1. Activating the Rural Voice on Health Care Reform April 1, 2009 – Lyons, Nebraska Presented by Herndon Alliance

2. * develop strong rural messaging * activate the rural voice * connect with the public, media, policy makers * help define the system change/health reform debate * help move health reform

3. Historically, opponents to health reform have had more success communicating with the public than proponents.

4. Good communication requires conviction and authenticity; being a walking dictionary is optional.

5. Drilling for Oil

6. Responsible Energy Exploration

7. Connecting on health reform? Almost 50 million people are uninsured; but 95% of the voting public is insured. People think about health care through a very personal prism.

8. Best way to connect: through values + beliefs

9. Values on health care Personalaffordable, sustainable Choice + controldoctor/patient relationship, quality Peace of mind + security Personal + shared responsibility

10. Barriers that stop the conversation Higher costs, lower quality (scarcity) Economic downturn Perceived lack of responsibility and/or fairness Cynicism for government & bureaucracy Fear of losing what you have

11. Words that Work Our Old Words Quality affordable health care American solutions Choice of public or private Choice and control Security and peace of mind Fair rules Universal health care Canadian style health care Medicare for All Competition Government health care for all Regulations

12. Sliding scale Prevention Guaranteed Government as watchdog Affordable health plans Smart investment in the future Free Wellness Required Public/Government health care Basic health care Inexpensive Words that Work Our Old Words

13. Its not just words... Start the conversation where people are Values + beliefs outweigh facts Anger motivates usfear shuts us down Proactive positive messages that: Build on high-order themes Create a unified voice Point to a narrative of a better future

15. Health care reform BIG themes

16. My budget My family My health My job Peace of mind What about me? People will agree that other people should have health care, but real support is always weighed against personal impact.

17. Messaging: personal Its not right that hard-working American families are struggling to afford health care. People shouldnt have to choose between filling a prescription or filling up at the gas station. Our leaders need to make health care more affordable for everyone before our costs rise even higher.

18. A core American value, helps make the case for guaranteed health care and system change Basic human right Fairness

19. Personal + shared responsibility We are all in this together. Responsibility

20. Public leaders set and enforce fair rules, but do not provide the service. Government as Watchdog + Guardian

21. Health is a basic component. The flaws of the health care system are a basic economic obstacle to: Providing for my family Affording our own home Putting our kids through college Starting my own business American Dream

22. Opportunities + Challenges

23. A 2009 Kaiser Family Foundation tracking poll, states that 38% of Americans think they will be better off if major health reform legislation is enacted. According to Drew Altman, CEO of the Foundation, if that number goes up, we will win health reform. If that number stays stagnant or goes down, we will not. We need good answers to the question what will health care reform do for me?

24. In talking about health care reform and system change, message around the value of reform for the insured + underinsured + uninsured

25. Messaging: Value of reform for the insured + underinsured + uninsured Affordable choices you can count on If you like your health careyou can keep it No more insurance company abuses Supporting your doctor + you We cant afford to wait

26. Challenging issues can be opportunities too! Cost of Doing Nothing System Change Government Role Choice of a Public Health Insurance Plan

27. Powerful CODN arguments Wages stagnant Costs rising Insurance company CEOs make in a day what working people make in a year Remember Understand the macro but feel the personal and speak about health reform as part of our economic recovery/protection (affordability)

28. Messaging: CODN (1) Health care is the top personal economic issue facing Americans. The majority of voters feel the economic challenges facing us make it urgent to reform health care.

29. Messaging: CODN (2) Unsustainable... projections for what will happen to the cost of health care are motivators for change NOW.

