From The Field M A Y 1 9 , 2 0 1 4 Stepping Out: One Foundation’s Lessons Learned from Leading a Ballot Initiative JESSICA HEMBREE Program Officer, Health Care Foundation of Greater Kansas City JANE MOSLEY, PH.D. Program Officer, Health Care Foundation of Greater Kansas City O n July 1, 2010, the South Carolina legislature increase. Thanks to this clear public health case, we received increased its tobacco tax from $.07 per pack to $.57 very little criticism for supporting the increased tax. Perhaps per pack. Prior to that date, the state of Missouri had surprisingly, we were more likely to be criticized by the “good been clinging to the second lowest tobacco tax in the nation. guys,” not for supporting the issue but for our approach, with Once South Carolina increased its tax, Missouri, at $.17 per some of our colleagues questioning the timing, Missouri’s pack, earned the distinguished position of the lowest tobacco readiness level, or the campaign’s efficacy. tax in the country, which provided momentum toward a On November 6, 2012, Missouri voters rejected the campaign to increase the state’s tobacco tax. tabacco tax increase by a margin of just 40,419 votes out In Missouri, tax increases are severely limited by the of 2.5 million cast. It was a tough defeat. HCF, which is Hancock Amendment, which prohibits tax increases beyond a committed to evaluation for learning, funded a retrospective certain threshold without a vote of the people. Increasing the evaluation of the effort, which included a post-election tobacco tax via a ballot initiative had been attempted and public survey. Although evaluating advocacy is more difficult failed twice in the 10 years leading up to the 2012 campaign. since it occurs in a highly dynamic context that is influenced While the Health Care Foundation of Greater Kansas City by many contextual factors, we felt a strong evaluation was (HCF) had been involved in the previous tobacco campaign in a necessary to inform HCF’s future advocacy work. Here are funding capacity, the 2012 tobacco tax campaign marked one of a few key learnings from the evaluation. the first times when HCF stepped into the public sphere in sup- port of an issue; by and large, our advocacy work had been PICK YOUR ALLIES CAREFULLY advanced through our grantees. HCF is a 501(c)3 public char- ity, which allows us to lobby, in contrast to private foundations. A small group of stakeholders representing public health and The 2012 campaign was marked by significantly more education groups oversaw the campaign, a strategic move to involvement from HCF, including $1.5 million of funding, keep the day-to-day decisions manageable. While HCF was sitting on and recruiting others for the campaign’s steering interested in the public health benefit of tobacco taxes, count- committee, and acting as a behind-the-scenes broker to help less others were primarily interested in the anticipated revenue. develop ballot language for maximum support. In addition, In determining how the revenue would be dedicated, HCF HCF was present in the media and civic community advocat- used public opinion surveys and focus groups to guide this ing for the passage of the tobacco tax ballot initiative. HCF’s decision. The coalition ultimately landed on education and more vocal and public role was borne from both necessity and tobacco control for the additional revenue. readiness. It took us time to develop the political capital and As a result, HCF and our key partner, the American Cancer civic presence to assume a public leadership role on this issue. Society, needed to secure the education sector’s support. Additionally, since HCF did not stand to gain financially from While we received some support from that sector, it never the added revenue generated by an increase in the tobacco tax, fully engaged with the effort. This was in part because HCF our public support for the initiative was viewed as “pure” and was not familiar with the education advocates and ended up lent the initiative significant credibility. with key partners who did not have sufficient capacity. While At the time, Missouri had the fourth highest adult smoking the momentum of local tobacco control efforts was a support rate in the nation and increased pricing stood to most strongly to the tax campaign, the evaluation showed that we did not change this number. High school seniors reduce their cigarette sufficiently incorporate those coalitions, and offered consumption by 6.5 percent for every 10 percent price grassroots outreach as a key area for improvement. LET THE PROFESSIONALS HANDLE IT the contrary, post-election surveys showed that voters never really believed that the revenue would be spent appropriately. The evaluation commended the campaign’s legal team and This mistrust was so high and heavily entrenched that none of signature collection firm. HCF contracted with a signature our messaging alleviated these concerns. collection firm