State Legislators: Who They Are and How to Work With Them: A Guide for Oral Health Professionals

March 2018

Why Should You Care About the State Legislature?

Because of the variety and complexity of the policy issues before them, state legislators often rely on their staff, researchers, experts in the field, lobbyists, practitioners and community members to gather information and develop policies that address a need or respond to an opportunity (such as new federal funds). Legislators have access to research through legislative staff or research organizations such as the National Conference of State Legislatures; however, they also rely on experts in the field—people like you—for information and firsthand perspectives about the effects of laws and public funding of oral health programs.

This guide is designed to:

Health Professional Shortage Areas (HPSA) - Dental

HPSA scores are developed for use by the National Health Service Corps to determine priorities for the assignment of clinicians. The higher the score, the greater the priority. State policymakers can use this data to inform policy. Data as of Jan. 1, 2018

Map of U.S. showing oral health professional shortage areas.Source: Health Resources and Services Administration

Understanding Legislatures and the Legislative Process

State legislatures vary from state to state, with differences in the number of legislative members and staff, time spent in session, legislative procedures, political makeup and so on. Despite these differences, however, the general legislative process is similar across states. This section summarizes the basics of the legislative process, including how bills become laws, and the people involved in the legislative process. It is important to know how the process works to communicate effectively with its participants!

Legislative Process

The legislative process—in theory—follows a predictable, rational path that goes something like this:

In addition to an understanding of the legislative process, it is important for stakeholders to engage in the budget process. The budget process may fund oral health and public health programs, and the budget can directly affect oral health policy.

While these are the steps in every state (except Nebraska, which has one chamber), the human factor is a significant part of the legislative process. “Missing from the preceding list of steps in the legislative game is the human equation,” Tommy Neal wrote in NCSL’s 2005 book, “Learning the Game: How the Legislative Process Works.” “State legislators come from all walks of life and bring with them a smorgasbord of priorities, agendas, alliances, personalities and biases.”

Infographic showing the legislative process.

Members and Staff

Many professionals support and interact with legislators, and each has a specific role in the legislature.

Time Spent in Session

States vary in how long legislators are in session, from nearly year-round legislatures like California, Illinois, Massachusetts, Michigan, New Jersey, Ohio, Pennsylvania and Wisconsin to sessions that last less than two months in Florida, Louisiana, Utah and Wyoming. Still others meet every other year (Montana, Nevada, North Dakota and Texas). Knowing when your state legislature is in session is critical. See NCSL’s State Legislative Session Calendar for more information.

Rules of the Game

Every state has formal rules that affect the process, including requirements about how many bills a legislator can introduce in a session, the deadline for introducing bills, and the process for assigning bills to a committee. Understanding the rules that govern the process in your state is important since they determine the timing and flow of bills through the legislative process, and shed light on pressure legislators may face to prioritize issues.

If you want to provide input on a specific bill before a specific committee (the appropriate committee for oral health issues varies by topic and state), you need to know when committee hearings take place and the rules for presenting testimony. While the process may seem cumbersome, the rules were designed to protect against a rush to judgment and ensure that policies are reviewed by many people before going into effect.

The Importance of Elections and Partisan Composition

For oral health professionals looking to communicate with legislators, do not underestimate the role of elections and political makeup within each state and across the nation. In 2016, 5,917 of 7,383 state legislative seats nationwide were up for election. In the same election, just 12 states chose governors. About 1,263 of the elected legislators were new to the legislature after the 2016 elections. On average, 20 percent of legislators are new each election cycle, which can pose a challenge for them to learn about wide-ranging policy issues, budgets and the legislative process in short order.

See the political makeup of the country between 2010 and 2018 above. These maps can change overwhelmingly in just one election. Understanding this context can be critical to effective communication with state legislators.

The day after an election, people in the state legislature face new colleagues, shifts in the balance of power and executive priorities. Strategies for communicating may need to change to fit new human or political realities. Furthermore, any work you did to educate legislative leaders, committee chairs or your own representative last year will need to be updated and repeated.

How to Communicate Effectively With Legislators

Those who want to contribute information to the legislative process should understand the constraints that affect how legislators respond to public policy issues or proposals. Although there are many constraints, the good news is that most legislators see themselves as students. Oral health is often only a blip on the political radar, but you can be the “blip” enlarger! Challenges include the following:

Map showing state egislative term limits.

Four Strategies for Effective Communication

1. Establish Contact and/or a Relationship with Key Legislators

Identify the committees of jurisdiction and the legislators on these committees who have the greatest influence concerning oral health issues. This may be the committee chair, interested committee members, or perhaps even your own representative. Contact key legislators, meet with them, and identify yourself as a knowledgeable and dependable resource. In short, establish yourself as the “go-to” person for oral health issues.

