1. Advocacy 101 Why Does Advocacy Matter? February 25, 2015 Presented by Amanda Pears Kelly National Advocacy Director National Association of Community Health Centers

2. The History of Community Health Centers: In the Beginning 1965- Community members in Boston, Massachusetts and Mound Bayou, Mississippi recognize the unmet needs of the poor and underserved in their communities and work to establish the nations first two Community Health Centers (CHC’s). The original health centers were funded under demonstration authority by federal Office of Economic Opportunity (OEO), the lead agency in the War on Poverty efforts of the Johnson Administration. 1975- Recognizing the strength, value and success of Community Health Centers, the Health Center Program is officially established under section 330 of the Public Health Service Act (PHSA). The new program provides targeted funding to medically underserved/high impact areas; sets minimum service and consumer majority policy Board requirements.

3. What Makes CHC’s Different Community Health Centers are owned and operated by their communities: –The Health Center Program is the only healthcare delivery system in the nation that maintains a 51% patient majority consumer board- to ensure the TRUE NEEDS of the community are being represented and cared for! CHC’s will ALWAYS provide healthcare to anyone and everyone, regardless of their ability to pay. CHC’s often provide multiple healthcare services from their sites in order to provide greatest access to care for all patients and ensure all healthcare needs are accounted for- one stop shopping for healthcare.

4. What is Advocacy? Giving voice on behalf of another. Acting in support of a belief or policy. The support of recommendation of a policy. What Else?!? –Making your voice heard. –Standing up for what you believe in. –Helping others who don’t know how to make their voice heard. –Getting involved. –Giving back.

5. Why is Advocacy Important? If not you, then who else? Healthcare is for everyone! Keep the lights on- job security. Who knows your community better than you? STOP being a bi-stander. The people we serve are in the greatest need but receive the least recognition. Accountability- holding your decision makers accountable. Working together- meeting the needs of the community.

6. Advocacy Has Rules! As an Advocate you need to know the Rules. It’s hard to break the rules, but you can do it if you don’t know what they are. Understand the difference between Grassroots Advocacy & Lobbying Make No Mistake – Health Centers can and SHOULD do both! Here’s Why…

7. Why Advocacy Has to Matter to Health Centers : Income Sources for Health Centers Marc Wetherhorn Consulting, LLC

8. Advocacy/Education Meeting with, calling, emailing, general communications to legislators or decision makers to educate them about your health center or the impact of issues to the Health Center There is NO LIMIT on the amount of advocacy/education Heath Centers may provide

9. Legislative Advocacy vs. Political Campaign Advocacy Legislative advocacy is allowed (within certain limits) Political campaign activity is entirely prohibited Marc Wetherhorn Consulting, LLC

10. Legislative Advocacy – “Lobbying” Advocating the enactment or defeat of pending or proposed federal, state, or local legislation. Marc Wetherhorn Consulting, LLC

11. Direct Lobbying vs. Grassroots Lobbying Direct Lobbying – communicating with legislators (including staff) Grassroots Lobbying – communicating with the general public in an effort to influence the vote of a legislative body Marc Wetherhorn Consulting, LLC

12. YES YOU CAN Can Health Centers Lobby? YES, and you should. More than 75% of a health centers’ budget is determined by federal, state and local government’s decisions. However, there are limits to what health centers can do. First of all, you cannot use ANY federal funds to lobby. Marc Wetherhorn Consulting, LLC

13. Allowable Lobbying Limits Substantial part test & Expenditure test –Expenditure test (IRC Section 501(h)) Clearer standard Allows 501(c)(3) organizations to elect to have their allowable lobbying measured by amounts expended for lobbying – Funds may be spent within certain limits, up to $1 million a year (e.g. 20% of first $500 thousand of “exempt purpose expenditures”) – No more than 25% of organization’s allowable lobbying expenses may be used for grass-roots lobbying Applies only if organization elects 501(h) treatment In short, the “real” restrictions apply to Federal Grant Dollars

14. Refresher: Lobbying, Voter Registration and Education, Advocacy Activity Lobbying = Face to face, phone call or email contact with legislator asking for action on a specific bill. Voter Registration (VR) and Education = Spectrum of activities. Advocacy/Education = meeting with legislators, or decision-makers to educate them about your Community Health Center. IRS limits Non-Profits to 5% of TOTAL budget (but not 330 funds!). Must be non-partisan! HRSA PAL encourages CHCs to provide VR (Not 330 funds). Amount of Advocacy/Education CHCs may provide is UNLIMITED!

15. One More Thing… Political Advocacy Can not Intervene in a political campaign –for or against a candidate –in an election for public office See Tax Exempt Organizations and Political Campaign Intervention www.irs.gov/charities IRS Rev. Rul. 2007-41 (June 18, 2007)

16. Why Does Advocacy Matter? Policy Decisions Do Not Happen in a Vacuum - Competing Priorities - Dueling Numbers - Health policy is about people Advocacy is Not Just Lobbying - Getting Policymakers to Pay Attention - Getting Legislators to Vote Yes (or No) Legislative Decisions ALWAYS Involve Politics - Good Policy Development is not enough - Sometimes votes matter more than relationships - What Good is Perfect Policy that Never Becomes Law?

