Written by Laura Wittcoff, MSW, LICSW
Social media can serve as an ‘activism platform’ voicing support for causes when shared virally (Mitchell & Larson, 2014) which can result in social impact campaigns creating and sometimes forcing change. A PEW Research Center report found that 20% of social media users changed their views on social issues due to something they saw on social media (Anderson, 2016). There are numerous recent examples of social activism which have garnered both public support and public action (#Giving Tuesday, #Black Lives Matter). The Human Rights Campaign (HRC) utilized Facebook as its advocacy platform to attract more members and gain traction for key social issues that raised public awareness (Goldkind, 2015). Media via interactive technology has become our first choice for giving and getting information and more recently for getting involved. 76% of Americans use Facebook daily, 51% use Instagram, 42% use Twitter (Greenwood, Perrin & Duggan, 2016); this medium is becoming the virtual street corner soap box (Open Air Outreach, 2016).
Nonprofit organizations (nonprofits) are a significant part of the U.S. economy (McKeever, 2015) and exist for social good. Nonprofits are learning the art and science of media opportunities including the benefits of social media to further enhance their exposure to explore opportunities of developing new funding streams, solidify volunteer and client interest and garner public trust so that they are in a strong position to combat the effects of a changing political environment (Pesch 2014, Smedsrud, 2015).
There are over 1.4 million Internal Revenue Service (IRS) registered nonprofits (501(c)(3) in the United States contributing approximately $905.9 billion to our economy (McKeever, 2015). 2014 was the first year (post the recession in 2007) to exceed the pre-recession giving of $355.16 billion (Giving USA, 2016) totaling $358.38 in private giving including individuals, foundations and businesses. Nonprofit organizations saw an increase in volunteerism (25.3% of U.S. adults, 62.8 million), representing 8.7 billion hours served, valued at approximately $179.2 billion. These figures do not include those nonprofits not required to register with the IRS as their annual revenue is less than $50,000. Giving and volunteering is on the rise; social media campaigns educate the public, encourage involvement and raise awareness with the hope of influencing those in decision-making positions (legislators, influential donors) (Goldkind, 2015, Giving USA, 2016).
Government sources (contracts and grants including Medicaid and Medicare payments) provided nearly one-third (32.5%) of non-profit revenues in 2013. In addition, human services organization (food banks, homeless shelters, youth services, sports organizations, legal and family services), representing over one-third of public charities (35.5%), accounted for less revenue (12.4 %) and expenses (12.7%). In contrast, hospitals representing only 2.4% of total public charities equating 49.8% of public charity revenues and 50.7% of expenses (McKeever, 2015). Human service organizations have access to fewer funds despite their number and those funds are restricted, not to be used for fundraising or marketing (National Endowment for the Arts, 2015). This places them in an economically disadvantaged position as compared to their hospital counterparts who have greater flexibility due to their larger donor base and their ability to access varied funding streams (McKeever, Ashley & Dietz, 2016, National Endowment for the Arts, 2015). Free social media becomes a viable choice for under resourced nonprofits to outreach to their constituencies.
Dr. Tom Price, the recently confirmed Secretary of the Health and Human Services Administration, has been interested in dismantling the Affordable Care Act for over six years (Kaiser Family Foundation, 2017). Representative Price is expected, in his new position, to lead the United States in the areas of health and well-being (medicine, public health and social services) (Kaiser Family Foundation, 2017) In Representative Price’s proposed bill, Empowering Patients First Act of 2015, he suggests that the United States should embrace a system of payer choice where individuals select their health care based on their individual needs. This proposal promotes a free health care marketplace where a segment of the population would benefit from receiving a tax credit by purchasing insurance although the benefit would be slightly less than the current benefit under the Affordable Care Act. This proposal is based on a certain percentage of the population applying to be part of a health care pool. Minnesota has had the most successful health care pool program as compared to other states where premiums were high and participation was low (Kaiser Family Foundation, 2017, Price, 2015, Smedsrud, 2015). Health care pools are generally for those who have higher health risks where health access is administered. Finally, this plan raises the limit for the health savings account (HSA) contribution including refundable tax credits for health insurance and pre-tax monies to be used for concierge (generally for wealthier individuals who pay a premium to be part of a physician’s practice) or direct practice medicine. It also eliminates some constraints on private contracts between physicians and Medicare beneficiaries, leaving amounts, that can be charged for services, as discretionary (Gertz, 2017). It also creates a system where high deductible costs ensures many subscribers will by-pass medical care until it becomes critical to avoid that deductible costs (Pollack, 2016). Another area of proposed policy is to have limits on the amount of contribution an employer must pay into their employee health benefit. (Price, 2015).
