Grassroots Advocacy and Health Care Reform

The HCAN Campaign in Pennsylvania

M. Stier

• Publisher: Palgrave Macmillan
• Year: 2013
• Print ISBN: 9781137339195
• eBook ISBN: 9781137341976
• Topic: Politics & International Relations
• Subtopic: Political Campaigns & Elections
• Index: Politics & International Relations

Grassroots Advocacy and Health Care Reform places a detailed account of how the Health Care for America Now campaign in Pennsylvania carried out contemporary issue advocacy in the context of an understanding of American politics.

1

A Federal Campaign

Washington and the States

In the following chapters, I describe the work that the Health Care for America Now (HCAN) campaign in Pennsylvania did to build a base of labor and activist support in our state and to engage those supporters in a series of actions and events designed to encourage the members of our congressional delegation to lead the way to and vote for health care reform. While my focus is on Pennsylvania, it is critical to understand at the outset that everything we did was part of a national campaign directed in Washington by HCAN’s campaign manager, Richard Kirsch, and field director, Margarida Jorge. In the following chapters, I’ll be pointing to our actions, most of which implemented or built on the national plan. So it will be helpful, and save repetition, if I first describe the national campaign and how we worked with Richard, Margarida, and the other members of the DC staff.

Our work in Pennsylvania was done as part of a national campaign. But not everything we did was directed by Washington. The national team did encourage and in many cases require state partners to hold events and actions on the same day. These reiterated state events were tied to national events and/or were packaged together for presentation to the national press and politicians. But we in the states had the freedom to decide exactly how and where we held those events. In addition to the national events, each state group had to meet other deliverables—press events, contacts with legislators, recruiting new activists, and so forth—which we were free to do as we saw fit. It was central to the national plan that state groups had the freedom to make these events as effective as possible in keeping our local political circumstances and targets.

Richard and Margarida had a lot of trust in our team, so we in Pennsylvania probably had more freedom than other state coalitions. And given the capacity we had in Pennsylvania, and the energy and creativity of so many members of our team, we did a great deal of work that went beyond the required actions and events. Some of the events we devised, such as our march to Washington, were adopted by Washington and became national actions. And, as I describe in Chapters 3 and 4, some of what we did in trying to build a strong sense of commitment to the campaign on the part of our coalition partners and activists creatively implemented the directions we received from Washington.

But while we had a lot of freedom in Pennsylvania, every bit of work we did, that which implemented the national plan and that which went beyond it, was part of the national campaign and would have been impossible without it. The point of this chapter is to show how the national campaign was set up and how it guided and supported our work. But it is not meant to be a complete account of the national campaign. The book written by our national campaign manager, Richard Kirsch, Fighting for Our Health, describes the origin of the HCAN campaign and how it was funded. It explains how the political strategy and messaging of the campaign developed Richard’s strategic insight about how to overcome the real difficulties in enacting health care reform. It describes the enormous effort Richard and our key partners made to build and hold a huge and unprecedented coalition together. And it gives many examples of states carrying out that strategy, especially in interaction with members of Congress.

What I want to do here is focus on the details of how HCAN in Washington directed the field campaign and worked with us in Pennsylvania. As you will see, the field campaign was central to HCAN, but it wasn’t the entire campaign. To understand the other aspects of our work, you will have to turn to Richard’s book and, no doubt, other histories to come.

Federalism and Political Advocacy

The HCAN campaign to enact health care reform was a national campaign to enact national legislation. But it was carried out in 43 states by 70 or so contracted state HCAN partners, some of which were coalitions of state-based organizations, as well as by many other state-based organizations, such as labor unions.

That HCAN was set up as a federal campaign was by no means unusual. Until the 1960s, almost all advocacy campaigns and national membership organizations were set up in a way that parallels our federal political system. Even if they were created by a national organizing committee, as HCAN was, they quickly established state organizations, which, in turn, took responsibility for creating local organizations. Only with the growth in the 1960s of national advocacy organizations run by professional managers that relied on either direct mail to raise funds or the Internet to both raise funds and mobilize activists was it conceivable that an advocacy campaign would not be organized in a federal way. However, even those managerial groups or Internet advocacy organizations turn to organizing state after state when they want to mobilize a large contingent of grassroots activists or build a coalition of those activists and labor unions.

