The Art of Reframing an Issue for Legislative Success

// The New Hampshire Oral Health Coalition’s journey to an Adult Medicaid Dental Benefit

In the realm of policy advocacy, effective messaging can make all the difference between a stalled idea and a legislative victory. Gail Brown, long-time Executive Director of the New Hampshire Oral Health Coalition, and its members understand this well, having navigated a long-standing struggle to secure an adult dental benefit for Medicaid recipients in the state.

While the state’s Medicaid program provides a full dental benefit for children, its adult benefit was limited to emergency-only care. Emergency care, primarily limited to extractions or pain medication, fell far short of the much more comprehensive approach to oral health — preventive and reparative dental care.

The Oral Health Coalition receives a general operating support grant from New Hampshire Children’s Health Foundation. “This enables them to conduct advocacy for pregnant and nursing women — and other adults — who can now access the Medicaid adult benefit,” said Foundation Program Director Patti Baum.

More Than a Nice Smile

Over a decade, advocates like Gail Brown and the Coalition sought to reshape the discourse and shed light on the far-reaching implications of oral health on overall well-being. They began to gain traction three years ago by reframing their message.

“One pivotal shift involved reframing the discussion from merely a “nice smile” to a broader narrative emphasizing the critical connection between oral health and overall health,” said Brown.

Most Americans do not know that dental decay and gum disease are actually caused by bacteria.

By highlighting dental conditions as diseases caused by bacteria, the Coalition and other advocates, including the NH Department of Health and Human Services, emphasized the gravity of the issue and its potential to spread within families.

“We made sure legislators learned that this wasn’t about people drinking soda or eating too much sugar,” Brown added, “and it couldn’t be stopped by flossing and brushing twice a day.”

“It was about preventing the spread of dental disease among members of a family – including pregnant women or young mothers spreading it to infants,” she said.

It’s Two-Generation

This reframing caused lawmakers to recognize the importance of not just treating one generation but considering the entire family unit in the battle against dental decay.

Crucially, they coined the phrase “Two Generation,” encapsulating the idea that addressing dental decay is a multi-generational process, requiring comprehensive care for families to break the cycle of infection.

“What that meant was that we could give kids a great benefit, but if we could get them in and get them taken care, they were returning home to families where they would be reinfected,” said Brown.

“We made the connection that it doesn’t make sense to only provide a children’s preventative dental benefit, if children can then easily be reinfected with bacteria within their families by sharing a water bottle or other common things parents and children do,” she said.

With this powerful narrative in place, the New Hampshire Oral Health Coalition garnered support from a diverse range of stakeholders, including both Republicans and Democrats, by illustrating the bipartisan value of the initiative.

Justification for Funding the Adult Benefit

The messaging strategy further capitalized on the notion of “Responsible Management of Scarce Resources” to address concerns about financing the dental benefit. By aligning the cause with prudent resource management, the Coalition effectively neutralized potential opposition and garnered widespread support, even from unexpected quarters like the Liberty Alliance, a coalition working to “increase individual freedom” in New Hampshire.

The strategy paid off, as the adult Medicaid dental benefit was passed with overwhelming support in the House, a unanimous vote in the Senate, and Governor Sununu’s enthusiastic endorsement. The transformation of the conversation from a limited emergency dental benefit to a comprehensive approach centered on overall health was a key driver of this victory, showcasing the impact of strategic reframing in the legislative process.

Still More to Do

While having an adult dental benefit added to the state’s Medicaid program is a huge win, Brown and the Oral Health Coalition have another long-standing issue in front of them.

“Our challenge now is getting enough dentists to take care of both children and adults in the family,” said Brown. She noted that Northeast Delta Dental has been very supportive, however it faces an ongoing challenge to encourage private-sector dentists to accept the rates that Medicaid pays for services.