The Affordable Care Act (ACA), also known colloquially as Obamacare, was established to reach and insure uninsured Americans with the intention of stabilizing the U.S. healthcare system by creating greater equity (access to healthcare is an entitlement) and by reducing late diagnosis costs and visits to the emergency room. Some of the benefits included: covering dependents until age 26, covering birth control and ‘well’ visits to primary care physicians. There were also employer requirements including stipulations to ensure employee coverage based on a certain number of employees. The Act also required all U.S. citizens and residents to have insurance by offering continuum of care options through Medicaid and Health Insurance Marketplaces (Kaiser Family Foundation, 2017). This requirement inverted the balance from the majority not having health insurance to the majority now having health insurance in the U.S. (Healthcare.gov, 2017). Medicaid insures more than 70.5 million Americans, the majority low-income. As part of the Affordable Care Act, the federal government initially increased reimbursement fees to compensate for low co-pays and no deductible fees, making it affordable and attractive for those unable to access private insurance. This resulted in millions of Americans becoming included in the healthcare system and with previously poor health outcomes (Renter, 2015). With the large influx of new patients, the federal government could not continue with the subsidy and needed to close that aspect of the program although some states continue to pay the rates to retain doctors within the Medicaid system (Renter, 2015). Medicaid expansion has been a source of contention between the Obama Administration and now the Trump Administration and with Dr. Price’s confirmation, eliminating it is one of his first directives.
The most significant shift resulting from Dr. Price’s proposed program is the repeal of Medicaid expansion. Medicaid expansion was designed to further support those individuals earning less than $30,000.00 per year where receiving health care benefits were subsidized by the federal and state government to support more of our working and nonworking poor. As of January 1, 2017, 31 states have initially adopted Medicaid expansion as well as D.C. (totally 32 participants) while 19 states have not (Kaiser Family Foundation, 2017). This creates a coverage gap in our country consisting of approximately 18 million people initially becoming uninsured, 27 million people, one year post the elimination of the expansion and marketplace subsidies and estimates as high as 32 million people in 2026 (Fritzsche & Masi), meaning that without the Medicaid expansion, many fall outside of Medicaid eligibility and below the limit for the Marketplace tax credits (Kaiser Family Foundation, 2017). As more people fall into this coverage gap area or delay going to see a doctor due to the higher co-pays or refuse medical treatment because of the higher deductible costs, nonprofits will need to step in to address the complex issues that emerge when we do not take care of this segment of the population. Nonprofits will be further squeezed financially providing services to this population while not having access to public money to fundraise or market to donors and volunteers (McKeever, Ashley & Dietz, 2016, National Endowment of the Arts, 2015). Creatively using technology can play a strong supportive role in the nonprofit sector by providing information and resources including where to access low-cost or free social supports, medical information as well as the opportunity to participate in a social media campaign that could influence the legislators and effectively change policy (Bolder Advocacy 2017, Alliance for Justice, 2017).
Andreas Marouchos, (2015) a marketing communications entrepreneur, suggests six benefits of utilizing social media in healthcare: peer-to-peer healthcare, citing that 25% of patients access the internet for support in managing their chronic medical conditions by engaging with others with the same diagnosis; healthcare education and accurate information educates the general public; the ability to provide more comprehensive services, because providers can review shared charts digitally and provide the best collaborative medical diagnosis using a multi-disciplinary approach; social support mechanisms are linked to positive health outcomes; public health surveillance supports the management of diseases from becoming widespread; and the potential exists to shift public opinion and thus, change health policy. Capitalizing on these six areas creates the opportunity to mitigate the anticipated coverage gap while raising public awareness (Maroushos, 2015).
Nonprofits are challenged with activating technology and spearheading viral social movements, perhaps mirroring historical on-the-ground movements as in the Civil Rights Movement (1960-1964) (Vox, 2017) and as far back as The Women’s Rights Movement (1848-1920) (history.house.gov, retrieved 2017) swaying public opinion to affect social change for good. A precedent is established and, based on the viral explosion resulting in women marching all over the United States, (womensmarch.com, 2017), going viral could become the media platform of choice for nonprofit activism.
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