How can you move a policy forward? What strategies need to be implemented, evidence compiled, or resources utilized? What is the plan for the legislative process?? For this Assignment
How can you move a policy forward? What strategies need to be implemented, evidence compiled, or resources utilized? What is the plan for the legislative process?
For this Assignment, you will create a Personal Legislative Agenda in which you will detail your strategy for moving your policy through the legislative process.
Begin working in Week 5, it is not due until Week 7.
- Review the Personal Legislative Agenda and Action Plan Exemplar to demonstrate how you will construct your Personal Legislative Agenda for the state and federal proposed legislation.
- Review the Personal Legislative Agenda and Action Plan Exemplar to determine which approach might work best for advancing your policy initiatives at various stages of the legislative process.
Submit a Personal Legislative Agenda detailing your strategy for moving your policy through the legislative process, using the Personal Legislative and Agenda and Action Plan Exemplar as your template.
In your Personal Legislative Agenda, choose from the strategies provided in Advocacy Toolkit resource that best suite moving your policies forward. Be sure to connect the strategies to the appropriate sections of the policy model you selected in Module 2.
Agenda: Nursing Shortage
See attachment for the form that needs to be used
Context: I am a Family Nurse Practitioner and volunteer two afternoons a week at a free primary healthcare clinic in South Florida. The majority of our families are Latino or Haitian immigrants, and most of the children have at least one undocumented immigrant parent. None of the families have health insurance, many suffer chronic conditions (such as, asthma, diabetes, and HTN), and their only source for medication is from the clinic.
Problem: The fear of deportation, incarceration, and/or family separation discourages undocumented immigrant families from seeking healthcare until the symptoms are so severe, they can no longer be ignored. There are very few specialists who will accept our referrals; those who do have long wait times for appointments or are too far away for most of our families. Access to affordable health insurance and comprehensive healthcare services are desperately needed for undocumented immigrant families in South Florida and across America.
Proposed State Legislation: HB 135/SB 640: Florida Kidcare Program Eligibility
My position: Support Oppose Amend Watch
Proposed Federal Legislation: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021
My position: Support Oppose Amend Watch
My Advocacy Actions
of Proposed Legislation
State: HB 135/SB 640: Florida Kidcare Program Eligibility
Increases income eligibility threshold for coverage under Florida Kidcare program; excludes undocumented immigrant children from eligibility
9/20/21: HB Filed
10/26/21: SB Filed
referred to Finance & Facilities Subcommittee; Healthcare Appropriations Subcommittee; and Health & Human Services Committee.
11/16/21: S 640 referred to Health Policy; Appropriations Subcommittee on Health; and Human Services; Appropriations.
Sent email thanking Representative Bartleman and Senator Hooper for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the Florida Association of Nurse Practitioners (FANP).
After reviewing the bill co-sponsors, I saw that my elected officials were not listed. Sent an email to my district legislators, Representative Joseph and Senator Pizzo to encourage them to co-sponsor the bill.
Signed up with Florida Senate Tracker to receive legislative updates on the status of the House and Senate bills.
Wrote a 250-word editorial for the Miami Herald praising the bill and pointing out the need to include undocumented children. It was published on 11/10/21.
I talked with co-workers at the clinic about the legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.
I’m a member of the county’s Women’s Democratic Club and talked about the legislation at our monthly meeting.
Neither of my elected legislators sit on any of these committees. I worked with FANP and Catholic Charities Immigration & Refugee Services to develop testimony about my experiences with undocumented immigrant families and children in South Florida; and worked collaboratively to develop a fact sheet comparing the health of immigrant and nonimmigrant children in Florida. Both were presented by organization lobbyists at the Health Policy Committee hearing for the Senate bill, with a request to amend the legislation to include undocumented immigrant children.
1/5/22: HB 135 was withdrawn.
3/14/22: SB 640 died in Health Policy.
Send thank you emails (as a member of FANP) to all sponsors and co-sponsors of the House and Senate bill.
I am on the Legislative Action Committee for FANP. Plan to attend meeting at the end of the session with our lobbyist to determine why the bill failed in two committees.
Work with FANP, Catholic Charities, and the bill’s legislative sponsors to research opposition to the bill and determine future plans to reintroduce a revised version.
Suggest to FANP that, moving forward, we consider forming a coalition with other nursing organizations, safety-net providers, and immigrant advocacy organizations. This would give us more resources, broader support across the state, and a more developed grassroots presence.
