The Future of Health Care Policy Is Not in Washington

The Senate’s halt of efforts to repeal the Affordable Care Act (ACA) saved the GOP from a protracted debate that threatened to expose a chasm in the party even larger than the much-ballyhooed divide between the House and Senate. The bigger split in this debate lies between the federal government and state policymakers, including governors of the same party as the president and congressional leaders, who ultimately have the responsibility of implementing these proposals.

The impasse at the federal level will shift the policy-making center of gravity away from D.C. Companies that want to have an influential voice in the health care arena should be increasing their focus on governors and state legislatures. Day-to-day policy decisions will continue to expand at the state level. As that happens, frustration by these officials, largely due to their perceived lack of impact at the federal level, will continue to motivate them to be more aggressive in setting the agenda.

Here’s what this means for state and local governments:

Devolution: The legislative package that cleared the House of Representatives included a limited block grant program for federal funding. States have long called for this and consider this aspect of the House plan to be a positive as it provides for more flexibility in program implementation, i.e. allowing local approaches to address the needs of local populations. However, most states have already gone through major adjustments required to expand Medicaid coverage and do not want to make huge changes again in such a short time frame. Nor do they welcome the notion of being saddled with expanded costs that were coupled with the new funding mechanisms. The idea of devolution – shifting accountability and costs from federal bureaucracies to state bureaucracies – became very popular with D.C. budget-cutters and fiscal conservatives interested in reducing the national outlays for health care.

Operating on a Tight Budget: Budget writers on Capitol Hill should remember that when addressing potential funding shortfalls, state legislatures have even less wiggle room than the federal government because most are required to live under a balanced budget – an idea long forgotten inside the Beltway. Expansions in state Medicaid coverage and ensuing cost increases must be offset by equal amounts of reductions in services, cuts from other parts of the state budget, or, an anathema to red state law makers, tax increases.

Governors Weigh In: The National Governors Association (NGA), through a bipartisan effort, released a set of recommendations aimed at addressing the needs of the constituents their members serve, as well as the financial constraints that come with public health care programs. The recommendations; however, begin with a general concern regarding the health of the partnership between the two governing levels

To address the troubling precedent in the decision-making framework as it currently exists, the NGA asks for a more active engagement to discuss policy changes. It also calls for a transition period to allow for adjustments to potential changes, and concluded the overarching principles on partnerships with a caution for national lawmakers:

“Supporting vulnerable populations is a shared responsibility between the federal government and states. It is critical that Congress continue to maintain a meaningful federal role in this partnership and not shift costs to states. Significant cuts to Medicaid will impact coverage for millions of low-income individuals and could impede state efforts to address the underlying factors driving health care costs, such as pharmaceuticals, long-term care and the social determinants of health.”

As a leading national grassroots firm, we appreciate the position of the governors and their attempt to expand the dialogue on critical domestic issues like health care to include the local perspective. Repeal, replace, expand or cut. The support of constituents and state policy leaders will be critical for success, no matter what direction Congress chooses.

This blog post was written by Brian Noyes, Executive Vice President, Direct Impact (a subsidiary of Burson-Marsteller).

Sharing our branding advice with the New York Stock Exchange

We are passionate about startup companies at Moving Brands and are fortunate enough to have had the opportunity to collaborate with some of the most successful and inspiring entrepreneurs from across the globe, including Uber, Asana and Flipboard.

When the New York Stock Exchange approached us to provide a chapter for its new book ‘The Entrepreneur’s Roadmap: From Concept to IPO’, we were confident that we had valuable advice for anyone looking to set up.

We always stress to any startup we work with the importance of carving a meaningful brand space for itself within its market. Having seen the benefits of this approach first-hand, our chapter naturally goes on to explain ‘Why Startups Should Spend on Brand’.

In the book, we look at how a startup can shape its identity through its story, structure and customer experience. We have found that this approach ensures a new business develops an authentic, engaging identity that helps inform all the other practical choices for a successful brand, such as tone of voice and color palette.

It’s true, in the hectic early days of establishing a startup, it can seem more important to focus on developing your product, hiring your team, setting budgets and identifying funding, and considering when and how to scale up. It can also be hard to justify the expense and time required to develop a killer brand.

