Amy Rosenthal: Balancing State Policies with Federal Results
On February 28th, the Public Policy Program and Schroeder Center for Health Policy hosted Amy Rosenthal, Executive Director of Health Care for All (HCFA)一a Massachusetts non-profit that advocates for health care equity and access at the state level. Drawing on a bevy of experiences working on state and federal health care advocacy as well as teaching at Harvard’s Chan School of Public Health, Rosenthal’s talk and Q&A titled “A Conversation about State-Level Health Care Reform” demonstrated how successful state-level policies and programs can transform into federal results.
Before pointing to specific examples, Rosenthal offered three, interconnected ways HCFA interacted with Massachusetts residents and promoted health justice一operating a helpline, organizing outreach and education campaigns, and advocating for policy changes. First, HCFA operates a helpline that fields over 25,000 calls in five languages, troubleshoots consumer concerns, and documents issues for future research. Rosenthal noted many policy initiatives and programs emerge from the helpline. Second, HCFA conducts outreach and education campaigns such as the Vaccine Equity Initiative to collaborate with local administrators, build trust with community leaders, and educate Massachusetts residents. Oftentimes centered around local, grassroots movements, HCFA collects qualitative data and testimony on a variety of health care issues. Third, HCFA uses the helpline and outreach programs to advocate for state-level change in health care policy. Using state-level data alongside quantitative data from the helpline, qualitative data from outreach and testimony, HCFA compels legislative sponsors to push bills addressing specific issues.
Recalling the prolonged battle over prescription drug reform in the 191st, 192nd, and 193rd Massachusetts General Court, Rosenthal credited data and testimonies from helplines and outreach programs for driving policy change. Initially failing to obtain a majority in the 191st and 192nd General Courts, the HCFA gathered data to demonstrate that 41.3% of Massachusetts residents struggled to afford prescriptions leading to decreased drug utilization rates. Disproportionately affecting people of color, the HCFA used testimonials to rally support for the bill during the 193rd General Court. After 6 years of negotiating with legislators and numerous meetings with the Health Policy Committee, a reform bill on prescription drugs passed on the General Court’s last day in 2024.
Though health care professionals tend to separate state and federal policies, Rosenthal encouraged students to interpret state policies and programs as experiments for federal policies and programs. Noting how Massachusetts is oftentimes cited in the United States for its innovation, Rosenthal argued state programs such as the Children’s Medical Security Plan (1996), which implemented a higher tobacco tax to cover health insurance for more children, inspired the federal government’s State Children’s Health Insurance Program (1997). Likewise, Rosenthal suggested provisions in Chapter 58 of Massachusetts’ Acts of 2006 served as a blueprint for the Affordable Care Act (2008). By using data and testimony driven data to formulate state policy, Rosenthal argued Massachusetts indirectly affected federal policies and programs.
Overall, Rosenthal suggested students should approach policy decision-making in a variety of ways before advocating for policy change. By understanding the data and impact behind decisions, Rosenthal argued that the HCFA provided a well-rounded analysis that took into account everyday circumstances of Massachusetts residents. Though unintentional, Rosenthal ultimately reflected that her advocacy at the state level indirectly impacted federal policies and programs.