Federal: H.R.3149/S.1660: HEAL for Immigrant Families Act of 2021
Eliminates the 5-year wait for immigrants to enroll in Medicaid and Children's Health Insurance Program coverage; excludes undocumented children and families from eligibility
5/12/21: HR filed 5/13/21: HR referred to Subcommittee on Health
5/17/21: S filed and referred to Committee on Finance.
Sent email thanking Representative Jayapal and Senator Booker for sponsoring and introducing the legislation. Neither are from my district, so I wrote as a member of the ANA and the American Association of Nurse Practitioners (AANP).
After reviewing the 90 co-sponsors in the House and 11 co-sponsors in the Senate, I saw that my elected officials were not listed. I used GovTrack.us to send an email to my congressmen, Representative Salazar and Senator Rubio encouraging them to co-sponsor the bill; there are no Republican co-sponsors in the House or the Senate.
Signed up with the Congress.gov tracking service to receive legislative updates on the status of the House and Senate bills.
Posted my support of the legislation, a link to a fact sheet on HEAL, and a “Contact your Legislator” link on my Facebook page. I also tweeted my support of the legislation to my Twitter account.
I talked with co-workers at the clinic about the federal legislation, of which most were unaware. I was able to provide more information to those who were interested in taking action.
I’m a member of the county’s Women’s Democratic Club and talked about the federal legislation at our monthly meeting. They were able to refer me to other local and regional groups that may be interested in learning more about and supporting the bill.
Pending: Still in the Subcommittee on Health and Ways and Means Committee in the House and the Committee on Finance in the Senate.
The ANA and AANP have not published positions on this legislation; legislation is not listed as a specific priority on the website.
I researched 19 advocacy groups supporting the legislation. I decided to join and financially donate to two—First Focus: Campaign for Children, and National Partnership for New Americans.
Both have legislative alert services and a national grassroots activism initiative.
Since neither of my congressmen serve on the committees that will be hearing the bill, working through an advocacy coalition complements my individual activism.
I will contact them to see how I can best support their efforts to advance this bill.
Connecting Kingdon’s Theory of Policy Change to My Personal Legislative Agenda & Action Plan
Kingdon’s Three Streams
Relevance to My Personal Legislative Agenda & Action Plan
The problem is that many immigrants do not have access to health insurance in South Florida and other parts of the country. The problem is further complicated by the fact that all immigrants are not seen as equally important or of value. They are separated into two groups—those who are here lawfully and those who are undocumented. It is important to my Personal Legislative Agenda & Action Plan that the problem definition be inclusive of all immigrants so that the most vulnerable among them—the undocumented—are included in the proposed policy solutions. Unfortunately, inclusivity creates divisiveness in how the problem is defined.
Nationally, there is no consensus across party lines regarding the provision of healthcare services or health insurance to undocumented immigrants. In Florida, the legislative and executive branches of government are controlled by the party that is unsupportive of undocumented immigrants. Also, healthcare is not seen as a basic human right in the U.S. Non-citizens cannot vote and therefore have no voice in the legislative processes. As a citizen and as a nurse, I have a moral and ethical responsibility to advocate for vulnerable populations who are denied the opportunity to speak for themselves.
While there have been some initiatives to expand Medicaid or offer the opportunity to purchase health insurance for immigrants who are here lawfully, undocumented immigrants are excluded from these proposals. While I support all policies that address the unmet needs of immigrants, I also must ask that policies excluding the undocumented be amended to include them. Policies that separate families, defund sanctuary cities, or unduly limit immigration exacerbate the problem and contribute to ongoing poor health outcomes and health disparities among immigrants. Part of my Personal Legislative Agenda & Action Plan is to monitor health policies that negatively impact (or exclude) this population as well as be aware of—and challenge—other immigration policies and regulations that indirectly contribute to the problem.
Likelihood of Policy Change
It is unlikely that the state and federal immigration and health reforms, I support, will be approved any time soon. There are deeply ingrained challenges in both the politics and policy streams at both levels of government, and the “legal” vs. “Illegal” differentiation prevents a single definition of the problem. My Personal Legislative Agenda & Action Plan, however, reflects my long-term commitment to raising awareness on this issue and advancing these policy priorities.
It is important for me to remain aware of issues and public/political opinion that frame the issue of immigration reform. To that end, my Personal Legislative Agenda & Action Plan includes subscriptions to legislative alert services at the state and federal levels. I also belong to two organizations that advocate for immigrants at the state and federal levels, which send alerts when state or federal proposals or regulations are introduced that impact the immigrant population. I already participated in one online campaign on this issue.
I am learning to carefully read and analyze proposed legislation, so I can engage with my elected officials in an informed manner.