30. Nebraska data $4,445 - Cost per uninsured today Poor health and shorter life $.75 B lost/yr (to the state economy) 1.29% as a share of GDP ESI 2006-2016 $10,777/family to $22,975/family 22% to 42% of average family income Average deductible in NE will increase about 38% between 2006 ($1,325) and 2016 ($2,120) New America Foundation, 2008

31. Messaging: CODN (3) Voters angry with greedy profits of insurance companies + CEO salaries.

32. System change: research findings Widespread support for health system change 69% of voters want either a complete overhaul or major reform Voters think about system change in personal terms and consider how change will affect their relationship with their doctorcrucial to connect on system change in personal ways We win the system change/ cost control/ improved efficiency/ comparative effectiveness arguments, even against potent attacks of big government and interfering with the doctor-patient relationship However, when these attacks dont have push back voters do begin to develop doubts

33. How insiders talk about system change System is inefficient System is costly System needs to improve quality outcomes System doesnt have enough primary doctors System is inequitable (ex: rural vs. urban) 16-17% of GDP - huge concentrated industry System is unsustainable for the American economy System needs to align incentives System needs to remove waste System needs updated health information technology

34. How voters talk about system change through a personal lens Health care is good if: I have choice of doctors and plans My doctor can do what is right for me I can afford my health care I can see my doctor when I need to Any changes to the system should: Help my doctors do their job and support them in providing the best care for me Simplify the system for both my doctors + me

35. Americans want reform that brings about: the best care for them + cost containment + affordable access 81% of voters are dissatisfied with the rising costs of their health care. 62% are concerned that all people have access to affordable care. We must not separate these system change issues.

36. System change supported by the public Payment reform Reward doctors for providing quality care Encourage preventionprovide incentives for people to actively manage their health before they get sick Allow professionals, other than doctors, to provide more care to both free up doctors and help control costs Modernize the system with health information technology Institute comparative effectiveness reforms but without data replacing their doctors judgment Control overuse of the system

37. Messaging: system change Greatest dissatisfaction among voters is with the rising costs of health care; want to contain costs while improving quality.

38. Farm and ranch families struggle with health care costs Often forced to buy insurance on the individual, non-group marketspending twice as much as group market ($11,200 vs. $5,600) 36% of farm and ranch families buy on the open market vs. 8% of American public Spend more, coverage less Threatens stability of family, viability of their business, the strength of the rural economy, and our nations rural heritage. Robert Wood Johnson Foundation/Access Project, 2007

39. Opposition messaging on system change The most effective opposition messages are ones that connect system change with interfering in the patient/doctor relationship and the quality of care we receive. We continue to win support, but we should be prepared with effective responses to the opposition.

40. Example of opposition message Forcing doctors to accept government mandated guidelines about treatments means putting government bureaucrats in charge of our health care, not our doctor. And pushing care down to lower level providers like nurses means well get lower quality care from people with less training. This isnt reform its a government takeover that will hurt patient care.

41. Biggest challenge.... Positive role for government and a choice of a public health insurance plan.

42. Messaging: positive role for government Set and enforce fair rules Be a watchdog

43. Government role under attack Bureaucrats will decide your health care Big government will get between you + your doctor Evidence based care is centralized decision-making (un-American)

44. Public health insurance plan Private choices only15% Public choice only9% Public and Private choices73%

45. Messaging: choice of a public health insurance plan Voters want it Choices Guaranteed back-up On the side of small business, farmers, and sole proprietors It already is working in 30 states A 75-year old smokescreen A competitive marketincreased competition

46. Define positive role and public plan debate The best defense is a good offense proactive Stay at a high level + avoid getting into details* On side of voter *Avoid getting into the details DO NOT get sucked into debating the details of reform. Avoid policy details and speak in the language of the kitchen table. Aim your messaging for the heart, not the head. If your message is not emotionally compelling, start again.

47. Kitchen table talk Relate health reform to the everyday life of real people. How will it benefit the person in front of you? Will they have choice, affordability, peace of mind? Acknowledge they are hardworking and create jobs for others. Messenger: farmer, small business voice.