Ever since the New Deal, people with an interest in politics have been focused on Washington. And to a growing extent, state politics has become nationalized as regional variation in the parties decline. In a political community that pays little attention to politics at all, the result is that fewer and fewer people pay much attention to state politics. And the news media has shifted its attention as well. News coverage of state politics is generally limited in our daily papers unless one lives in a state capital. About 6 months after I first moved to Philadelphia 16 years ago, I joked with some friends by saying, “I’ve been a political scientist for about 20 years, so I know we have a state capital and state government, but I’ll be damned if I could have discovered that by reading the Philadelphia Inquirer.” I later learned that not only the Inquirer but also the Daily News had excellent reporters covering our state government—which is in Harrisburg, by the way. But their reports were often relegated to slots deep in the paper.

Our health care activists were no exception. People often asked me, “Why don’t we just have a big national rally instead of doing all this work in Pennsylvania?” Indeed, at our first HCAN retreat, I was one of a number of people who focused (too much) attention on when and how we should do a national rally. So it makes sense to start this chapter by explaining why politicians and effective organizers focus our thoughts and actions around the states.

To begin with, state governments play critical roles in providing goods and services to all of us—from education to roads and bridges to health care to social services for those who are elderly, disabled, or poor. Indeed, with the important exceptions of Medicare, Social Security, and veterans’ benefits, almost all other federal programs that benefit individuals flow through the states. And the goods and services provided by the states are provided by a large work force, which is unionized in much of the country. (The public employee unions are powerful advocates not just for themselves but also for the huge span of constituencies they serve, from inmates in prisons to people with disabilities.) So public policy advocates and labor unions—and businesses as well—must be focused on what happens in state governments. And they are all organized with that focus in mind. That’s true even in a state like Pennsylvania, where the state capital is a small town far from the major population centers of Philadelphia, Pittsburgh, and the Northeast cities of Wilkes-Barre and Scranton. Major business associations and labor unions as well as policy advocates and service providers are either based in Harrisburg or represented by a political director or legislative liaison there. Even those groups that don’t have the resources for a full-time presence, such as the progressive coalitions America Votes and State Voices, frequently meet there and are heavily engaged in state legislative lobbying or elections to the state legislature.

Even more important, the political careers of our national senators and representatives are totally embedded in their states. The political support that governors, senators, representatives, and all other political officials and aspirants seek to mobilize to gain and hold office are almost all based in their states. Some national advocacy groups mobilize resources for statewide and state-legislative elections. And there are national groups that develop model legislation for both liberals and conservatives. But these national ideas only become effective if adopted by state-based political officials. And national money for state elections is still overshadowed by what is raised within each state.

And finally, the most powerful and thus most coveted political offices in our country after the presidency—governor and senator—are elected by the voters of the states. Governors—and, for the party not holding the governor’s mansion, the senior senator—are at the pinnacle of their state parties. They play a critical role in the lives of every community and every politico in the state. Their support can move legislation and help the careers of politicians who are members of Congress, state legislators, or appointive officials in the federal or state executive and judicial branches. Their opposition can stifle political careers and legislation.

Thus even though our senators and representatives play a critical role in national politics, their orientation to national issues—including how liberal or conservative they are as compared to other members of their parties—is shaped by their relationships with their own states and the key political groups, from businesses to nonprofits to labor unions to grassroots activists, within them. The political careers of senators and representatives are built mainly on the relationships they have forged in their own localities and in their state. And their future in politics is based on those same relationships. Even if they have ambitions for the presidency and vice presidency, those ambitions are made possible in part by the support they have in their own state and by the help they get in reaching out to other states from their in-state base.

