Model Stakeholder Engagement Strategy
Securing the legal authority to establish a public option program at the state level requires the deployment of a multifaceted stakeholder engagement strategy. Here we describe an approach to engage stakeholders and advocate for a public option. Developing and nurturing strong partnerships with stakeholders and state legislators (ideally bipartisan and bicameral, where feasible) early in the process will help lead to early buy-in, consensus around the design of a public option program, and establishment of long-term support for the program.
This document is intended for state policymakers, including both state legislators and state government officials, as well as advocates at the state level. The primary target audience of advocacy is the state legislature since they will make the decisions that shape the authority to establish the public option program. Stakeholder engagement may vary based on state dynamics (e.g., political control of state legislature and executive branch), as well as the policy design of the public option program (e.g., whether hospital and/or insurance carrier participation is mandatory or optional).
This strategy should be employed in tandem with the process of developing, implementing, and evaluating the public option program. See our model process and timeline for state public option implementation.
Approach
1. Define the goals of the engagement: Generally, the goal of the engagement is to secure the state legal authority to create a public option program. Central to this goal is the development of authorizing legislation that advances the purpose of the public option program and addresses to the fullest extent possible the concerns of stakeholders, since they will serve a critical role in the advocacy and ultimate passage of the legislation.
2. Identify key stakeholders: Given that the public option program is likely to shake up the health care system, engaging a diverse group of stakeholders, representing different – and even conflicting – interests early in the process will help improve the likelihood of securing state legal authority and subsequently implementing a public option program. Collaborating with existing coalitions with aligned goals could help facilitate the formation of partnerships and the dissemination of information.
Certain stakeholders will adamantly oppose pursuit of the public option program and may actively attempt to block such reform. Still, efforts to involve these stakeholders, particularly during the phase of conceptualizing and designing the public option program (see Phase 1 in the model process and timeline) may help mitigate challenges in moving the legislation through the legislative process (see Phase 2). In addition, engaging federal officials from the Centers for Medicare and Medicaid Services (CMS) may be particularly helpful if the state intends to pursue a federal waiver as part of its public option program.
The necessary stakeholders may include the following:
Health Care Industry: Insurance carriers, hospitals, physician groups, professional associations, and health insurance brokers
Consumers: Potential enrollees, employers, patient advocacy groups, and trade associations
Policymakers and Government Officials: State legislators (ideally bipartisan and bicameral and preferably legislators who sit on committees with jurisdiction over health insurance reform), governor’s office, government agencies with jurisdiction over health insurance reform, and CMS (including the Center for Consumer Information and Insurance Oversight (CCIIO) and the Center for Medicare and Medicaid Innovation (CMMI))
In addition to convening stakeholders representing various health care-related interests, seeking individuals and groups with diverse backgrounds and life experiences and from different parts of the state can help enrich the discussion and promote health equity.
3. Establish a structure for collecting input and feedback: Setting up mechanisms to collect input and feedback will help keep stakeholders engaged at all stages of the legislation development process. Soliciting public comments in response to a request for information can facilitate the collection of feedback in a relatively organized manner for specific purposes (e.g., on desired elements and considerations for a public option program, draft public option program proposal). Creating a process for the lead state agencies to respond to comments, providing rationale as to why specific recommendations or considerations were or were not incorporated could help promote transparency throughout development.
Additionally, providing opportunities for real-time two-way communication (e.g., listening sessions) can help encourage dialogue and further transparency. When planning listening sessions or other town hall-style meetings, consider ways to make the meeting as accessible as possible to encourage participation. Considerations include holding in-person meetings (if safe to do so) in multiple counties throughout the state, offering individuals the option to virtually participate in meetings, and convening meetings at different times to account for varying work schedules and other obligations.
For example, throughout the public option development process, Colorado convened 20 listening sessions across the state, conducted focus groups, and considered over 260 comment letters on the draft and final proposals for a public option. Similarly, Washington State held a public comment period during the fall of 2019 on the standard plans and convenes regular public meetings for stakeholders to engage on policy and design considerations.
4. Advocate for legislation authorizing the creation of a public option program: Engaging stakeholders from the outset will culminate in a range of advocacy activities aimed at building political support in the state legislature behind the desired public option program. Below are suggested advocacy strategies:
Pursue the support of state legislators with a track record (based on voting record and public statements) of supporting health care reforms aligned with the goals of the public option program as well as state legislators that are members of key committees with authority over health insurance reform.
Mobilize stakeholders to advocate on behalf of the public option program by meeting with state legislators, holding briefings to educate state legislators and their staff, testifying at hearings before key committees, and raising public awareness about the program (e.g., op-eds, advertising campaigns, town halls)
Develop materials with clear, concise, and actionable messages to enhance advocacy activities. Examples include fact sheets tailored to different audiences (e.g., state legislators, other stakeholders) and letters of support from stakeholders and legislators (e.g., “Dear Colleague” letter)
Gauge support for a public option program through polling, message testing, and focus groups
Anticipate and prepare for counterarguments from the opposition by identifying individuals and organizations that would attempt to block the legislation and developing talking points to bolster the rationale for a public option program
The following chat reflects concerns that were raised by stakeholders during the development of the public option programs in Washington State and Colorado.
With the support of Arnold Ventures