However, we firmly believe that putting time, thought and energy into branding right at the start of a business delivers direct benefits in the long term. A strong identity can attract investment, with well-thought-through brands securing higher valuations from venture capitalist firms.

Our chapter includes the advice that your brand experience should flow throughout the business, whether that is the micro-interactions in an app, the conversational exchange of a chatbot, or the motion design of a web page. This is where the magic of your brand lies, and the things that customers remember about your company. Helping you to stand out from competitors in a ‘sea of sameness’.

To read the chapter of the book in full, download it here.

The post Sharing our branding advice with the New York Stock Exchange appeared first on Moving Brands – an independent, global creative company.

Were the Prime Minister’s Eyes Too Big for Her Stomach on Executive Pay?

By Meg Powell-Chandler, Director, Public Affairs

There are two important skills in politics – the ability to identify the problem, and the ability to identify a workable and achievable solution to it. Theresa May’s Government has been very successful at the first, think back to her speech on the steps of Downing Street which was welcomed across the political divide for identifying the social and economic problems that face this country.

Where it has been less successful – and the General Election result was a consequence of this – is that the solutions to these social and economic problems have failed one or both of two tests: popularity and achievability.

Turning to the issue of Corporate Governance, the Prime Minister came into office with radical words. In the very short leadership campaign set against the context of Sir Philip Green and Mike Ashley, she stated “the people who run big businesses are supposed to be accountable to outsiders” and committed to employee representatives on company boards, increased transparency around pay ratios and binding shareholder votes on corporate pay.(1)

These policies were based on the idea that it doesn’t matter how much you improve the lot of the people at the bottom and the middle, they will always compare their lot to those at the top. The approach that gave rise to her political mantra: ‘A country that works for everyone, not just for the privileged few’.

With 6 in 10 people supporting workers on boards(2) and 57% of the public agreeing with the statement “Government should encourage companies, through measures like taxes and Government contracts, to cap bosses’ salaries at a maximum of 20 times the company average”(3), it looked at least like the Prime Minister’s solutions were popular. What about the achievability test?

In the newly formed department for Business, Energy and Industrial Strategy, corporate governance was highlighted as a No10 priority and plans were quickly drawn up to show the Prime Minister what could be achieved and quickly.

But the plans presented by BEIS fell short of the ambition of Theresa May’s rhetoric. Rather than Civil Servants trying to limit the political will, it was instead a presentation of the lessons learned from previous attempts of Corporate Government reform. These lessons, simply put, are as followed.

If you want to do anything impactful in this space you need primary legislation.
Primary legislation is a high risk strategy: the right will reject the premise of intervention in the running of a private sector company, the left will want a solution ten times more radical than you are proposing. Both sides will amend to high heaven and if you are able to get it out of the Commons in one piece (which is highly unlikely) you then have the whole battle again in the House of Lords, which is full of even more radical ideologues on both sides.
The resulting Corporate Responsibility Green Paper published in November last year, was seen by many as a U-turn on the Prime Minister’s clear commitment to put workers on company boards.

It is becoming clear that the Government’s response to the consultation on this Green Paper due to be published next week will dilute plan even further. Measures around transparency will survive, but it’s been suggested that anything requiring legislation will be dropped.

The Conservative manifesto made clear what a majority Conservative Government would do on corporate pay and governance – and, whilst is may have been slightly less radical than May’s early rhetoric would suggest, it would be far more than many Conservative MPs would have felt comfortable voting for.

With the General Election resulting in the current parliamentary arithmetic, any radical move on corporate governance is likely dead in the water, but given the importance May has attributed to this issue other avenues to effect change will no doubt be explored.

Meg Powell-Chandler is a Director in Burson-Marsteller’s UK Public Affairs practice. She previously worked as a special adviser in 10 Downing Street and to Greg Clark, the Secretary of State for Business, Energy and Industrial Strategy.

1. Theresa May Speech in Birmingham, 11 July 2016, link
2. TUC Press Release, 29 November 2016, link
3. ComRes, Sunday Mirror / Independent Political Poll Jan 2017, link