Taking it to the People: Engaging the Public in Health Reform Implementation

Educating the general public about the ACA and soliciting input on policy decisions are crucial tasks for state policymakers. Unlike key stakeholder groups, members of the public typically lack an in-depth knowledge of the law, and communicating on these issues can be challenging. A recent Kaiser Family Foundation poll found more than half of respondents said they did not have enough information about the law to know how it would affect them personally.
Several states, including California, Oklahoma, Georgia, Colorado and Kentucky, have created user-friendly websites that update residents on the state’s health reform implementation activities. These sites feature implementation information broken down by consumer group, agendas for upcoming stakeholder meetings, and web forms that residents can use to provide input. Some state agencies are also using social media to reach diverse audiences. The Idaho Department of Insurance includes health reform news in its Twitter feed and the Nebraska Department of Insurance uses a Facebook page to help in Exchange planning.
Beyond a website, effective public outreach can utilize community forums, presentations to local groups like chambers of commerce and civic organizations and web surveys. In Oregon, a state with a 20-year history of health reform, state officials partnered with stakeholders to conduct anengagement campaign leading up to the 2009 creation of the Oregon Health Authority, the organization overseeing most state health care programs. Those efforts—which resulted in input from thousands of people statewide—helped lay the groundwork for continued public discussions about the state and federal health reform.
States don’t need to have an extensive history with health reform to successfully engage the public in ACA implementation, says OHA Director Dr. Bruce Goldberg. State Refor(u)m recently interviewed him and he offered these lessons from the Oregon experience:

• Invest in infrastructure: Coordinated, effective outreach requires putting together a plan and investing in the people, materials and other infrastructure required to carry it out. Before enacting state reforms, Oregon cobbled together several funding sources to hire a person to travel around the state and meet with hospital staff, elected officials and other opinion leaders about local health care challenges. The state later hired a community engagement coordinator and devoted resources to polling, organizing stakeholders, and holding more than 100 public meetings. A challenge for many states is how to make these kinds of investments in light of shrinking budgets.

• Language matters: While terms like “health insurance exchange” and “accountable care organization” have become part of the health policy lexicon, they can be surprisingly difficult to explain to a general audience. In Oregon, officials spent a lot of time figuring out how to talk about complex health care topics in a way that was meaningful to the public. They also used comments from early surveys and meetings to get a feel for what themes resonated with people, developing a message about reform that highlighted local values and personal stories. For more on how to talk about the ACA, check out this article from AmericaSpeaks, an organization that works to engage citizens in public decision-making.

• Make the most of the web and social media tools: Officials in Oregon used a variety of web-based resources to disseminate information about state health reform and gather input from the public. Meetings of the Oregon Health Policy Board use live streaming on the Internet, with citizens submitting questions to the board via email. A monthly e-bulletin goes out to more than 10,000 recipients, and others receive updates via Twitter and Facebook.

What is your state doing to include and get input from the general public in the implementation process? Share your state’s work on State Refor(u)m by going to the states page, finding your state and clicking on the related milestone, or engage in a cross-state discussion on the issue.