Building a Strong Field Operation

So any national political advocacy campaign that really seeks to influence members of Congress has to operate in states. But there is more than one way to do that. HCAN made three critical choices that, in the context of early twenty-first-century progressive politics, were highly unusual.

The first was to focus almost as much money and a great deal more time on our field campaign than on television and newspaper advertising directed at members of Congress. HCAN’s goal was to create a team of organizers that would build a base of grassroots proponents of reform from both labor and citizen activists and then mobilize that base to influence members of Congress directly and indirectly by taking action in congressional offices, on the streets, by phone, and online. HCAN and its partners did spend a bit more money on paid media than on the field campaign. But taking into account how expensive paid media is relative to the cost of field organizers, it is striking that 40 percent of our $48 million budget went to the field. The centrality of the field could even also be seen in the organizations asked to join HCAN. It was, of course, open to all. But the groups we sought out were those that could do mobilization on the ground.

Why did we focus on a field campaign? Because we believed that the only way to build the kind of support for health care reform that would make a difference in Congress was to engage citizens in the process. The bubble of Washington is hard to break through. Even if you believe, as I do, that the left-wing picture of Congress as being bought by “special interests” is a wild caricature, it is certainly true that the Washington bubble is filled by a conventional wisdom of elite opinion that is heavily influenced by cautious politicians and political operatives as well as by a huge army of lobbyists, most of whom work for business interests. For reasons I explore in Chapter 2, those cautious politicians were reluctant to take on a major effort to reform health care. Their caution was reinforced by an armada of lobbyists representing the well-heeled insurance, pharmaceutical, hospital, and medical industries, which had strong and conflicting views about the future of health care. We could not hope to match the connections these lobbyists had made with members of Congress and their staffs or answer every argument those lobbyists and their research departments could put forward. Our only hope for puncturing the bubble was to make sure that members of Congress heard the voice of their many constituents who needed and supported health care reform. They had to hear from people directly in lobbying meetings, phone calls, and street demonstrations. And they had to hear from them indirectly in the form of media reports on our campaign. Members of Congress had to know that their constituents would be watching and waiting to see if they would act on this critical issue. Only a field campaign in the states and districts of members of Congress could accomplish that task.

Building on Existing Progressive Infrastructure

HCAN made a second wise and unusual choice: to build its state campaigns on existing progressive infrastructure and especially on the local affiliates of the four major national networks of multi-issue state advocacy groups—US Action, the Association of Community Organizations for Reform Now (ACORN), the Center for Community Change (CCC), and the Northwest Federation of Community Organizations (NWFCO). In all but five of the states—Michigan, Pennsylvania, Arkansas, Texas, and Nevada—leadership of the HCAN campaign was turned over to one of these local affiliates, not to another organization or someone hired, as I was, directly by HCAN. But even where a separate state director was hired, no organization was suitable for leading the campaign statewide, HCAN also contracted with existing organizations, as it did in Pennsylvania, where ACORN, Penn Action (the local affiliate of US Action), and the Philadelphia Unemployment Project (which had a loose relationship with CCC) became HCAN partner organizations.

Relying on existing progressive organizations was a controversial decision. The alternative, which is followed by most national advocacy campaigns, is, in the common phrase, to “parachute” someone into the state to begin organizing on their own or to form a coalition of local groups. This model can lead to some effective work, especially if two conditions are met. First, the national campaign must choose someone with experience working in the state and some credibility with key figures in the state, in particular the leaders or political directors of major unions and the heads of advocacy organizations. And second, there must be a commitment from the national organizations that are part of the advocacy campaign to encourage their local affiliates to work with the state campaign leader.

HCAN made the right choice. Local advocacy organizations that are already leaders of a broad multi-issue coalition or that have taken part in such coalitions have relationships with other potential coalition members from labor and community groups and typically have experience and knowledge of the legislative targets. This makes it much easier to form a new coalition around a national advocacy campaign. They already have the staff and membership to get a new advocacy campaign off the ground. And they have a very strong incentive not just to carry out discrete actions and events in support of some legislation but also to carry out a long-term campaign that involves building and expanding a base of supporters.