48. We all benefit from the rural voice setting a higher frame and/or rebutting attacks Visionthe value of reform from a rural perspective Fairnessneed standards so all are treated fairly and with dignity Real choicesimportance of both public and private plans Sustainabilityimprove the care people get AND control the costs

49. Questions & Comments www.herndonalliance.org sherry@herndonalliance.org

50. Messaging: personal Its not right that hard-working American families are struggling to afford health care. People shouldnt have to choose between filling a prescription or filling up at the gas station. Our leaders need to make health care more affordable for everyone before our costs rise even higher.

51. Messaging: fairness Real reform means putting Americans back in control of their health care. We need better oversight and sensible rules to make sure that insurance companies provide fair and affordable coverage.

52. Messaging: responsibility We need to make health care more affordable for everyone, and everyone needs to pay their fair share. We need solutions that work for families and businesses alike. But the insurance companies and the drug industry must be part of the solutionputting the well-being of patients before their skyrocketing profits.

53. Messaging: government as watchdog We need leaders willing to take on insurance companies, by setting clear, high standards for whats covered, preventing them from requiring patients to jump through hoops just to get insured, and saving billions by cutting administrative costs and moving to electronic medical records. If we stopped wasting doctors time with paperwork, theyd have more time for us and we wouldnt have to worry about overloading our system.

54. Messaging: American dream Its time we got America back on track. And one of the best ways to help our economy is to fix our broken health care system. Making health care more affordable would put money back in our pockets so that we can send our kids to college or start that family business weve always dreamed aboutthats what America stands for.

55. When Wall Street collapsed, taxpayers footed a $700 billion bailout. But Main Street is hurting too. Americas working families are struggling to pay skyrocketing health care costs and premiums. Too many of us can no longer afford or have been denied coverage. Our economic recovery is tied to fixing our broken health system. Messaging: CODN (1)

56. Our health care system is broken. Americas working families are struggling to pay skyrocketing health care costs. Too many of us either can no longer afford or have been denied coverage. The number of uninsured Americans keeps rising. And the staggering amount$56 billion annually of uncompensated care to the uninsured just increases the cost of health care and premiums for all of us. The current path is unsustainable and were all paying the pricewe have to fix this problem now. Messaging: CODN (2)

57. Messaging: CODN (3) Main Street is hurting. Americas working families are struggling to pay skyrocketing health care costs and premiums, while their wages remain stagnant and their health benefits sliced. Too many of us can no longer afford or have been denied coverage. Meanwhile, the CEO of United Health Insurance was paid more than $350 Million in a single year and the industrys profits keep soaring. Now is the time to stop the greed and take care of the health of all of us, not just the profits of insurance companies.

58. Messaging: system change We need to make sure doctors have access to the latest research that compares the effectiveness of different treatments, such as comparing which drugs work best. This will help doctors and patients make more informed choices, rather than risk our receiving less effective treatments.

59. Messaging: positive role for government Hardworking Americans need protection from insurance companies that increasingly deny us coverage for pre-existing conditions, change policies at whim, and raise our premiums whenever they want. We need an independent voice that is on our side, sets and enforces rules that are fair to our families, as well as businesses. We need a tough, fair and independent watchdog on our side.

60. Messaging: public health insurance plan option Its just wrong for people who work hard and pay taxes to go without affordable, quality health care. Too many middle class Americans are struggling to afford health care they can count on for themselves and their families. We need a public health insurance option as a guaranteed backup that will always be there to ensure quality affordable health care coverage is available no matter what happens. It would give millions of hard- working families peace of mind.

61. Messaging: small business Small businesses are struggling with rising health care costs. That's a serious problem for all of us, because small businesses are the engine of job creation in America. Were strangling small businesses and American ingenuity, as people stay in so called safe jobs that have health care rather than doing what Americans have always donestart a business with a little capital, a lot of elbow grease, and a good idea.

62. Messaging: small business We need tax breaks for small business to help them with health care costs. Tax breaks will lighten their load so they can get back to what they do best…create jobs in our hometowns. Our health care crisis is bad for the economy and cripples the American dream of owning your own business. The success or failure of a business should depend on innovation and hard work – not the cost of health insurance.