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Advocating for Preventive Care :

1 Mary Thompson, PT, PhD, GCS Advocating for Preventive Care

Defining Advocacy:

2 Defining Advocacy Support for a cause Influence outcomes A means of bringing about social justice Empowerment May embrace a wide variety of activities Individual or group activities Usually a volunteer activity done within or outside of one’s day-to-day job

What is Advocacy?:

3 What is Advocacy? Advocacy is the tool citizens use in our democracy to bring about improvements. Advocacy represents the strategies devised, actions taken, and solutions proposed to influence decision-making at the local, state & federal level to create positive change for people and their environment. Does not include lobbying by its true definition Lobbying is an attempt to influence specific legislation Advocacy may look like lobbying but directed to a cause or public policy issue.

Who is a Self-Advocate?:

4 Who is a Self-Advocate? I define me! A person from a vulnerable population who speaks out A self-advocate is a leader Self-advocates work together to make life better for people like themselves A self-advocate works hard to make a difference in their community

Why is Self-Advocacy Important:

5 Why is Self-Advocacy Important People from a vulnerable population are the experts on their lives. Encourage them to speak up about their life. Tell them that is a way they can help make things better. If all self-advocates work together with allies, they can make a difference.

Advocates Need Knowledge of…:

6 Advocates Need Knowledge of… Preventative care in general and preventive programs Clientele needs and benefits received Funding sources and needs Government process and structures Roles of pertinent elected officials

Advocates Need Knowledge of Funding:

7 Advocates Need Knowledge of Funding Sources Employer-based Insurance Public Financing Medicaid Medicare Needs Reduce spending (all sources) Balance the overall State &/or Federal budget

Government process & structures and roles of elected officials:

8 Government process & structures and roles of elected officials Legislative Branch State government Federal government How advocacy fits in at either level Executive Branch Regulator process How advocacy fits in

Texas State Government:

9 Texas State Government Branches of government Legislative branch Executive branch Judicial branch Checks & Balances Governor Lieutenant Governor TX Supreme Court

Passage of Law in Texas – Odd years:

10 Passage of Law in Texas – Odd years See figure on right Illustration shows bill introduced in the House. Bills also introduced in the Senate. Bills with the best chance of passage begin with both House & Senate versions.

Procedures governed by TX Constitution & by rules adopted beginning of each session.:

11 Procedures governed by TX Constitution & by rules adopted beginning of each session. B ill must read on 3 separate days. 1st reading: Bill introduced & referred. 2nd reading: Bill back to floor. 3rd reading: Final vote. If bill amended: must adjust differences. When passed by both bodies: Governor acts (or doesn’t).

Passage of Law In Texas: Even years:

12 Passage o f Law In Texas: Even yea rs Why doesn’t the Texas Legislature meet every year like everyone else? What happens in even years? Work on interim charges Task force Hearings Planning Draft legislation

Passage of Law In Texas: Big Picture:

13 Passage o f Law In Texas: Big Picture Who is the most powerful person in Austin in terms of elected office? What is the most powerful committee(s)?

Passage of State Law & Advocacy:

14 Passage of State Law & Advocacy Pre-Bill > Communicate needs & interest Introduce Bill in H &/or S> Support/assist in working bill Assist others to see value of bill Full Committee(s) > Subcommittee(s) > Hearings & Markup > Full Committee > Hearings & Markup > Report Full H &/or S (may amend) for vote > Encourage nonsupporters Thank supporters Conference Committee & Report > Governor > Act signed into law or vetoed & returned to Congress for override or sustain veto > Encourage Governor to sign IDEA CONSEPTION IF PASS, GO TO AGENCY FOR REG.s

Advocacy via TPTA Legislative Days:

15 Advocacy via TPTA Legislative Days TPTA plans legislative days in Austin for each district. Meet with lobbyist &/or Gov’t Affairs chair. Fact sheet on current legislation important to TPTA. Strategies may be different based on what is going on Visit your senator & representative. Sometimes TPTA provides screening & health education once per session.

Federal Government:

16 Federal Government Branches of government Legislative branch Executive branch Judicial branch Checks & Balances

Passage of Federal Law:

17 Passage o f Federal Law Introducing Bills Role of Committees On the Floor of House & Senate Final Steps

I’m just a bill:

18 I’m just a bill http://video.google.com/videoplay?docid=7266360872513258185&q=I%27m+just+a+bill&total=2041&start=0&num=10&so=0&type=search&plindx=2

Introducing Bills:

19 Introducing Bills Originated by anyone - presedent, congressman, person or group. Sponsored (introduced) by any House or Senate member. To have a chance at passage, then need to be sponsored both in the House and Senate.

Role of Committees:

20 Role of Committees Assigned to the committee/s which has jurisdiction of the subject matter contained in the bill. Example: 1994 Health Care Reform House Ways & Means: Rostenkowski (D-IL). Energy & Commerce: Dingell (D-Mich.). Education & Labor: Ford (D-Mich.). Senate Finance: Moynihan (D-NY). Labor & Human Resources (currently called Health, Education & Labor) : Kennedy (D-Mass).

