3 questions to reshape your policy agenda

3 questions to reshape your policy agenda

By HealthConnect Fellow Mary Nelle Trefz, Health Policy Advocate with Common Good Iowa

Like many of my fellow advocates, I am beginning to look ahead to 2021 and prepare for the upcoming legislative session. One of the first things I do to prepare is develop a policy agenda—a list of priorities that will serve as my roadmap for the coming year, guiding how I spend my time and where I devote my resources. Thousands of bills come before the legislature each session and with an anticipated budget shortfall this year, it will be more important than ever to be strategic in developing our priorities for the 2021 session.

Developing a policy agenda is normally a combination of looking back (What worked last year? What could we have improved?) and looking to the future (What threats have emerged? What new opportunities can we leverage?). But a mentor recently asked me three questions that have challenged me to take a different approach to crafting my agenda and to think bigger and bolder about the change we can lead for Iowa’s kids.

Here are those three questions and how I’m thinking through them:  

1. What would it look like if… ?

In my case, asking this question—What would it look like for kids if Medicaid operated as you imagine it could?—encouraged me to think outside the box, to not be constrained by the political or fiscal landscape and to get back to why I started this work to begin with. It allowed me to dream about a brighter and healthier future for our kids.

Here are a few of the things that I dreamed about:

  • Reduced health disparities: Medicaid and CHIP are primary sources of health coverage for all children. But Medicaid plays a particularly important role for children of color, who are disproportionately represented in the Medicaid population, often due to systemic barriers that lead to more families of color living in poverty. For example, Black children make up 5 percent of Iowa’s child population but nearly 10 percent of the Medicaid population.[1] Improving how Medicaid delivers care to kids can serve as a critical vehicle for reducing health disparities. Research shows that Medicaid/CHIP coverage for children expands access to health care and has long-term benefits.
  • Medicaid as the "gold standard" for pediatric health care: Medicaid’s comprehensive, high-quality care would serve as a model pushing the private sector to follow, improving the standard of care for all kids.

Reflecting on this question was important because it reminded me to focus on some of my long-term goals. With the fast-pace of sessions (often lasting 100 days or less) and rapid election cycles, advocates can easily get caught up in prioritizing quick wins and short-term gains. While these wins have their place, I needed this question to help me “zoom out” and see the bigger picture of what I want the landscape of children’s health care to look like in Iowa.

2. What are the barriers to creating the reality you just imagined?

This question brought me back to Earth a bit as I thought about some of the challenges I have faced over the years, but I was facing these barriers with a new perspective. I had been reminded of my BIG goal and I wasn’t going to let a few challenges get in my way. It made me think of a statement Senator Elizabeth Warren made when she announced that she was suspending her campaign for President: “Choose to fight only righteous fights, because then when things get tough—and they will—you will know that there is only one option ahead of you: Nevertheless, you must persist.”

Many of the barriers that I identified are challenges that other advocates are also wrestling with:

  • How do we make kids truly a priority for our decision makers and elected officials (especially when there always seem to be more “pressing issues” or crises that bump kids down the list)?
  • How do we overcome the inertia of status quo?
  • Kids issues shouldn’t be a one-party issue, but many of the issues impacting kids have become overly politicized. How do we break through the noise and create lasting change?
  • How do we flip the script and instead of focusing all our time and energy in defensive mode (protecting programs from cuts and harmful changes), how do we create the space needed to be bold and proactive?

While we often acknowledge the barriers we face (there is nothing like a good venting session!) we can’t stop at simply identifying these barriers; we must develop a plan to overcome them, which brings me to the third question...

3. What role do I want to play in overcoming those barriers? 

This final question prompted some self-reflection:  

  • Where are my strengths as an advocate?

  • Where are my weaknesses?

  • What kind of an advocate do I want to be?

  • How can I work with partners to leverage our collective strengths?

I want to be a persistent presence for kid—that broken record who is always asking, “What about the kids?” I want to help our policymakers develop a pediatric lens with which to analyze their policy decisions, illuminating how their decisions positively or negatively impact the children and families of Iowa. I want to be viewed as a true partner in this work, collaborating with my fellow advocates and bridging new partnerships with unexpected allies. I want to be solutions-oriented and a problem-solver, coming to the table ready to roll up my sleeves and work to make things better for Iowa’s kids.

This last question also left me with a new roadmap, not my policy agenda roadmap, but a sense of direction and renewed purpose. I was reminded of what I was working for and my commitment to playing a role in addressing the barriers to achieving this goal, and the knowledge that together, with my partners, we would persist.

As you consider your own agenda and why you’re advocating this year, join me in asking these questions. There is so much turmoil and distress in the world right now and we are caught up in deep political divides, but if we stay focused on the bigger picture of what we want to achieve together and why that matters to our future, we can see the path ahead.