Angela Monson has been protecting health care access in Oklahoma for four decades
Angela Monson has been here before, fighting for health care access and safety net programs when powerful forces are aligned against both.
As a fiscal analyst for the Oklahoma Legislature in the 1980s, she protected state funding for Federally Qualified Health Centers while federal budgets were being cut. Later, she led a statewide grassroots advocacy coalition to push for Medicaid expansion. As an Oklahoma State Representative and State Senator in the 1990s and 2000s, she championed universal health care, not because she thought it would happen right away, but to center the conversation on health care as a basic human right. Today, she continues to advocate for health care access as Outreach and Legislative Director for Together Oklahoma and works with HealthBegins and Share Our Strength as part of the national Medicaid Food Security Network.
Through the years, she has had big wins like helping to create Oklahoma’s standalone state Medicaid authority. She has also planted a lot of seeds that are still waiting for the right conditions to blossom. Through it all, she has stayed laser focused on her goals and learned valuable lessons about what it means to push for health equity in environments that aren’t always receptive to it.
HealthBegins spoke with Monson about the importance of taking a long view of advocacy and why the language we use when talking about health and health care matters. She also shared ideas about what people can do over the next four years to protect health care access and safety net programs. (The conversation below was edited for length and clarity.)
Can you talk about a moment when you faced a challenging advocacy effort and succeeded?
In 1984, I ran for office for the first time, and my platform was to create a universal healthcare system. I lost the race. I lost a race again in 1986, still working and talking about health care. I finally won an election in 1990, and my very first bill introduced was a universal healthcare bill that looked like Canada’s system. I never thought that we would get close to passing it; I just wanted to elevate the debate. And lo and behold, the bill passed out of the committee in the Oklahoma House of Representatives, where I was serving then. And it came within 14 votes of passing from the House floor. It was crazy.
You’re talking about reframing what success means and celebrating incremental victories, which is powerful. How did you build on the momentum of that bill?
Fast-forward a few months when the leaders of the House needed a vote [for a different bill to pass], needed my vote. And a friend said, “Don’t give them your vote unless you get something.” So, I asked for a funded blue ribbon panel that could really travel the state and talk to communities about health care, healthcare access, and what change would look like. And we got that. And what came as a result of all of those community-based meetings, news releases, and attention was the Oklahoma Health Care Authority. We were able to introduce legislation and create a standalone Medicaid agency, which gave even greater focus to the issue of health care. We never got a universal healthcare bill, but we got our Medicaid agency.
What lessons did you draw from that experience? What can others learn about advocating for health equity in environments that are indifferent or even hostile to it?
Start by saying health care is everybody’s issue, because it is. It’s an employers’ issue because premiums cost a hell of a lot, and that’s money that they can’t invest in the business or their workforce. It’s a chamber of commerce issue because they represent those employers, and when we try to bring new employers to our state, it’s harder without a robust healthcare system. It’s a community issue because in some places, hospitals are the largest single employer around. If you lose a hospital, you really do begin losing a community. Then ask, what is each group’s particular concern? How do we connect to them? We worked with neighborhood associations, civil rights organizations, fraternities and sororities. It is about building those relationships and those connections that can be harder. It takes time.
People also need to know more about how the system works. They know that health care costs a lot. They know that a copay that was $10 might be $45 now. They know things, but they don’t know the why. So, educate people a little more about systems. We did that way back when we went around the state. We had town halls. We did all kinds of things that taught people how Medicaid works and how private insurance works. Does that help mobilize people and empower people? I think so. Then you got to use that power. If elected officials have the ability to give us what we want, then we got to put the pressure on them and let them know this really is what we want.
People often have deeply held beliefs about things like government or government programs that can stand in the way of some of the policies you’ve advocated for. How do you navigate those conversations?
Seventy-five percent of all kids in Oklahoma are covered by Medicaid, but their insurance card says United Healthcare or Humana. And when you go to a physician’s office or to the pharmacy, rarely do they call it Medicaid. So, I think to some extent, renaming and reframing these programs is helpful. I do believe that the majority of folk in this country think that health care is a basic human right, whether or not most elected officials do, and polls kind of substantiate that.
When we were working on the Affordable Care Act (ACA), people said they hated Obamacare, hated the ACA. But then the next questions were, “Do you think it is okay for your kids to still be on your health coverage at 26? Do you think health insurance should cover pre-existing conditions?” And people would say, “Oh yeah, I love that.” People have strong feelings about program names and politicians. I tell folk when we talk about health care, just use words that describe what you’re talking about. Stop using labels. Words matter.
What advice would you give to health care professionals and community partners who want to preserve access to health care and support vulnerable U.S. residents during the next four years and beyond?
We are up against some very large, powerful forces. But the power of people to organize, to strategically work collectively together can make a huge difference. And that’s what it’s gonna take. Every chance we get in the next four years when people are being elected to office—whether it’s for school board, city council, county commissioner, state legislature, or Congress—we have to work to make sure that health care is at the forefront. Ask them questions. Put them on the hot seat. Make them make a commitment. Do they believe that health care is a basic human right or not? How should it be funded? Is there a means through our collective tax system that we should do a better job in funding and financing healthcare services? I’d ask them what wellness looks like to them. What does a thriving family look like? Make them articulate those views.
And then I would say collectively to all of us who are working on this issue, we gotta figure out what it is we want. Sometimes we can’t get the whole ball of wax, but whatever it is, we got to clearly articulate that. We got to figure out who’s with us and, unfortunately, who’s going to be against us. If we can articulate that opposition, we can build a better argument to knock it down. And then we have to come up with those tactics to know who has the power to give us what we want and what pushes their buttons, whether it’s an elected official or a hospital administrator or an insurance company. What is it that they don’t like? Do they not like bad press? What is it that they want? Do they want to get reelected again? And we have to exert that collective power, pushing those buttons to make people do what we want them to do. Those of us who work in the industry, as much as we can, need to help educate and break things down for regular old folk. I think it’ll be easier for them to engage in the fight with us.
You’re really clear that this is a long-term fight and that some wins don’t come for decades. How do you stay focused and keep your spirits up when change isn’t happening at the pace you want it to?
That came with experience and time. I have a strong spiritual foundation about why we as humans exist. And that guides not just my work in health care, but whatever else I do that I consider a justice and equity issue. To stay in this kind of fight, we as humans have to have a sense of responsibility. This is important for my kids, my grandkids, somebody else’s kids and grandkids. We also have to have faith and believe that good will always prevail. If you don’t, you’ll stop doing a lot of things that are hard. But if we are willing to keep standing, then eventually we can make a difference. And it might be a dent in the door today. Tomorrow it could be the windows coming out. And before long maybe that whole door comes down. You also must enjoy life no matter what. We’re fighting stuff, but there’s always a place of peace.
Kate Marple is a Boston-based writer who specializes in helping nonprofit, health care, and legal services organizations develop practices to ensure that the stories they tell are shaped by and benefit people directly impacted by the issue(s) those stories are about. Her website is https://whotellsthestory.org.
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