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The CHCF Blog

What I Learned from My 20-Year Fight for Children's Health Coverage

Bob Brownstein, Director of Policy and Research, Working Partnerships USA
Bob Brownstein
Bob Brownstein

This article is adapted from remarks delivered at a David and Lucille Packard Foundation event celebrating California's commitment to universal coverage for children.

I'm the public policy and research director at Working Partnerships USA (WPUSA), a San Jose-based community organization that drives the movement for a just economy by bringing together public-policy innovation and the power of grassroots organizing. It's the same job I held 16 years ago, when my organization and People Acting in Community Together (PACT) boldly announced that Santa Clara County would be the first in the nation to provide health insurance for every child.

When we began our quest, neither of our organizations specialized in health policy. PACT is a multi-ethnic, faith-based group that emphasizes grassroots organizing to empower everyday people to create a more just society. WPUSA was originally focused primarily on strategies to create quality jobs. But with the help of a small grant from The California Endowment, we were able to launch the Children's Health Initiative, a campaign that reached 20 counties and eventually secured the support of state government to provide health coverage to all of California's children. California counties and/or public health plans created their own insurance products for those who couldn't qualify for other government programs — primarily the undocumented. We came up with a catchy name for the insurance program in Santa Clara County: Healthy Kids.

In light of the new direction we're seeing from federal policymakers, I've assembled a list of key lessons that led to our victory that may be valuable in the years ahead:

  • Remember the political power that can arise out of people's need for health care. Neither WPUSA nor PACT focused on health policy. But both groups had a common method of operations — seeking to find out directly from our constituencies what they needed and wanted. Working Partnerships and PACT chose health insurance as a priority because our constituencies told us it was their priority.
  • Progress is often created by groups committed to organizing. WPUSA and PACT both have research capacities and are highly creative. But the reason we succeeded in launching the Children's Health Initiative (CHI) was because we had a commitment to organizing. Sure, we could talk the talk, but we could also walk the walk by mobilizing the community to insist that the initiative be funded. Organizing isn't just a numbers game. In one case, we got a recalcitrant city councilmember's pastor to call and remind her of the morality of caring for kids.
  • Be opportunistic — timing is critical. If we hadn't seized the moment when tobacco settlement funds became available at both the county and city level, budget-conscious officials might never have committed to CHI. Even in dark times, there are opportunities. When they occur, people and organizations have to be ready to take determined action — even if it involves risks and doesn't fit normal grantmaking or governmental budgeting cycles.
  • Coalitions produce strength. The Children's Health Initiative succeeded because WPUSA and PACT were joined by the full labor movement, the faith community, school leaders, health care providers, and others. Everybody has their own highest priority issue. But there are times when profound change will only happen by working together. I will never forget watching big, tough plumbers hammering the San Jose City Council to support CHI. Their kids already had coverage through a union contract. But they stood there — cashing in their political capital — for a broader cause.
  • Few political victories are granted to those unwilling to fight. Our county government immediately supported CHI thanks to gutsy leaders like Jim Beall and Blanca Alvarado. To secure funding from the City of San Jose, we needed to win a battle. Of course, we should always make a maximum effort to persuade our leaders of the righteousness and feasibility of our objectives. But sometimes persuasion fails, and pressure is needed. That doesn't mean you have to be loud and abusive. It means you have to be strong, and sometimes you have to be brave.
  • Caring about children is an almost universal human quality. In organizing support for CHI, it immediately became apparent that there was an almost instinctive way that people embraced the proposal. Children are innocent, and most people will work hard to protect them from harm. It's often said that the most successful political initiatives are those that give people something they already believe in. Health care for children was — and I believe still is — one of those issues.
  • Think big. The power of the CHI idea was that it proposed universal coverage for kids. I gave about 50 speeches on CHI during the first year of the program. Every time I said Santa Clara County will be the first to have health insurance for 100% of its kids, I got spontaneous applause. I give a lot of speeches on a lot of subjects. When I call for incremental change, even on critically important issues, I just don't get the kind of response I got for the Children's Health Initiative.
  • Be ready to think even bigger. For we organizers and advocates in Santa Clara County, health coverage for children was never the ultimate goal. We sought universal coverage for everyone. After energetically supporting widespread enrollment in the ACA Medi-Cal expansion and in Covered California, our local coalition created the Primary Care Access Program. This initiative offers coverage to adults ineligible for insurance under Medi-Cal or the ACA.
  • Saving even one life justifies the entire effort. Our inability to save all victims of injustice does not diminish the importance of protecting every single person that we can.

About Bob

Bob Brownstein has been the research and policy director at Working Partnerships USA for 17 years and was a leading strategist in developing the Santa Clara County's Children's Health Initiative. Bob is chair of the County Health Reform Stakeholder group and has played a leading role in the adoption of affordable housing policies, transit equity programs, city and county living wage policies, and San Jose's successful minimum wage initiative. He previously served as chief of staff for County Supervisor Susanne Wilson and budget director for San Jose Mayor Susan Hammer. He has a bachelor's degree from Princeton University, a master's in political science from Stanford University, and a master's in environmental studies from San Jose State University.

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