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Making Our Voices Heard

As we all know, this is a time of great upheaval in our country. Some of that is related to the changes in federal government, but much of it is heavily influenced by other events and trends in our country and around the world. Health care certainly has its share of change and uncertainty. It is easy to focus on the threats that this upheaval brings and they are real. However, this kind of upheaval also brings opportunities that are easy to ignore and even when we don't ignore them, it is sometimes hard to figure out how to take advantage of them.

As I've gotten somewhat involved in this kind of advocacy recently, I've discovered opportunities and ways of giving input that I really had no idea about.

Myth #1 that I believed is that it is very hard or even impossible to give input on government regulation or proposed rules. Simply untrue. Virtually all proposed federal government regulations are open for public comment on line before final versions are adopted. Many meetings are open to the public. I am one of two chaplains who sit on the National Quality Forum's Standing Committee on Palliative and End of Life Measures. All of our meetings are open to the public in person or by phone and anyone so attending gets an opportunity to comment usually at the end of the meeting. Our minutes are available to the public on line. Many other health care related proceedings are also open to public comment. Admittedly, finding out about these opportunities is not easy, but over time one can learn.

Myth #2 that I believed is that legislators have no real interest in hearing from constituents.  All one has to do these days is follow the trials of members of the House of Representatives especially when they return home, and you know they do provide opportunities to hear from constituents and most know they should pay attention especially if they have two year terms.  For a while, Paul Ryan, Speaker of the House, had a phone line open to gather comments on the Affordable Care Act (aka Obamacare).  It was shut down apparently after being flooded with pro-ACA calls.

So there are opportunities but how best to take advantage of them? First, don't undersell the expertise we have and how much we know.  We know the obstacles that people face in coping with illness and injury and we know a lot about what would help them. Stating clearly and succinctly who we are and what we do generally gives us instant credibility on health care issues. We should never be timid about claiming our authority to speak.

Second, educate yourself on the issues of interest to you on the state and federal level that you might want to give input on/support/oppose. This again can be complicated but with some searching over time, one can get connected to information sources that specialize in issues we as chaplains care about. As an example, here in California where I live a bill that would mandate palliative care (and thus potentially spiritual care) for all recipients of Medi-Cal- the state Medicare system- passed the legislature some time ago but is now held up in the legislature's budgeting process. The bill known officially as SB1004 is only one page so very easy to understand. Following its progress is difficult. The way I have been doing it is to be in the media lists for an organization called the Coalition for Compassionate Care California ( that has championed palliative care as well as advance care planning. Again, this is a natural issue for health care chaplains and we should be weighing in on it The HealthCare Chaplaincy Network has been a co-signer of several letters supporting the implementation of this bill but this is a case of "the more the merrier." Certainly, similar issues and pathways exist in other states.

Finally, be clear about the "ask". At the end of the day, legislative agency staff who read your input want to know what you want them to do. Just complaining or just asking that "something" be done is a waste of time. So, on SB1004 we want them to implement the bill and make sure that spiritual care is a mandated service as part of that implementation. Being able to quote one or two studies here about how attending to spiritual issues is what patients want is helpful.

Yes, all of this takes time and effort.  But it SB1004 is implemented, it will be a huge benefit to many Californians and a model for Medicare providers in other states.

Its time to make our voices heard. 

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