Section 1: Collecting background information and data

Prepare for the campaign by conducting research necessary to frame a compelling message that will persuade key policymakers to champion the issue, and that will help you build grassroots support to win over the legislature and governor to your cause. Hard data is essential to showing projected economic and health benefits for the state and their constituents.   

Topics include existing taxes, Medicaid spending, and the political climate for raising taxes and defending or expanding health access.

Over time, you will likely need to update this research as you refine your message and develop policy reports, talking points and fact sheets supporting your goal and rebutting opposition arguments.

The state budget

1. What is the current fiscal environment in your state? Is there a budget deficit or surplus? Is there enough revenue to maintain or expand programs or are cuts being proposed?  
2. Compared to other states, how much of personal income is devoted to state and local government?

Tax policy

1. Are there any problematic features of your state’s tax code (for example, a cap on revenue growth)?
2. Have there been recent efforts to increase any state taxes? Were they successful?  Who supported or opposed them?  
3. What is the current state tax on cigarettes and other tobacco products? When were the taxes last raised, and by how much?
4. What are the current tobacco taxes in surrounding states?
5. Who are the champions – and opponents - of raising tobacco taxes and of expanding Medicaid and other health programs both inside and outside of state government?  Assess their capacity to influence legislative leadership, the governor and other key players in the state administration.

Tobacco-related health and economic costs

1. What is the smoking rate in your state? Among children? Among adults? Among pregnant women? How does that compare to neighboring states with different tobacco tax rates?
2. Compared to other states, how much funding is currently allocated to tobacco prevention and control efforts, including cessation services?
3. How much do tobacco-related illnesses cost the state overall? What are the costs to the state Medicaid program in particular?  
4. What is the cost of tobacco-related illnesses to businesses in lost productivity?

Health coverage

1. What are the current Medicaid and SCHIP income-eligibility levels for children, parents and other groups?  How do these compare with other states? With the national average?
2. What percent of state residents are uninsured? What percent of low-income residents are uninsured? What proportion of the uninsured could be covered by expanding eligibility for Medicaid to higher income levels?
3. What barriers block Medicaid enrollment? For example, burdensome sign-up requirements, lack of outreach, benefit limits, co-payments, shortage of providers.

Public opinion

1. Have any recent polls assessed public support for a tobacco tax increase?
2. What guidance do the polls offer about messages likely to resonate with the public?

Section 2: Building and maintaining a campaign coalition

An effective campaign coalition is almost always key to success. The most triumphant coalitions are convened and managed by a core of diverse consumer and provider groups who are willing to:1) share the work, the power and the blame; 2) contribute cash, staff or materials; 3) agree to mobilize their members; and 4) commit to making decisions through a governance process that prohibits side deals. Although many tobacco tax campaigns are launched by health access and tobacco control groups, enlisting organizations for doctors and hospitals as core partners can be extremely effective because of their clout and credibility with lawmakers.

To build the trust and strong relationships needed among the groups, it helps to have a staff able to direct coalition members to a role in the campaign that showcases their strengths and makes a significant contribution.

Recruit diverse organizations

1. You will need partners who:  
   • are policy advocates for Medicaid and health access
   • are policy advocates for tobacco control and prevention
   • can mobilize a grassroots base for a policy campaign
   • can raise funds to support a campaign
   • have credibility with lawmakers
2. Use resolutions, case statements and presentations to attract potential partners to fill any gaps in these categories. Partners include consumer advocacy groups, tobacco control organizations, policy think-tanks, organizations for low-income, disabled or older people, disease support groups, labor unions, and health providers including doctors, hospitals and community health centers. Make sure potential partners understand the coalition’s overarching goal to direct new tobacco tax revenues to reduce smoking and increase access to health coverage.
3. Identify the core concerns or policy priorities of each potential partner that would have to be included to ensure their participation. Assess any conflicts among those priorities.
   • An example of an indirect conflict is that one organization wants to spend tobacco tax revenue to expand Medicaid eligibility and one wants to pay Medicaid providers more.  This type of conflict can be resolved though a transparent and fair decision-making process.  
   • A direct conflict would be where one organization supports expanding Medicaid eligibility and another organization opposes it.  This type of conflict is probably not resolvable.

Develop a governance structure

1. Establish operating principles or ground rules.
2. Name an executive committee or steering committee to manage the campaign and make quick decisions when needed. The committee should include a cross-section of coalition members.
3. Establish working committees, representative of the coalition membership, for areas such as research and policy analysis; outreach to new groups; grassroots mobilization; media advocacy and communications; legislative and administrative advocacy; fundraising and development.