In some states, the best way to reach legislators may be by building a relationship with key people on their staff. Follow up by contacting them periodically as a reminder that you are interested in being a resource. A good time to contact them, for example, might be on the heels of newly released data; you can help them interpret the data and discuss ways the legislature might address issues the data highlights.

Another way to develop relationships with legislators is to engage in legislative oral health caucuses. Oral health caucuses allow stakeholders to access legislators with a professed interest in oral health. Many meetings are open to the public and provide a venue to discuss oral health issues that are important in your state or community. The box above outlines key features of legislative oral health caucuses.

If your professional capacity restricts you from such activities, consider making similar contact with your own organization’s governmental relations staff, other influential people who are allowed to contact legislators or connecting with a community-based advocacy group to offer your expertise and assistance.

Keep in Mind

Oral Health

Oral Health Caucuses: State Highlights

Oral health caucuses may engage in a range of activities or discussions about improving oral health in your state. Identifying the champions, the issues, and modes of engagement and communication of the caucus are critical components in developing a relationship with state legislators.

Massachusetts started the first legislative oral health caucus in the nation in 2005. Over the years, the caucus worked with oral health stakeholders to prioritize certain oral health services. Legislative champions may choose to reach out to their constituents through local media outlets to explain why an issue is important to them. Oral health stakeholders might also choose to highlight the work of legislative champions for their own members or constituents.

The bipartisan oral health caucus in the Missouri General Assembly was created in 2013. The Missouri Oral Health Coalition, which is made up of many stakeholders, helped initiate the caucus by reaching out to legislators. The coalition raised state-level oral health concerns with the caucus, which spurred legislation and funding allocations for oral health. The bipartisan caucus’s accomplishments include reinstating the state dental director and facilitating access to local oral health services.

2. Network With Others

As the adage goes, it’s not always what you know, but who you know that counts. Getting information into the hands of legislators may be more about the relationships you have—with the media, state agencies, foundations and other stakeholders—than your direct relationship with a legislator. Informing a network of individuals can efficiently and effectively raise awareness about a wide range of oral health issues.

Furthermore, oral health issues cross many jurisdictions and interest areas, among them health, insurance, licensing, workforce development guidelines, Medicaid and public health. The broader your coalition, the more support a lawmaker can expect among his or her colleagues.

Keep in Mind

For ideas and resources on how to develop a local or statewide network, research organizations in your community and build communication infrastructure for your network, visit the DentaQuest Foundation’s Oral Health 2020 Network, which is a nationwide network of oral health providers and stakeholders.

3. Raise Awareness Through Information and Resources

Why is education so fundamental? Because even experienced legislators need access to current data and objective analysis on rapidly changing issues. Oral health professionals can play a role in raising awareness about issues affecting children and adults in each legislative district. When they’re not at work in the state capitol, legislators interact with the community in various ways and often organize multiple venues for a “give and take” with their constituents—at town hall meetings, online blogs and conversations, and other settings.

Another method to educate policymakers is to raise important issues with the people and organizations that legislators rely on for information, including legislative staff, researchers, the media, foundations and charitable organizations, state agencies, membership organizations and others.

For state employees, this might mean ensuring that your government relations person knows your priorities and has your most recent data to share with legislators. Although this may seem one step removed, it may be an effective strategy, particularly if the information is coming from a trusted source for the legislator.

Keep in Mind

4. Frame Your Message

At any given time, one issue or a small group of predominant issues or controlling ideas may drive the actions of a state legislature. For many years, states have been dealing with tight budgets; therefore, focusing on effective and efficient strategies is often the filter through which legislators evaluate all proposals and funding requests. As a result, it is important to frame the message by addressing several key points.

For more information on how some stakeholders frame oral health issues, consider resources from the Frameworks Institute, such as the “Watch Your Mouth Campaign” or “Getting Stories to Stick: The Shape of Discourse on Oral Health.”

Consider the language or image you use to increase the odds that people will pay attention to your message. People bring their own experiences and frames of reference to bear, and the words or images you use can determine whether your audience will be open to the message or turn away from it. Creating receptive listeners requires that you pay attention to how you frame an issue so people feel that it benefits everyone. Ideally, messages should all align with “big ideas” or shared beliefs, such as responsibility, prevention or success. Many people have the perception that dental care is secondary to traditional health care. Use your expertise as an oral health professional to make the connection between the health of the mouth and the health of the body.

Keep in Mind

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