know how to listen to what is said/not said Know how to compromise Know how to build coalitions Know how to use the media Know how to maintain your sense of humor and enjoy the process 10 Knows of Advocacy

15. Advocacy Skills/Tools/Strategies Tactics • Identify the issue • Craft the message • Develop Coalitions • Communicate the Message

16. Identifying the Issue • You care deeply about it /are knowledgeable • The general public is invested in the issue • There is a critical mass of pediatricians and health care professionals/experts concerned about the issue • A feasible solution to the problem exists but needs to be disseminated • Interest in the issue already exists among influential decision-makers • There may already be recognition that the issue is a problem in the adult population in your community; but there has not been any discussion about how this problem impacts children and adolescents

17. What You Need • The facts and reliable information • Partner with sources of evidence • Develop a fact sheet to inform, educate, persuade • Stories or examples that illustrate the issue/the proposed action • Up-to-date/factual data are key! • Specific data on the specific issue for your state/ region/community/hospital/clinic • Include contact information for you/your organization (address, phone number, website address, email address, business cards) • Your personal experience • The stories of your patients’ experiences

18. Phone Calls to Congress • You have the option of calling your member’s Capitol Hill office or a district office • Ask to speak with the Health “L.A.” (Legislative Assistant) • State up front that you are a pediatrician andconstituent • You may get voicemail. That is fine and to be expected. Leave a message and ask to be called back.

19. Keep your message short, clear and simple: “I urge the Congresswoman to support adequate funding for Title VII Health Professions Programs, including pediatrics.” • Leave your contact information and offer to serve as a resource for any questions about this and other topics related to child health.

20. Leave Behinds/Fact Sheets • No more than one page; no more than 2 or 3 key points • Be clear about what you want the elected official to do • Keep your “ask” short, clear, simple and state it up-front: “I urge you to provide $300 million for the Title VII Health Professions Programs in FY 2008. This allocation merely restores funding for these vitally important physician training programs to FY 2005 levels.”

21. Add state or district-specific data whenever possible (i.e. ___number of children uninsured in your state; __ eligible but un-enrolled in SCHIP or Medicaid) • Remember that the person reading your document may have no background whatsoever in medicine, public health or healthcare. Avoid using medical jargon or acronyms that a member of the general public would not understand • Include your contact information—full name, address, phone number and e-mail address

22. Value of Coalitions • Shared vision of children’s needs • More effective to work together • Share resources and workload • Variety of perspectives • Increased knowledge of community needs

23. Developing a Coalition • Invite a broad-based group of people/organizations to join that reflect the breath of support for the issue • Maintain active membership in the coalition • Ensure the equality of voice in deliberations of all coalition members • Avoid competition among coalition members for the same resources and/or funding • Compromise is often required

24. Letters • Make sure you identify yourself as a pediatrician (child health professional) and a constituent in the first paragraph • If you have access to AAP resources consider the use of the draft sample letters on AAP’s website by logging on the AAP Member Center at www.aap.org/moc. Click on “Federal Affairs” at the bottom of the page. If not, contact the APA as these are under development. • Personalize, personalize, personalize—how will this issue effect the elected official’s district or state?

25. Letters • Thank the elected official if he/she has done something positive on behalf of children and adolescents • Include your contact information • E-mail or fax your letter – it is always best to email to a specific staff person

26. Dear Representative/Senator: As a constituent and pediatrician, I urge you to act now to reauthorize the State Children’s Health Insurance Program (SCHIP). Over the past 10 years, SCHIP has provided children, who would otherwise have been uninsured, with a vital source of comprehensive health insurance. Reauthorization of SCHIP offers Congress a historic opportunity to come together once again – on a bipartisan basis for the nation's children – to build on SCHIP and Medicaid's remarkable successes. Nine million children currently live without any private or public health care coverage. Every day that Congress fails to enact SCHIP reauthorization, another 2,000 American children are added to those ranks. I look to you, as a political leader for our state, to reauthorize and fund SCHIP not for partisan gain, but because it is the right thing to do at the right time. Sincerely,Your name - Your street address City, State Zip

27. Leave Behinds • Make your “leave behind,” or issue fact sheet, visually appealing by including white space and minimizing the amount of text • Have no more than 2 0r 3 key points to support your ask/request • Be as specific as possible with data/information on the subject • Include your contact information