Maintain the coalition

1. Develop core messages about the campaign (see media section).
2. Announce the coalition with a news release or news conference, and plan public displays of unity through meetings with policymakers, Op-Eds in local newspapers, and advertisements.
3. Conduct regular meetings, calls and email updates to keep members informed and to build trust.
4. Develop a campaign work plan and budget.
5. Plan a series of coalition-sponsored campaign activities, such as petition drives, letters to local newspapers or blog entries, community meetings with key legislators, rallies and lobby days at the state capitol.
6. Set up action alert systems.
7. Develop a fund-raising strategy that includes a list of possible donors and a formal proposal for presentation.

Section 3: Formulating strategic policy goals

Setting specific goals for use of the tobacco tax revenue will help drive the campaign and help determine how large an increase to pursue. Health-related goals may include maintaining or expanding coverage for children and families; reducing smoking among teens or preventing tobacco-related diseases.

Positive health outcomes can be exponentially increased when funds from a tobacco tax increase are used to prevent or decrease tobacco use or to expand health coverage to people with low incomes. Using the money for coverage can also more than double the amount of revenue through federal matching funds.

When setting goals, it is crucial to focus on what is feasible both politically and within your coalition.

Evaluate possible goals and their costs

1. What are your health coverage goals? What populations do you want to cover or protect from cuts? Up to what income level? How much would this cost? (When using a tobacco tax to support Medicaid, it is advisable to project revenue and spending over several years to ensure that there are sufficient funds to sustain coverage.)
2. What are your goals related to tobacco control? For example, expanding smoking cessation programs or improving screening and treatment of tobacco-related illness. How much would achieving these goals cost?
3. Are you also trying to reduce smoking and tobacco-related health costs? By how much? The higher the tax, the bigger the impact.
4. What other policy goals and uses for the revenue make political sense in your state? What would these cost?
5. Do you need to add or adjust goals to attract certain powerful partners or constituents?
6. How much do you have to raise the tobacco tax to achieve your goals?
7. What is politically feasible? What will coalition members agree to?
8. Will you focus on cigarettes only, or also seek to raise taxes on other tobacco products, which can increase and help sustain the revenue generated?

Build a case

1. Use the data gathered early in the campaign to develop a persuasive case for your goals. Develop policy papers, fact sheets and other materials.
2. Draft legislation or find a legislative sponsor who will do so.
3. Prepare information to rebut expected opposition arguments, such as the impact on low-income smokers, the effect on small retailers and the decline in tax revenue in future years.

Section 4: Organizing and mobilizing a grassroots network

Constituent pressure from the grassroots is every policy campaign’s most powerful weapon. Coalition campaigns have an added advantage of drawing on the diverse membership of many organizations.

Grassroots network building starts with each group in the coalition engaging its own board, staff, and members. The effort expands to involve others who would benefit from the health advantages of increasing the tax.

Most important, it’s at the local level that the campaign can find the compelling stories of uninsured and underserved neighbors who would be helped by the campaign goals.

Organize your existing grassroots supporters

1. Identify key legislators you will have to persuade to pass the tax, including leadership and those on committees overseeing taxes, public health or health coverage. Lawmakers whose districts border states with higher or lower tobacco taxes are also important targets. List the communities in their districts and ask each coalition partner to identify constituents in the districts or members who have a good relationship with these lawmakers.
2. Identify state administrators who oversee policy on taxes, public health, or health coverage and create a personal profile, including home town, college, current address and career history. Ask each coalition partner to identify members who have connections to these officials and who might be able to influence them.
3. Encourage each coalition partner to customize the campaign message and a call to action that addresses their self-interest, as well as the rewards of helping to win improvements in the lives of their neighbors and friends.
4. Schedule briefings or training about the campaign goals for grassroots members of all the coalition partners. At these gatherings, encourage members to brainstorm about additional local allies among their neighbors and friends, and figure out how to recruit them into the campaign.

Expand your grassroots base

1. Schedule meetings with potential allies to explain how the tobacco tax campaign might benefit their members and how those members can participate.
2. Reach out to unaffiliated supporters, using a petition or resolution backing the tobacco tax increase, or a flyer that asks them to attend a rally. Good locations to reach out include: town hall forums, community meetings, health fairs, door-to-door in neighborhoods, online through disease support groups and social networking sites, such as Facebook and MySpace. You may also be able to post flyers in offices and waiting rooms of health and social service providers, legal services, and community groups.

