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After the Health Bill Collapse: Where Do We Go from Here?

By Chuck Alston, Senior Vice President, MSLGROUP

“Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew healthcare could be so complicated.” — President Donald J. Trump, Feb. 27

“We’re going to be living with Obamacare for the foreseeable future.” — Speaker Paul Ryan, March 24

With the collapse of Republican efforts to repeal and replace Obamacare, the Affordable Care Act remains the law of the land. But while the Trump Administration and Capitol Hill turn their attention elsewhere, the debate over the future of the nation’s health care system isn’t going away. Neither is the fact that health care is complex.


For these reasons, this is no time to relax. While the overriding narrative of health care policy for the moment is Washington finger pointing, in due time attention will turn back to the fundamentals that drove the debate:

Why is health care so expensive, and what can we do about it?

Should the government provide health care coverage to every American? If so, how and how much?

Moreover, the Trump administration can still influence the failure or success of private insurance markets (think marketing dollars and cost-sharing subsidies), experiments with alternative payment and delivery systems (think rules that change innovation pilots), or Medicaid expansion rules (think qualifying requirements).

What does this mean for you?

Start by reconsidering how you tell stories that address these questions and issues. The Triple Aim — better population health, better care/experience of care outcomes, and lower costs — is a useful tool for organizing your stories.

Your stories should demonstrate how your business and clinical models (or those you favor) deliver on the Triple Aim, no matter whether you represent patients, providers, payers or purchasers. A close corollary: The more your models (and hence your stories) reflect the paradigm shift from volume to value, the better.

The collapse of the legislative effort is a natural hook to start a new conversation. Much of the checklist I laid out in the previous memo about health care communications still applies. This memo focuses on the what, how and where of storytelling.

Listen to your lobbyists. The absence of a moving target on Capitol Hill does not diminish the importance of coordinating closely with your government affairs (GA) team. Ask them: What resonated — and what fell flat — on the Hill? What is your new assessment of our friends, foes and fence sitters? In particular, did new champions or allies on or off the Hill emerge? Who needs to hear more from the folks back home?

Assess your narrative. In recent years, the hospital lobby has alternated its messaging between the impact of coverage decisions on patients and on jobs. It is worth noting that each shares a focus on people, not revenue. The pharmaceutical industry, under attack for its pricing, is now pouring millions into a campaign to change the subject, emphasizing the industry’s “biopharmaceutical innovations and life-changing progress.”

Both conducted quantitative and qualitative research into how to frame their industry and its issues. But if you don’t have a research budget, you can still reassess your overall narrative, your messaging and proof points with any available data points. Again, talk to your own lobbying team; look at what drew likes, shares, retweets, etc.; analyze how much time was spent on content; assess what your friends and foes did. Even if you end up pretty much where you started, the exercise is worthwhile if for no other reason than to bolster your confidence.

Tell stories with people and proof. Restock your bank of patient and provider stories to explain the impact of existing policy and the changes you still want to occur. And while people remember stories about people, they also want facts.

Politics is local, so is storytelling. Members are reading hometown newspapers, and local media is always looking for a hook to a Washington debate. Instead of competing for a Beltway mention, make your proof points relevant with local publications in the districts of key members. With the right data and national hook, the story can then be repurposed for DC tips sheets, broadening your reach.

Make the complex simple. Because health care is complex: you have to work hard to make it simple. If it helps patients stay well, get better quicker, or lowers their cost, say so. And say why. Your DC friends will remain hungry for new facts to back your shared position, and that they can use to help sway fence sitters.

When talking points won’t do. Wonks actually like complexity. Some influential committee staff, think tank types and media members will still dig into a meaty study that a member, his immediate staff or a tip sheet reporter doesn’t have time for. They want to judge your facts, arguments, and even methodology for themselves. They are the people who will tell your GA team that your position wasn’t strong enough, or lacked serious underpinning. This is the time to commission research to shore up those weaknesses.

Put away your blunderbuss. This is the time for narrowcasting. Your best communications vehicles for the time being may be one-on-one meetings with members, key stakeholders and media. A better one pager, infographic or case study, or targeted op-eds and LTEs, may be the order of the day. You should repurpose these as native content for paid Linked in or Facebook campaigns.

Think more about the “who” than the “where” of your paid efforts. Your paid media narrowcasting should target by geography and occupation. It’s not only effective it’s also efficient.

Say thanks with care. Creating consequences — positive and negative — is typically the order of the day during and after a major legislative battle. This is one case where you clearly can’t assume that a member voted for the outcome you wanted for the reason you wanted.

Work on your website. Were people able to find the information they needed when they needed it? Ask around, starting with your own team and your analytics. Do it convey your messages clearly and effectively? Did you have something shareable other than a PDF to make your case? Was your landing page for paid digital media links strong, with a clear call to action? If the answer to any of these is no, there’s your to-do list.

Changing course isn’t saying you were wrong, only that you can do better. Good communications can learn from process engineering. The legislative failure of “repeal and replace” lands you at the halfway point in the continuous improvement cycle of Plan/Do/Study/Act. You have Planned, and you have Done. Now is the time to Study and Act.

Got a question? Contact me:

ChuckAlston1Chuck Alston is a Senior Vice President at MSLGROUP in D.C. He is an expert in healthcare policy.

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