« June 2015 Issue

A Big Victory in Big Sky Country

If you listen to political prognosticators these days, you might think that the fight to expand Medicaid is a lost cause. With a conservative show of strength in last November’s midterm elections and ACA repeal efforts constantly underway in Congress, it’s easy to overlook the real story. And nowhere is the real story – that the fight to close the coverage gap is alive and well – more apparent than in the state of Montana.

On April 29, Governor Steve Bullock signed the HELP Act into law, a bi-partisan compromise that will enable 70,000 Montanans to access health care coverage through Medicaid. This victory was the result of a smart, strategic and people-powered campaign, expertly coordinated by consumer health advocates. But long before that celebratory day at the state capitol in Helena, the hard work began in communities across Montana. The advocates also had the consistent backing of Community Catalyst. The multi-year effort was supported by Community Catalyst’s Affordable Care Act Implementation Fund with financial resources as well as policy and communications counsel and support.

In 2012, four organizations, Montana Women Vote, Montana Human Rights Network, Montana Budget and Policy Center, and AARP Montana, recognized the opportunity to increase access to health care coverage for thousands of low-income Montanans. Although the coalition would grow substantially over the next three years, steady campaign leadership by these organizations was crucial to success.

“We knew it was a tremendous political opportunity. We have been fighting a lot of defensive battles, holding on as programs are chipped away, and trying to defend against bad policy after bad policy,” says Sarah Howell, executive director of Montana Women Vote. “The opportunity to expand coverage to thousands more low-income Montanans in one fell swoop is something that did not go unnoticed.”

After an initial fundraising push, the campaign hit the ground running – organizing events across Montana, collecting stories of people who fall into the coverage gap, and putting pressure on moderate legislators who had indicated, either publicly or privately, they might support closing the gap. After a spirited debate during the 2013 legislative session, unfortunately, all bills to expand Medicaid failed to pass. The coalition faced a strategic crossroads. Although they were pushing for Gov. Bullock to call a special session, chances of that seemed slim. As a result, coalition leaders began to consider a ballot initiative. This was risky for several reasons – plus the coalition would have only 10 weeks to gather tens of thousands of signatures. But Howell and her co-leaders worried if they held back the campaign would lose momentum because Montana’s legislature wouldn’t convene again until 2015, a full two years away. 

Looking back, Howell describes the ballot initiative signature push as a turning point, “It kept the issue alive, allowed us to scale up our efforts, and we were able to keep the pressure on moderate Republicans. They saw that they couldn’t just tough it out through the session and have it go away again, there was going to be a constant public push until something happened.”

Collecting signatures was an all-out effort as coalition members tried to reach Montanans wherever and however they could. Though not enough to get a question on the ballot, they gathered 25,000 signatures, an incredible achievement in a large and rural state. These new supporters were a huge boost to their grassroots efforts, which would play a key role in the legislative campaign to come.

As the 2015 legislative session began, the coalition determined their best strategy was to ramp up public pressure on moderate House and Senate members. With a rapid response grant from the ACA Implementation Fund, the advocates ran radio ads in targeted districts that raised the voices of Montanans in the coverage gap. Adding to the urgency by using the slogan, “70,000 Can’t Wait”, the coalition activated the grassroots network they had built over the past two years.

“Through data collection and tracking we were able to tell which folks would take action every time we talked to them, who had personal stories, and who might want to volunteer,” Howell says, “The simple strategy of continuing to engage these folks over and over again was what was most successful for us, even in the uncreative way of just calling them on the telephone!”

As the campaign continued, there were bumps along the way. National media declared the campaign dead when Bullock’s Healthy Montana Plan was defeated by the legislature. And the organization with millions of dollars in funding from the Koch brothers, Americans for Prosperity, targeted moderate legislators by running paid advertisements, holding town halls and accusing them of abandoning their conservative principles. Rather than just fighting back – the coalition used its grassroots network to overwhelm AFP’s tactics.

“We had invested in two years of constant grassroots field organizing in these targeted legislative districts so when AFP started holding town halls and threatening legislators, we had folks there ready to respond,” Howell explained. “They stood up and said ‘I respect this legislator for doing the right thing and for making this decision based on values, not on fear’.”

Fortunately, the hard work, years of grassroots organizing, and smart handling of the opposition paid off. Through several rounds of nail-biter votes, a compromise plan by Republican Senator Ed Buttrey passed both chambers of the Montana legislature and was signed by the governor.

Although there is work left to do to make the plan a reality, it is a significant victory in the fight to close the coverage gap and more proof that effective advocacy on the ground makes a difference. It sure will for the 70,000 Montanans who won’t have to wait much longer for affordable health care coverage. 

Lucy Dagneau, Associate Director of Communications

O N   T H E   W I R E

Inside Philanthropy and The Chronicle of Philanthropy covered the announcement of the $14.8 million grant awarded by The Atlantic Philanthropies to Community Catalyst for The Center for Consumer and Community Engagement in Health System Transformation.

The Voices for Better Health project released a new video, “Building Bridges to Better Health,” highlighting an innovative collaboration between providers and consumer advocates to infuse geriatrics best practices into the Demonstration Projects for people with both Medicare and Medicaid (dual eligibles). The video was screened on May 15 at the AGS Annual Scientific Meeting, at a forum jointly hosted by Community Catalyst and The John A. Hartford Foundation ChangeAGEnts initiative.

Project Director Alice Dembner speaks with Insurance News Net about the need for stronger federal regulations to make mental health care a priority.

Katherine Howitt, Associate Director of Policy, explains how momentum from the outside helped push Montana’s Medicaid Expansion bill in POLITICO.

On New Hampshire Public Radio, Dental Access Project Director David Jordan explains the important impact dental therapists have on improving communities’ access to oral health.

Join us in congratulating recently promoted staff members: Melinda Crosby to Development Coordinator; Lucy Dagneau to Associate Director of Communications; Katherine Howitt to Associate Director of Policy; and Emily Polk to Program & Policy Associate. 

Community Catalyst Annual Breakfast
November 4, 2015
One Federal Street Boston, MA 02110

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