National campaigns that parachute someone in to lead a statewide effort often have trouble finding people with the connections that make for effective coalition building. Those people have little incentive to do intense base-building work. They won’t have the organizational staff, membership list, or other resources to jump-start a state campaign by engaging in the actions and events that build for the future. So advocacy campaigns that rely on Washington-supplied staff tend to focus on mobilizing grass-top calls from labor and other local leaders and on doing earned media events or op-eds that are designed and produced in Washington. If labor in the state is interested, then a Washington-directed staffer might be able to bring some people to these events. If labor is not, or the Washington-appointed person doesn’t have the connections or skills to mobilize labor, little will be accomplished. A Washington-appointed state advocacy leader can, of course, ask local organizations, like those that became part of HCAN, to do some of the work. But for obvious reasons, that breeds resentment on the part of those organizations and is thus rarely successful. And even if people join these cookie-cutter events, they are unlikely to focus on themes or individual stories that resonate locally and thus are not likely to get much play in the newspapers or on television.

So working with existing advocacy organizations in a state is the best way for a national advocacy campaign to build an effective state campaign. Indeed, it was the only way for HCAN to get up to the scale we needed quickly enough. A national campaign that supports existing advocacy organizations can also make a huge contribution to the growth of long-term progressive capacity. Taking part in a national advocacy campaign helps local organizations train their leaders and staff to think strategically and to carry out a wide variety of operations, from base building to direct advocacy, more effectively. It provides resources and training for online efforts. It gives local organizations an opportunity to get good publicity for their work on an important issue. And, of course, it helps the organization expand its base of members or supporters, which not only can be a source of financial support but also enhances its capacity to influence other legislation, thereby making it a more attractive partner to other national and state campaigns.

So why, then, do so many national campaigns hire individuals or consultants to be their local representatives rather than following the HCAN path? Largely because they don’t trust the local affiliates of national organizations to do the work properly, or at all. That’s not a foolish concern. A national campaign needs to get credit for its work under its own name and has to have a national message and a national strategy, even if that message and strategy are tailored for different states or congressional districts. A national campaign also needs to move quickly and all at once. State and local organizations, however, want to put their own name forward. They are also inclined to adopt strategy and messaging that fit their usual approach. Since state and local issues may be of greater importance to their leaders and funders than a national advocacy campaign, state and local organizations are not inclined to jump when the national campaign asks. And, of course, those organizations might be happy to take money from Washington and do little with it.

So a national advocacy campaign that relies on state and local organizations that are also doing other advocacy work, and that have their own institutional concerns, risks seeing its name ignored, its strategy abandoned, its message diluted, and its work put on the back burner or neglected entirely. But these problems are not the whole story. To be really effective, a national advocacy campaign needs organizers willing not only to do the work delegated to them but also to make a deeper commitment to the campaign. They need people ready to take responsibility for making the campaign as effective as possible in their states.

HCAN did a number of things to overcome these difficulties. First it invested a lot of money in state affiliates. HCAN could demand that state and local partners be fully committed to the campaign, because it was paying a premium for that work. But money isn’t the whole story. The fight for health care reform took much longer than we had expected, and our money for the field fell short of what we needed. But the HCAN field team still turned out exemplary work, even as its funding was cut late in the campaign. Second, HCAN also invested in and relied on the national partners of these local affiliates, all of which were on the steering committee. The national and regional field managers of ACORN, US Action, CCC, and NWFCO had the primary responsibility of making sure that their local affiliates were following the national plan and getting the job done. They were part of a team of field managers that helped plan and implement the national field plan and devise rapid responses to new developments. (Because John Freeman of Michigan and I were hired directly by HCAN, had two of the largest state operations, and were respected by Margarida Jorge, we were invited to join the weekly field manager calls. This experience helped me get some insight into the national field campaign as a whole.) Tying the field managers so closely to the planning and implementation of...

Table of contents

• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgments
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Conclusion