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Communications Strategy Was Center Stage in Texas Advocates’ Win of Postpartum Medicaid Extension

The road to success for a recent 12-month postpartum Medicaid extension in Texas in 2023 was paved with years of advocacy work on the ground. For years, advocates at Texans Care for Children and other organizations have worked to build trusting and collaborative relationships among all the groups working to advance the crucial maternal health issue and had established a diverse coalition of groups supporting the bill, including organizations from the left and right side of the political spectrum, business groups, faith leaders, children’s advocates, associations of medical professionals, and others.

And the organization consistently emphasized that this was a group effort, requiring policy staff, communications staff, strong partners outside the Capitol, and committed legislators and staff inside the Capitol, all of whom would need to cooperate and coordinate.

A recent maternal health advocacy video from Texans Care for Children. 

Importantly, Texans Care for Children focused on two communications goals from the first attempt at passing the bill in 2019 through its passage in 2023. First, after the legislation passed only one chamber  in 2019, the advocates made sure that going forward, legislators would be judged on their efforts to get the legislation passed in future legislative sessions. Even though the failure in 2019 was disappointing, Texans Care took advantage of the moment to publicize the huge missed opportunity in addressing maternal health, and why policymakers must make it a priority in the following session. They were featured in eight earned media placements promoting this messaging — and in dozens of other media stories and opinion pieces over the next four years. This helped make it difficult for legislators to abandon the issue in subsequent sessions.

Second, while many of the high profile issues of the session were viewed as partisan battles between Democrats and Republicans, it was important to make sure that postpartum coverage for moms was viewed as a bipartisan effort that Republican and Democrat lawmakers would both get credit for passing.

One of the ways that advocates demonstrated that it was a bipartisan bill was by frequently shining a spotlight on statements of Republican support, not just from the Republican Speaker of the House but also the inclusion of the policy in the Governor’s budget and in the state GOP platform. For example, during the next legislative session in 2021 (the Texas State Legislature convenes every other year), Texans Care for Children capitalized on the Speaker of the House’s Healthy Families, Healthy Texas package, and ensured the package, and the organization’s two priority bills within the package, stayed in the spotlight. They also worked behind the scenes in numerous ways to ensure bipartisan support for postpartum Medicaid extension, including the release of a comprehensive report to elevate the issue and position Texans Care as the leading expert. Their efforts were partially successful as a version of the postpartum bill passed with only six months of additional coverage, but Texans Care and their partners had more work to do. 

And one of the additional benefits of the diversity of the coalition is that appropriate messengers were available to speak with individual legislators on both sides of the aisle, depending on what their concerns or priorities were, whether it was the cost of the bill, the impact in certain communities, or concerns that the bill could encourage abortions.

In 2023, Texans Care employed all the advocacy strategies of the past years, including media outreach, building relationships with key legislators, and utilizing well-positioned partners at key activation points. They also featured the stories of mothers potentially affected by the legislation or who benefited from extended coverage during the Public Health Emergency, strengthening the authenticity of their campaign and the direct ties to everyday Texans. 

As the bill was debated in the Texas House and Senate, Texan Care’s messaging strategy focused on bolstering bipartisan support, including showcasing like-minded states and their success at similar efforts. 

When House Bill 12 passed, CEO Stephanie Rubin pointed to this communications strategy and coordination among partners, legislators, and staff as crucial. “This victory was more than five years in the making,” Rubin says. “What really made the difference is strong legislative leadership paired with the strategic approach we took to build relationships and coordinate messaging throughout the advocacy campaign.” 

It’s a communications approach that emphasizes strategy, consistency, relationships, leading with lived experience and expertise, and being flexible enough to take advantage of opportunities as they arise. According to Peter Clark, Director of Communications at Texans Care for Children, this was essential – because it was important to elevate the messages that would ensure maximum bipartisan support, sometimes amid potentially turbulent health care debates. 

“When we measured success, the priority was not metrics like engagement with our own social media posts,” said Clark. “We were more interested in whether reporters, partners, and legislators adopted our messaging, how our messaging resonated with target audiences, and how much influence we had in shaping the narrative at key inflection points.”

“Building momentum, delivering key messages, effective lobbying, storytelling, and all of the other elements of the successful advocacy on HB 12 relied on developing and then strategically deploying a strong and diverse coalition,” said Rubin. “We were proud that more than 172 organizations signed on to our statement urging passage of HB 12, and we couldn’t have done it without the enthusiastic support of our partners.”  

Clark describes the communications processes for engaging partners and collaborators. “We met regularly with supporters to discuss strategy, provide updates on messaging, share updates, determine plans for committee hearings, and more,” he said. “We also provided talking points and sample social media posts.”

When the bill finally passed with overwhelming support, Rubin and Clark knew years of planning, strategy, and collaboration had been critical. 

“While every policy change effort is unique and requires thoughtful strategies, pivots along the way and plenty of patience, our blueprint for success can be applied to early childhood education and many other issues,” said Rubin. “We are constantly learning from both our wins and setbacks and are also cheering on our colleagues as they press forward in support of children across the country.” 

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