29. In-Person Visits • One of the most valuable advocacy opportunities is the personal visit with staff or the elected official. • Focus on one issue • Be clear about what you are asking for • Provide personalized examples

30. In-Person Visits • Be prepared to meet with someone who may be young and has a limited background in health policy (avoid medical jargon, acronyms) • Expect the unexpected (walking and talking, standing in the hallway, meeting in the reception area; meeting for 5 minutes or an hour) • Dress appropriately

31. If you don’t know something, say so and offer to follow-up – and make sure you do! • Provide written materials with greater detail (fact sheet, leave behind) • Provide your contact information and encourage follow-up • After the meeting, send a thank you letter by fax or e-mail • Follow-up and maintain the relationship; become your elected official’s resource on child and adolescent health issues • Be persistent

32. Outline • Overview of Congress & Process • Introduction to Advocacy • Specific Issues • Title VII • SCHIP • Others

33. Title VII Health Professions Programs http://www.aamc.org/advocacy/hpnec/start.htm

34. Title VII Health Professions Programs -FY 2005 $300 million -51% cut in FY 2006 to $145 million -FY 2007 increase to $185, but still short of ‘05 levels -President Bush’s FY 2008 budget provided only $10 million (for SDS program) and zeroed-out all other Title VII programs -House/Senate FY 2008 Labor-HHS-Education Conference agreement - $212 million

35. Statement of Administration Policy: “The Administration strongly opposes H.R. 3043 (L-HHS-E appropriations bill) because, in combination with the other FY 2008 appropriations bills, it includes an irresponsible and excessive level of spending and includes other objectionable provisions.” “[The President’s] Budget proposed to eliminate or reduce funding for a number of HHS activities that have not been proven to be effective, have already achieved their intended purpose, or are duplicative of other activities, such as Health Professions training grants and the Preventive Health Block Grant. The Administration urges the House to adopt these reforms, in order to be a better steward of the taxpayers’ dollars.”

36. SCHIP Reauthorization

37. House passed the Children's Health and Medicare Protection (CHAMP) Act of 2007 (H.R. 3162) by a vote of 225 to 204 on August 1st. Senate August 2nd, passed the Children's Health Insurance Program Reauthorization Act of 2007 (S. 1893/H.R. 976) by a vote of 68-31. President Vetoed the bill, Veto override failed – House and Senate passed a second version and a veto is pending.

38. What You Can Do • See how your member voted: http://www.aap.org/moc • Let members of Congress know why SCHIP is so important to providing comprehensive, quality health care to children, and the critical need to reauthorize the program. Currently SCHIP is authorized until 12/14/07. • Set up an in-person meeting or send a message including the following key points:

39. In the 10 years since it was enacted, SCHIP and Medicaid have reduced the number of uninsured children by more than one-third. Despite this, there are still 9 million uninsured children in America, the vast majority of whom are in families with jobs that do not offer their children access to affordable coverage. • Uninsured children are twice as likely as insured children to miss doctor visits and check-ups - and less likely to receive care for illnesses such as sore throats, earaches and asthma. When uninsured children go without needed care, small health problems can grow into bigger ones.

40. Pass SCHIP legislation that contains $35 billion in new funding to reach millions of the children who are eligible for SCHIP or Medicaid but un-enrolled. • Every day that Congress fails to enact SCHIP reauthorization, another 2,000 American children are added to those ranks. • Any SCHIP legislation must also strengthen and improve health care for children by including a fair physician payment component, addressing citizenship and documentation issues, and strengthening pediatric quality measurement.

41. Other Important Issues • Reauthorization of and adequate funding for the Agency for Healthcare Research and Quality • Adequate funding for the Children’s Hospital GME program • Support for and funding of the National Children’s Study

42. Outline • Overview of Congress & Process • Introduction to Advocacy • Specific Issues • Title VII • SCHIP • Conclusions

43. Choose your issue Identify supporters Develop a strategy Frame your message Identify solutions Educate Mobilize supporters Testify Persevere And… Tips for Advocates

44. AND WHEN ALL ELSE FAILS… VOTE!! 2008 Presidential election and elections for 435 members of the House of Representatives and 1/3 of Senate is November 4, 2008

45. Questions?