Mobilize

1. Plan activities for grassroots activists, such as meetings with local legislators, attendance at hearings, rallies, or even an appreciation party. Plan some activities in the state capital and others in local communities.
2. Establish a network of local grassroots leaders in key legislative districts who can organize training and action. Training might include practice sessions with talking points before meeting lawmakers. Actions might include helping previously identified constituents contact legislators.
3. Build a storybook of local families who have been hurt by tobacco use or lack of health care. Share these stories with media and lawmakers, while explaining how the tax revenues will help these families.
4. Use a website, message board or telephone tree to share regular updates with local activists, and to mobilize them with action alerts.

Section 5: Developing a communications and media strategy

Effective communication is essential to winning early public and political support, and building a strong defense against opposition arguments.

The strategy should target statewide and local media markets. Stories of local families hurt by tobacco use or lack of health care, as well as reports on the economic benefits of a tobacco tax can be particularly effective. Get local leaders to write Op-Eds and letters to the editor. Use the expertise of the coalition’s communications staff.

Identify the basics

1. Goals – Briefly summarize the campaign’s goals and strategies as determined in Section 3
2. Target audience - specific legislators, staff members, committee members, etc:
   • Primary audience - people who can make your goals a reality
   • Secondary audience - people who influence the primary audience
3. Messengers - Select and train spokespeople from among the coalition membership. Recruit respected, articulate community members who will reach your target audiences. Seek out those with personal stories to tell about tobacco-related illnesses or lack of health coverage, or with expertise about the economic benefits of a tobacco tax. Hold training sessions for spokespeople to help them stay on message.
4. Tactics - Determine what communications tools will best reach your target audiences and help you meet your goals.

Develop key messages and materials

1. Develop compelling messages specific to your target audience that speak to their values, highlight the problems of smoking and lack of health care, and promote the tobacco tax and using the revenue for health access. Simple is better.
2. Help coalition members customize the message by emphasizing a policy goal that directly affects their constituency and their organizational mission.
3. Prepare materials emphasizing your messages, including:
   • Summary paragraph or two about your campaign and your coalition
   • Brief and specific fact sheets. You may also want to prepare fact sheets to counter opposition arguments about the impact on small retailers, how much the revenue may decline in future years, and other issues.
   • Talking points for local and statewide activists to use when speaking with policymakers or the media.
   • FAQ documents that address such information as: how many people are hurt by smoking, how much money the tobacco tax increase will raise, how many people will be helped by using the tax revenue for health access.
   • Proposals to potential funders describing the coalition, its governance, the projected policy outcomes and the budget.

Communicate directly with coalition members

1. Use a newsletter, intranet or message boards
2. Host a statewide webinar in the evening and invite board members of coalition organizations to learn more about the campaign

Communicate directly with the public

1. Distribute fact sheets and brochures
2. Develop a campaign website or blog
3. Use email or online social networking
4. Buy advertising in major media if you have the budget for it. National groups, such as the American Cancer Society Cancer Action Network or the Campaign for Tobacco Free Kids, may also be willing to buy advertising in support of the campaign.

Develop an earned media plan

1. Select media outlets that will reach your target audience – including television, radio, newspapers, blogs and other online venues
2. Identify reporters and editorial board members who cover health, taxes and politics, with special attention to local media outlets in the districts of legislative leaders.
3. Identify the authors of widely read local and statewide blogs. Contact these people to explain the campaign and its goals.
4. Plan events and release of reports that are newsworthy, such as:
   • Launch of campaign
   • Announcement of significant endorsements
   • Reports on the economic and health toll of tobacco-related illness and lack of health coverage, and the benefits of the tax increase
   • A public opinion poll showing support for your goals
   • A storybook on real people who have been hurt by the use of tobacco products or the lack of health care coverage
5. Write media advisories or press releases, and distribute them, as well as reports, not only to reporters, but directly to your grassroots supporters and to policymakers. Every media event is a campaign to educate both policymakers and the general public.
6. Offer your spokespeople as guests on radio talk shows and live online chats.
7. Be prepared to respond quickly to new developments or opposition tactics by sending out press releases, letters to the editor, Op-Eds and blog entries.

