Washington:

Coverage to All Children

Lessons Learned

Multi-year campaigns can create the momentum for larger change. The success was the cumulative effect of years of advocacy. During some periods, Washington actually went backwards. But, by documenting the harm to children for the media and policymakers, it was possible to turn children’s health coverage into a high profile issue. In particular, children’s coverage became a central issue during the state’s 2004 Gubernatorial campaign, which resulted in a commitment by the winning candidate (Governor Gregoire) to take action soon after she was elected.

Identifying policymakers who can be champions and work strategically is critical for success. Without the Governor’s leadership from her first days in office, covering all kids would not have been possible. Her public commitment to the issue resulted in major inroads towards achieving coverage for all children. However, having key champions in the House and Senate allowed advocates to continue to have a voice when there were areas that needed more attention than what they were getting under the Governor’s leadership. It was critical that the leadership and staff from the House and Senate regularly met with the Governor’s office to discuss the common goal of covering all children. These conversations allowed the process to unfold and move quickly without many process-oriented obstacles.

A strong coalition where all members feel ownership helps solidify support. The coalition consisted of representatives from the provider community, children’s advocacy groups, hospitals, the insurance industry, and many other organizations. All members of the coalition had a role in helping to draft the proposal that the Health Coalition for Children and Youth (HCCY) developed. Because all members of the coalition were involved in the development of the proposal, they felt a strong sense of responsibility for getting it passed into law. Additionally, the sense of ownership about the proposal helped the coalition work towards consensus when there were areas of potential disagreement.

Coverage for immigrant children is best incorporated into an “all kids” message. While Washington was able to secure some coverage for immigrant children prior to the 2007 session, these gains were small and very contentious. However, the comprehensive bill in the 2007 legislative session that addressed a wide range of policy improvements to cover all children and improve their access to care proved to be an effective strategy for covering immigrant children.

After policies are adopted, significant work is required to successfully implement them. Now that the law is on the books, coalition members are working with the state agency on the subcommittees implementing the program. These subcommittees are co-led by members of the coalition and representatives from the state agency and are focused on three areas: outreach and enrollment, renewal and application simplification, and identifying performance measurement and accountability benchmarks for medical homes.

Once a policy success is achieved, it is vital that the results of the success are continually documented and shared with the public and policymakers. Washington was an early leader in covering children—a fact not well known by the public at the time. Moreover, these gains in coverage were not seen as victories and positive investments in the future, but rather as financial burdens by policymakers. If instead, Washington’s early successes in covering children had been understood and praised by the public and policymakers, the state might not have taken the backwards steps it did in 2002.