As a Catholic, I have also financially contributed to and become a grassroots member of Catholic Charities-Immigration and Refugee Services, which has allowed me the opportunity to raise awareness and discuss my experiences with immigrants to congregations in my area.
I was recently asked to prepare committee hearing testimony that could be adapted and submitted at some future point, when needed.
I am also a member of the Florida Association of Nurse Practitioners, and I serve on the organization’s Legislative Action Committee. In that role, I have been able to raise awareness of immigrant health issues in the organization and in our “Policy Watch” endeavors at the national level. I am a member of the American Association of Nurse Practitioners and the American Nurses Association (ANA). (The ANA has an Issue Brief
supporting healthcare for undocumented immigrants.)
Although I am not a “single issue” voter, I am mindful of candidate positions on immigration reform and plan to contribute financially to—and vote for—those who most align with my values and priorities as a nurse and citizen.
I need to learn more about the opposition to these reforms, so I am better prepared to address their arguments. I plan to listen to media sources more aligned with the opposition and to search the literature to separate fact from hype and opinion. I have learned that the key to policy advocacy is to be informed and prepared, so when engagement with my elected officials is needed (on an issue I am passionate about), I’m ready to engage.
Public Health Policy Advocacy Guidebook and Toolkit APHN Public Health Policy Committee
Updated Toolkit: 2021 Original Toolkit: 2016
What is Advocacy? Why is it Important to be an Effective Public Health Advocate? Advocacy as a Strategy Advocacy vs. Lobbying
Are Professional Organizations like APHN Allowed to Advocate or Lobby? Why Should Professional Organizations Participate in Advocacy Efforts? Why Should Public Health Professionals Participate in Advocacy Efforts?
How Does a Bill Become a Law? The Federal Budget
Federal Budget Impact on Public Health The Federal Budget Process
How a Legislator's Office Works
The Development of APHN Policy Positions What Constitutes APHN Policy? APHN's Policy Analysis Steps APHN's Public Policy and Advocacy Process
Goals of the Advocacy Guidebook and Toolkit – 4 Part 1: Advocacy as a Tool and Strategy – 5
Part 2: Understanding the Public Policy Process – 11
Part 3: Organizational Advocacy – 15
TABLE OF CONTENTS
Being an Effective Policy Advocate Policy Advocacy Methods
Inside vs. Outside Advocacy Strategies Advocacy through Social Media Coalition Building Identifying Legislators/Decision-Makers to Contact
Letter Writing Tips for Effective Letter Writing Addressing the Letter
Sending an Email Personal Appointments or Visits Making a Phone Call Advocacy Tips to Remember
Part 4: Individual Advocacy – 19
Part 5: Advocacy Tips and Tools – 27
Toolkit Acknowledgements – 35 References – 36
TABLE OF CONTENTS
GOALS OF THE ADVOCACY GUIDEBOOK AND TOOLKIT
Provide an overview of advocacy and the policy making process.
Strengthen the ability of organizations and individuals to advocate for policy change using a variety of effective advocacy strategies.
Share tools and resources for public health nurses and other public health professionals engaging in advocacy.
Establish a framework for identifying policy goals, creating a plan of action, and effectively building the case for change.
Advocacy is participating in the democratic process by taking action in support of a particular issue or cause. Advocacy is the active support for policies and programs that can improve health in families and communities.
WHAT IS ADVOCACY?
PART 1: ADVOCACY AS A TOOL AND STRATEGY
WHY IS IT IMPORTANT TO BE AN EFFECTIVE PUBLIC HEALTH ADVOCATE? Public health nurses and other public health professionals are on the front lines of responding to public health needs related to communicable and chronic disease, natural disasters, and preventive health services. Members of the Association of Public Health Nurses (APHN) and other public health organizations are in a great position to advocate for what is known to be effective in promoting health and preventing disease.
In order to create effective public policy, it is very important for public health professionals who are knowledgeable about factors that influence health within our communities, including social determinants of health, to be involved in the policy formation process. As constituents and members of the public health community, public health professionals are often asked to provide educational information and advice to decision- makers, such as policy makers and other public representatives.
As public health professionals, our acquired knowledge and diverse experiences can provide the basis for strong and effective public health policy and the achievement of health equity. Consistent with our standards of practice, it is our obligation and ethical responsibility to incorporate the identified needs of populations in policy development and implementation. It is also our professional duty to develop the skills needed to advocate for public health and the public health workforce before decision-makers.