17. Action = Effective Advocacy Effective advocacy has one requirement: ACTION –Simply discussing issues, challenges, and plans is NOT effective advocacy. To Be An Effective Advocate & Attain Your Goals You MUST –Make advocacy an ongoing commitment and priority. –Translate discussions, plans, and passions into moveable actions. –Make your voice and perspective heard and understood.

18. Effective Advocacy = Power Grassroots advocacy is about: BUILDING POWER –Power is not measured by the number of advocates on a list –Power is not measured by the number of small (or even large) victories we win. Power must be measured by our ability to successfully advance our own agenda and to make it unthinkable that any other political or special interest would ever want to take us on.

19. The Real Deal: Relative Effectiveness of Advocacy Communications 1. A visit to your health center 2. A personal meeting back home 3. A personal meeting in Washington 4. Personal telephone calls 5. Personalized Letters (faxed) 6. Personalized emails 7. Template emails (ineffective unless in volume)

20. Advocacy 101 The Basics Know what you want Know who can give it to you Know what they want Know how to make the loudest squeak Advocacy is an ongoing effort Keys to Successful Advocacy Advocacy is a competitive activity There are winners and losers and, sometimes a stalemate is a win! Advocacy is an ACTIVE, not a passive process You are not the only one who wants something; So you have to be heard through the din of all the other interests

21. Goals 1. To win 2. To positively Impact Advocacy Targets 3. To build an Ongoing Capability 4. To involve your board and staff 5. To involve the community

22. Metrics 1. Can someone get the target on the phone? 2. Can you get the target to your center & how often? 3. How often is the center in the media? 4. How many local organizations/elected officials do something CONCRETE to support you? 5. How many grassroots advocates do you have? How active are they? 6. How many voters have you registered? Do they vote? 7. How much of what you ask your targets for do you get?

23. Recognition - Recognize your targets -Recognize your community supporters -Recognize your best grassroots advocates -Recognize your advocacy leaders -Recognize your center!

24. Empowering Yourself Through Advocacy Your level of commitment is directly related to your ability to make an impact. You must demonstrate personal commitment to your issues if you expect to receive the support and commitment of your officials and community members.

25. Do’s & Don’ts of Health Center Advocacy Dos: – Know What You’re Asking For – Know Your Audience – Know Your Opponents – Know The Rules – Make a Commitment – Be Polite – Say THANK YOU – Keep it Simple Don’ts: – Offer Answers You Don’t Have – Assume Knowledge of Health Centers – Believe Someone Else is Taking Care of Your Advocacy – Burn Bridges – Be Intimidated – Confuse Being Quiet for Being Polite – Express Partisanship – Forget to make your ASK

26. Making Effective Advocacy Happen: Building A Culture Of Advocacy In order to realize the full potential of our grassroots power it is critical that we create a culture of advocacy at the local, state and federal levels Building a culture of advocacy means: –Changing the culture and attitude from within the health center, recognizing advocacy as a critical and mandatory component to our daily work and planning. –Making a commitment to doing the work to build and organize our grassroots in order to fully realize the potential of our grassroots power. –Growth and recognition of grassroots advocacy and effectiveness the same way other critical skills and programs are recognized for health center staff and boards.

27. MAKE YOUR VOICE HEARD!

28. HEALTH CENTERS FUNDING CLIFF Mandatory funding expires at the end of FY15 Without action by Congress, up to 70% cut to Health Center grants NHSC, THCs in same position (though ALL mandatory)

29. Access is the Answer Advocacy Campaign To force Washington to fix the Health Center Funding Cliff we have launched Access is the Answer– our campaign to organize EVERY HEALTH CENTER ADVOCATE to get Congress & the Administration to fix the Health Center Funding Cliff. The goal of the Access is the Answer Campaign is to demonstrate on a massive scale, the support that local communities have for health centers. To Accomplish this Goal we are asking every Health Center to take 3 Action Steps as part of the first phase of the Campaign.

30. Access is the Answer Phase 3 Action Steps: What can YOU do right NOW?! 1.Engage Your Health Center Board 1.Pass a Cliff Oriented Board Resolution 2.Send a Letter to Your MOCs from the BOD 2.Engage Health Center Patients & Staff 1.Collect Patient Advocate Cards 2. Launch a Staff Letter Campaign 3.Engage State Legislators & State Partners 1. Collect Individual Support Letters 2. Request Support for Sign On Letters via S/RPCAs

31. Templates in English, Spanish, Media templates Fliers and notecards Sample social media posts and images Sample Scripts & One pagers www.saveourchcs.org/about.cfm www.nachc.com/cliff Cliff estimator Cliff graphs Talking points and FAQs State-by-state fact sheets on economic impact HELPFUL RESOURCES TO FIX THE CLIFF

32. HEALTH CENTERS SUCCESS & OUR COLLECTIVE FUTURE DEPEND ON THE STRENGH OF OUR ADVOCACY. Local connection is the key to policy change – build relationships and demonstrate impact over time Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center The challenges ahead are huge, as are the opportunities. We have to take them on TOGETHER. ADVOCACY: THE BOTTOM LINE

33. Questions? apearskelly@nachc.com