Edelman Public Relations, in partnership with AHCA, implemented an advocacy campaign to place a patient face on the eldercare community’s fight to restore cuts in Medicare that were part of the 1997 Balanced Budget Act.  The “Keep the Promise – Save Our Seniors” campaign was strategically designed to build momentum using special events, earned media, grassroots support and tactical research.  Our efforts achieved the needed results – federal legislation restoring needed Medicare payment dollars.


At the outset of the year 2000, the nation’s long-term care community faced a mounting crisis:  While the costs of skilled nursing care continued to rise, payment for that care – chiefly through the government programs Medicaid and Medicare – were not keeping pace.  By the summer of 2000, one in ten U.S. nursing home beds was in a facility operating in bankruptcy, representing more than 2,000 facilities nationwide.  Yet Congressional health policymakers largely remained focused on other issues, reluctant to address what they regarded as a problem in the provider community, not a problem brought on by insufficient Medicare reimbursements for care.


In conjunction with the Alliance for Quality Nursing Home Care, AHCA commissioned national survey research and an analysis of Medicare spending for various patient acuity levels, enabling us to define our approach, our key messages and our audience.  

Preliminary Survey Research confirmed the necessity of framing our advocacy as a battle to adequately fund that part of Medicare whose beneficiaries truly are among our oldest and most vulnerable citizens.  In purest terms: election-minded Members of Congress needed to hear from their own senior constituents that SNF Benefit funding was high on their priority list.

Careful Medicare Spending Analysis revealed a vital and surprising fact: While Congress had intended budget-balancing funding reductions in Medicare legislation enacted in 1997, actual spending cuts were much greater.  This finding led to one of the main “pillars” of our messaging: persuading Congress to restore funding that had been withheld unintentionally due to executive branch implementation frustrating the lawmakers’ intent.  


Our main focus was to put a “human face” on our campaign and emphasize that restoring withheld Medicare funs for skilled nursing facilities is for the benefit of the patient, not for the benefit of healthcare providers.  We used earned media, grassroots support, coalition support, tactical research and staged media events to demonstrate strong senior-citizen demand – nationally and in key congressional districts and states – for restoration of needed Medicare resources for skilled nursing facility residents.


Facing an uncertain timeframe in which Congress would take up our issue, the Campaign was specifically designed to build momentum over time:

Memorial Day Campaign Launch – The campaign was launched over Memorial Day Weekend 2000 with 20 separate events held in target media markets across the country.  Each event featured skilled nursing caregivers, patients and their families uniting in a call for the Administration and Congress to restore Medicare funding.  The press conferences resulted in dozens of prominent state print articles, coverage on nearly 100 local television networks, numerous radio news stories and hundreds of letters to Vice President Al Gore.

National “impact” study – At a May 2000 Capitol Hill press conference, AHCA released a study by the former Chief Actuary of the Health Care Financing Administration (HCFA), the federal agency that oversees Medicare.  The study revealed that HCFA’s own allocation system was consistently under-paying the country’s skilled nursing facilities and that by 2004, skilled nursing facilities would receive $15.8 billion less in Medicare funding than Congress intended.

State-specific impact studies – At a press conference in August 2000 at the National Press Club, figures were released by research and industry experts that showed how much each state’s seniors would lose in Medicare funding for their skilled nursing needs – unless Congress acted to correct the funding failure.  These figures were furthered released throughout the nation, giving our study “legs”, with more than dozens of state publications carrying the story nationwide.

Online – The “Keep the Promise!” Petition – Mindful that seniors are the fastest-growing segment of internet-savvy Americans, in August 2000 we took the grassroots portion of our campaign online.  Using various portal sites we invited readers to link to www.keepthepromise.com, where they could add their names directly to a petition.  Partnering with Juno, a free internet service provider with over nine million subscribers, we launched a Juno Advocacy Network ad campaign at 100,000 senior Juno subscribers.  In just five weeks, the ad generated over 18,000 petition signatures.  

Labor Day Rally on Capitol Hill – On September 5, 2000, we staged a rally with 150 caregivers (administrators, nurses, certified nursing assistants, physical therapists) from across the country on the steps of the Capitol calling on Congress to restore Medicare cuts. Keynote speakers included a facility administrator, a caregiver and a family member and author who recently published a book about her elderly parents and the nursing facilities.

Petition Unveiling on Capitol Hill - On September 9, 2000 a petition of more than 30,000 concerned seniors and healthcare providers was delivered to Congress at a Capitol press conference.  The petition, on five 8 X 4 foot panels served as the backdrop for the press conference.  The press conference featured key House members, nursing home residents, family members and caregivers (averaging over 85 years of age!) who gave their support for restoring Medicare funding and added their names to the petition.


The Keep the Promise … Save our Seniors Campaign was widely successful in all its efforts including:

  • hosting numerous special events garnering national and key state attention
  • garnering national and state earned media
  • educating key policymakers through targeted policy and media briefings, mailings, third-party contact, earned media and grassroots education
  • coordinating more than 70 one-on-one meetings with key Senators and Congressmen
  • generating large volumes of trackable communications to Capitol Hill and the White House at critical times during the year.
And, as a result, we achieved our key objective when on December 15, 2000, Congress passed the Benefits Improvement and Protection Act (BIPA) of 2000 that restored $35 billion to Medicare over 5 years -- $1.6 billion of which was specifically allocated to skilled nursing facilities – an extraordinary return on investment.  And President Clinton subsequently signed BIPA into law.