ADVOCACY AS A STRATEGY
Creating needed policies when none exist. Reforming harmful or ineffective policies. Ensuring good policies are implemented and enforced.
Advocacy is also a strategy to influence decision-makers when drafting laws and regulations, distributing resources, and making other decisions that affect public health issues, infrastructure, and the workforce. The purpose of utilizing advocacy as a strategy is essentially about three things:
1. 2. 3.
The goal of advocacy is policy change.
ADVOCACY VS. LOBBYING One important question is, “How is advocacy different from lobbying?” Although most people use the two terms interchangeably, it is important to understand the difference between advocacy and lobbying.
ADVOCACY By advocating for systems change, public health professionals can encourage changes that help large sectors or populations and set the context in which individual decisions and actions are made. Public health advocacy is taking a stance about laws and regulations that can impact individual and community health. For example, advocacy has been effective in recent years in reducing exposure to tobacco smoke and improving nutrition in schools.
Advocacy includes activities such as participating in a town hall meeting or demonstration, conducting a public forum or press activity, or developing an issue brief for your state or local policymakers on a particular public health issue. These types of activities do not constitute lobbying as long as you are not urging a policymaker to take a position or action on specific legislation. Public health professionals should know their organization’s expectations around advocacy and whether they are advocating with their organization or as a private citizen.
LOBBYING What then, is lobbying? To be considered lobbying, a communication must refer to and express a view on a specific legislative proposal that has been introduced before a legislative body (local, state, or federal). This means working to influence the outcome of specific legislation—trying to get a bill passed or defeated—by communicating your organization’s views or position to those who participate in the formulation of the specific legislation—your members of Congress, your state legislators, your local elected officials, or the staff of policymakers.
ARE PROFESSIONAL ORGANIZATIONS LIKE APHN ALLOWED TO ADVOCATE OR LOBBY? APHN has been granted tax-exempt status by the Internal Revenue Service (IRS), and must follow specific laws pertaining to advocacy and participation in political campaigns. Tax-exempt organizations are allowed to engage in lobbying and advocacy activities related to specific issues, legislation, and regulations but are not allowed to intervene in a political campaign for or in opposition of a certain candidate or policymaker. As an organization, APHN is involved in advocacy around improving public health. When you are participating in advocacy activities as a member or leader of APHN, it is critical to understand these advocacy and lobbying guidelines. Members of other public health organizations should learn more from their organization’s leadership.
Larger organizations like the American Public Health Association (APHA) and the American Nurses Association (ANA) employ staff that are registered as lobbyists with the U.S. Senate and House of Representatives. This requires the organization to report the amounts expended on their lobbying activities. APHN does not have paid lobbyists and relies on APHN members to advocate on behalf of public health nursing and issues that affect health in our communities. Another important distinction to keep in mind is that APHN is not lobbying when it is asked to present testimony or respond to an inquiry before the federal or state legislature. It does not constitute lobbying because the organization was asked to testify. If APHN requests to testify, then this does constitute reportable lobbying.
As an organization, APHN also has to be concerned with the question, “How much lobbying is our association allowed to do?” Whenever the association expends resources—staff and/or funding—on lobbying activities, we must track these expenditures for APHN’s tax records.
In addition, a not-for-profit organization may not spend more than 25 percent of its permitted lobbying total on grassroots lobbying. What is the difference between grassroots lobbying and direct lobbying? Grassroots lobbying is appealing to the general public to contact the legislature about an issue. Direct lobbying is contacting government officials or employees directly to influence legislation.
If an issue is to be decided through a ballot initiative or referendum, appeals to the public are considered direct lobbying, because the public in this instance acts as the legislature. This is helpful to nonprofits that elect to come under the 1976 law, as they may only devote 25 percent of their total lobbying expenditures to grassroots lobbying. APHN does not engage in grassroots lobbying.
It is important to note that states can have specific state laws that govern lobbying local and state policymakers. Should you have any questions or would like additional information about your rights and the legality or compliance of your individual or organizational lobbying activities, please contact a local ethics official or an attorney in your area for more details.
Keep in mind that this is just an overview of advocacy and lobbying guidelines. The Internal Revenue Service (IRS) website provides more detailed information on lobbying guidelines for nonprofit organizations.
There are a lot of good reasons why professional organizations such as APHN should actively participate in the public policy development process. First and foremost, we can make a difference as an organization and in concert with other stakeholders. Our creative thinking can help find workable solutions to public health problems. In fact, advocacy, telling our legislators what we want, is at the very heart of democracy. Policy makers need to hear our stories as public health professionals and learn from our expertise in order to address th
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