Health Care Coverage for the Uninsured Consensus-Building Project

Despite widespread agreement across the political spectrum that all Americans should have access to health insurance, diverse and spirited opinions on how best to address this problem have left the issue deadlocked for years. Frustration over this impasse, and a conviction that something could and should be done about it, led to convening an unusual partnership starting in January 2004.

This process was initiated and organized as a project of Search for Common Ground (SFCG) and its U.S. Consensus Council - a diverse, bipartisan leadership group that works to promote consensus-based approaches to addressing issues of national importance. SFCG partnered with the Meridian Institute, another nonprofit organization with substantial experience in assessing and facilitating policy consensus processes, to serve as the facilitation team.

In early 2004, a group of leading health care organizations (the Advisory Group) met to assess whether, and under what conditions, it would be possible to reach consensus on how to expand health care coverage for the uninsured. Between February and June 2004, the facilitation team conducted a thorough assessment, interviewing 50 health care and political leaders representing a wide range of viewpoints. The Advisory Group, composed of leaders from organizations representing diverse interests and involvement in the health care coverage issue, guided the process.

The assessment's findings included:

• There was widespread agreement that providing health care coverage for millions of uninsured Americans is an important, timely issue;

• There were no irreconcilable, fundamental moral and ethical issues among parties;

• There was widespread interest in a consensus process to solve this issue; and

• Despite wide-ranging ideological differences among those interviewed, there was a surprising convergence on key approaches, including incremental options for increasing health care coverage.

Based on the report, the Advisory Group agreed to proceed with a consensus-building process. The facilitation team and the Advisory Group worked jointly to identify and enroll a diverse and representative group of influential stakeholders on the issue of health care coverage for the uninsured, thus ultimately forming the Health Coverage Coverage for the Uninsured project, or HCCU.

The facilitation team led participants through a consensus-building process - a unique approach for bringing together diverse stakeholders to seek agreements on how to address a particular public policy issue. The hallmarks of the process are: i) Consensus decision-making: participants make decisions by agreement rather than by majority vote; ii) Inclusiveness: as many necessary interests as possible are represented or, at a minimum, approve of the discussions; and iii) Facilitation: an impartial facilitator, accountable to all participants, manages the process, ensures that the ground rules are followed, and helps maintain a productive climate for communication and problem solving.

In late 2004 and early 2005, the process moved to an agreement-building phase - during which participants shared with each other the nature of their individual interests, agreed upon ground rules and committed to the shared goal of expanding health coverage for as many people as possible, as soon as possible.

The Economic and Social Research Institute and the Lewin Group were enlisted to provide research and analytical support for the process. Negotiations continued throughout 2005 and 2006 - involving more than a dozen meetings altogether. The result of the HCCU's collaboration is the proposal released on January 18, 2007.

Download the following PDF documents:

Final HCCU Agreement
HCCU Backgrounder
HCCU Press Release
HCCU Media Highlights