to get the issue on the ballot. Simultaneously, two unrelated issues fielded signatures almost entirely with BE MINDFUL OF YOUR ENVIRONMENT volunteers but did not qualify for the ballot due to under- collection. At the same time, a volunteer signature collection This campaign was lost on such a narrow margin that every effort could have helped generate public support for the single decision could have made the difference. According to initiative. precampaign polling, we did not have a lot of wiggle room. The campaign committee contracted with a campaign man- The tobacco tax was being considered in a relatively toxic ager, public relations firm, direct mail firm, and paid media political environment where voters, recovering from an eco- firm to execute the campaign plan. Supporters of the tax nomic recession, had no appetite for tax increases of any spent roughly $5 million on the effort, relative to just $2.4 kind. These prevailing political winds, far outside HCF’s million spent by the opposition. The campaign supporting control, played a strong role in this campaign. This is an the tobacco tax focused its paid media on television, while the important lesson learned for HCF—watch for windows of opposition relied heavily on radio and billboards. Despite opportunity that coincide with our goal of advancing health spending less than half as much, the opposition’s communica- policy. Factor in political context and prevailing public tions tactics were very effective. Their paid media questioned sentiment, and be selective about expending financial and whether the additional revenue would be used as the ballot political capital. language promised and portrayed the tax as a general tax increase that would apply to all Missourians. KNOW YOUR OWN PLAYBOOK BE PRACTICAL While not surfaced through the campaign evaluation, we would like to add one internal lesson learned. The ballot language to increase Missouri’s tobacco tax Following the wake of the tobacco tax campaign, HCF has a included items that were specifically intended to reduce whole new set of tools and tactics at our disposal. When we opposition. The first was language to close a legal loophole consider how to engage on a policy issue, we are now more that was giving small tobacco manufacturers a competitive comfortable leading and even lobbying. While this latitude is edge over large ones. Missouri is the only state that has not important, it also means that we need to be clear internally and enacted language to close this loophole, which was created as with our board about how we will be positioned on any given a byproduct of the 1998 master settlement agreement. Big issue. Not every issue we take on is going to look like the Tobacco was very invested in seeing this loophole closed. tobacco tax campaign, as there are multiple other roles HCF This meant that Big Tobacco stayed out of the fight entirely, might fill, including being a silent backer, directly lobbying leaving the small tobacco manufacturers and convenience legislators, and building up grantees over the long haul. As a stores as the primary opposition. result, we have an explicit conversation internally and with our board whenever we take on an issue to determine what role we LIVE YOUR MISSION are playing. This helps line up internal resources and ensures According to the evaluation, the campaign had too many key that we have a shared understanding of HCF’s particular role messages, hitting on both the importance of education fund- in moving an issue forward. ing and the public health value of increasing tobacco taxes. We hope these lessons will help our peers in the philan- Our messaging was further complicated when opposition ads thropic field. Advocacy and policy development is certainly an portrayed the tax as a general tax increase. In retrospect, emerging area of practice, and ballot initiatives are one of HCF’s value proposition was that we were supporting the tax many important ways to advance public health. purely for the public health benefit. Our messaging should have pushed the public health message, rather than attempt- ing to sell the tax based on the added revenue. The evaluation also suggested that the campaign did not sufficiently play up the “good guys versus bad guys” dynamic, wherein all the public health groups supported the tax and only small tobacco companies opposed it. Much of the campaign messaging attempted to assure vot- ers that additional revenue from the tobacco tax would truly be dedicated to education and health. This was in response to a widespread mistrust that dollars would be spent as intended, Views from the Field is offered by GIH as a forum due in large part to previous revenue increases that were for health grantmakers to share insights and experiences. If you are diverted from their original purposes. Despite messaging to interested in participating, please contact Osula Rushing at 202.452.8331 or orushing@gih.org.