Role of Committees continued:

21 Role of Committees continued Usually assigned to a subcommittee. Subcommittee holds hearings, may edit the bill, & then report back to the full committee. Bill may be amended in the subcommittee or full committee. Majority in committee must vote in favor of bill for the bill to be reported out to the floor.

On the Floor: Bill placed on calendar for consideration:

22 On the Floor: Bill placed on calendar for consideration House Consideration: Limited debate on the floor--Rules Committee determines Bill may be amended on the floor. Senate Consideration: Unlimited debate on the floor - fillabuster Bill may be amended on the floor.

Final Steps:

23 Final Steps Resolution of differing versions informally, by original committees, or conference committee: were the "real" law is crafted. Final version of bill brought back to both House & Senate for vote. Bill passed  Goes to President. President may sign it into law (bill Act) , veto, or do nothing. If veto  back to Congress with objections. 2/3 vote in Congress can override a veto.

Passage of Federal Law & Advocacy:

24 Passage of Federal Law & Advocacy Pre-Bill > Communicate needs & interest Introduce Bill in H &/or S> Support/assist in working bill Assist others to see value of bill Full Committee(s) > Subcommittee(s) > Hearings & Markup > Full Committee > Hearings & Markup > Report Full H &/or S (may amend) for vote > Encourage nonsupporters Thank supporters Conference Committee & Report > President > Act signed into law or vetoed & returned to Congress for override or sustain veto > Encourage Pres. to sign IDEA CONSEPTION IF PASS, GO TO AGENCY FOR REG.s

Executive Regulation - After law is passed:

25 Executive Regulation - After law is passed Responsible governmental agencies write rules, regulations, & or guidelines to make the law "do-able". Proposed rules & regulaitons published in the Federal Register (or equivalent state pub) Public hearings before or after regulation s proposed. Due process applies to regulatory agencies.

Review the Federal Rule Making Process:

26 Review the Federal Rule Making Process Medicare as an example: see website below http://www.archives.gov/federal-register/tutorial/tutorial.zip Public Hearings

Example: Tim Kauffman & 1986 30-day rule:

27 Example: Tim Kauffman & 1986 30-day rule Kauffman: in private practice; sees primarily elders. Concerned about Medicare’s imposition of 30-day recertification requirement on non-Medicare patients. Wrote letter to HCFA, cc to APTA & legislators. HCFA justified decision. Kauffman sent 2nd letter challenging rationale. A physical therapist in HCFA phoned Kauffman. Kauffman called chair of Senate Finance committee. The staff member found situation to be unbelievable. Many physical therapist s continued to push issue. Senator cosponsored an amendment to change it. The bill passed & the regulation was recended.

Advocates Need…:

28 Advocates Need… Communication skills Written Document facts and opinions on issue Keep track on phone calls (date, time, name/title, phone number, topic) Follow up phone call with email or letter Verbal Face-to-face meetings best Use personal stories or examples to make points real LISTEN Read body language

How to be More Effective in the Advocacy Process: Dos & Don’ts:

29 How to be More Effective in the Advocacy Process: Dos & Don’ts Make sure your legislator knows people who are affect by bill. Be honest, direct, brief, & positive. Supply 1 pg. fact sheet. Talk with staff. Write thank you notes. Be a patient advocate. Don’t forget there are other issues. Don’t hesitate to say you don’t know something. Don’t press for results on the 1st visit. Don’t be offended if legislator misses or is late for appointment.

An Example:

30 An Example The Section on Geriatrics - Section Advocate for TX Advocates work creatively Projects dictated by their own passions/interests Advocate projects are related to promoting the value of PT to consumers, educating other PTs/PTAs about best practice geriatric physical therapy, reaching out to PT/PTA students, &/or recruiting more members for the Section on Geriatrics.  Advocates work to expand activism in their state by supporting & empowering other Section members in the state to also take on grassroots projects.

Another Example:

31 Another Example The US Surgeon General is an advocate for preventive care Obesity Tobacco use Drug and alcohol abuse Asthma Diabetes Acting Surgeon General Rear Admiral Steven K. Galson, M.D., M.P.H. 2007-present

Qualities of Successful Preventive Health Advocacy Programs:

32 Qualities of Successful Preventive Health Advocacy Programs Collaboration between health care groups, public health, community groups, and educational groups Physicians & other providers, patients & consumers, public health officials need to work together to be effective.

Creating a Culture of Advocacy in Your Workplace:

33 Creating a Culture of Advocacy in Your Workplace Understand what your patients/clients care about and helping them succeed Patient/client satisfaction is not enough – establish relationships Entices the patient/client to become involved in their own success Talk about advocacy Model advocacy

Being an Advocate for Preventive Care in Your Workplace:

34 Being an Advocate for Preventive Care in Your Workplace Provide classes for the community Encouraging patients/clients to: have appropriate screenings and tests visit the appropriate health care provider if they are experiencing problems Can be an ethical issue Making adequate time for education on preventative care when, in our current health care environment, there’s no reimbursable code for preventive care, even though we as providers are obligated to provide it.

Blackboard Discussion:

35 Blackboard Discussion If you have ever gone on a legislative day, tell us about the experience. In the near future, what are YOU going to do to advocate for preventive care?

Thanks for listening, now talk, then do.:

36 Thanks for listening, now talk, then do.

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