Section 6: Lobbying elected and appointed policymakers

All efforts of the campaign build toward this work, convincing the legislature and governor to support increasing the tobacco tax and devoting the funding to health care. To win them over takes a two-pronged strategy using facts, powerful constituent stories and political pressure:

1. Targeting key members of the legislature and state administration in the capital using experienced advocates from coalition member groups
2. Targeting local legislators in their districts using community leaders and constituents

Pre-campaign activities

1. Identify and brief lawmakers in the House and Senate who might be willing to champion the campaign’s proposed legislation.
2. Identify and brief key policymakers in state administration whose policy goals are consistent with your campaign aims.
3. Identify and assess the strength of potential opponents. Include elected and appointed policymakers, as well as special interest groups, such as tobacco industry representatives.
4. Create a database for tracking contacts with lawmakers that can be updated and consulted on-the-go.

Lobbying in the capitol

1. Build a team of experienced lobbyists from the staffs of each coalition member group to plan a strategy in consultation with the coalition steering committee that builds in intensity as the legislative session progresses. The team’s first tasks are to tally likely supporters and schedule briefing meetings between steering committee members and key legislators and administrators.
2. Develop a one-paragraph pitch to use when catching lawmakers in the corridors, as well as talking points for a longer meeting or for testifying at a committee hearing.
3. Set up regular policy briefings for the rank and file legislators.
4. Intensify lobbying as the legislative session progresses, meeting regularly with key supporters and targeting opponents with campaign materials and activities specifically designed to respond to their objections. For example, bring in business leaders who support the tobacco tax to meet with opponents who oppose any tax increase.
5. Coordinate activities with grassroots organizers in local legislative districts so that opponents feel pressure from both angles.
6. Seek out new groups to broaden your coalition if needed to pressure opponents in the legislature or administration. Medical societies and hospital associations can bring substantial clout to advocacy efforts.
7. Hold rallies or lobby days that draw supporters from across the state and that emphasize how the tax increase will improve the lives of your state’s residents, focusing on constituents of key opponents. Also feature legislative supporters, so the media can identify your heroes and foes. Time these events for maximum effect – the first hearing of the bill, before a vote, or as the bill heads for the governor’s office. These events are also useful for solidifying your grassroots efforts.

Grassroots activities in local legislative districts

1. Train grassroots members in advocacy skills, including letter writing, telephoning and making presentations. Brief them on campaign goals and profiles of local legislators.
2. Bring constituents to meet with legislators to explain how their families are affected by tobacco use or lack of health care.
3. Reach out to local media outlets by featuring local residents and policy experts. (See media section.)
4. Gather petitions and mount email or post-card campaigns.
5. Give awards to legislative supporters, and publicly thank them using the letters section of local newspapers.
6. Increase constituent pressure on undecided legislators or opponents by canvassing their neighborhoods, getting campaign donors to call, or facilitating meetings between these lawmakers and your legislative supporters.

Post-campaign activities

Even if you win passage of a tobacco tax increase, you may need to continue organizing to ensure that the money is spent in accordance with your policy goals. Pressure on administration leaders, as well as lawmakers, may be helpful with this part of the campaign.

Section 7: Participating in a regional campaign with neighboring states

The primary benefit of working regionally is pooling strategic expertise and resources within a shared economic and political culture.

In addition, a regional effort can help counter opponents’ arguments that raising taxes in one state will just drive customers across the border to buy their cigarettes. Other benefits of regional campaigns include: shared policy research; expanded media coverage; peer-to-peer campaign support; and a compelling fundraising strategy.

A regional effort may attract extra support from national organizations.

Start up

1. Leaders of local or national organizations focused on tobacco control, health advocacy, specific diseases or provider alliances convene a meeting with representatives from neighboring states.
2. The groups agree on common goals and develop governing principles for a regional alliance to provide technical assistance and material support to state-based campaigns.
3. 3. Ideally, each state agrees to advocate for the same increase in the tobacco tax, at least initially, but sets its own goals for use of the revenue.

Best practices

1. Develop a coordinating committee with membership from each state coalition.
2. Select an "executive" group authorized to make key decisions and respond quickly when needed.
3. Refrain from making deals with lawmakers or other interested groups without consulting the executive committee.
4. Conduct monthly conference calls to share strategies and ideas.
5. Respect and recognize the contributions of each partner.

Opportunities for regional synergy

1. Combining state data into regional reports can highlight the positive impact of raising the tobacco tax on both the economy and health of the region.
2. Conducting regional polling and coordinating media strategy can increase the bang for the buck.
3. Enlisting support of businesses that operate in more than one state can boost impact and ease fundraising.
4. Developing a regional pitch may attract funding from national groups and foundations.
5. Encouraging friendly competition among lawmakers from different states may speed action.
6. Making presentations to regional gatherings of governors or legislative leaders can reinforce your message.
7. Establishing a regional structure can help individual states bring new groups into the coalition.

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