A Senior Citizen awaits her immunization
While everyone's been knocking doors, I've been implementing a new GOTV strategy: vaccinating elders in remote villages to get Rio Arribans to the polls.

Almost everyone in my extremely rural Hispanic and Native American county is a Democrat. I can't politic for candidates while on the job, but I can campaign for health care. I can encourage citizens to register to vote for the Española Hospital Mill Levy, and to call our Republican Governor in support of the ACA. If they happen to blacken a bubble for Heinrich, Lujan or Obama while they're out to support the hospital, well that's their business!

Judging from the fact that Rio Arriba was the only county in NM that increased voter participation since 2008 (76% of Rio Arribans voted compared to 62% statewide), it appears this strategy worked!

Video and audio below the squiggle.

Tierra o Muerte
Tierra o Muerte outside Tierra Amarilla, NM
It all started this July. The New Mexico Department of Health had come before the Rio Arriba Community Health Council the previous year to inform us we'd registered fewer seniors for immunizations than any other county in New Mexico and to enlist our help. Only eight of our viejitos had been registered in the state immunization database as of 2010. In 2011, we conducted a series of outreach events at senior centers in remote mountain villages, raising the number of immunized elders to 561, and Rio Arriba County to second in the state.

But now I wanted to do more.

I wanted to be first. I wanted Governor Martinez to opt into the Medicaid expansion. I wanted to implement a $200,000 outreach program without any staff or funding. I wanted our hospital to qualify for federal subsidies for Medicare. And I wanted my fellow Rio Arribans to show up at the polls to vote in record numbers.

Pride is half of the battle.

Brenda Romero, Española Hospital Administrator
Brenda Romero, Española Presbyterian Hospital Administrator
I called up Brenda Romero, our hospital administrator, and told her I'd thought of a marketing plan to increase the percentage of Medicare recipients from 55% to 75%, making us eligible to earn Sole Community Provider status for Medicare, and hence, a $1.8 million federal subsidy. According to data released by Medicare.gov, I could make the argument on the radio that Española Hospital surpasses all other hospitals in the region for quality.

In rural northern NM, relationships are more important than billboards. If Brenda would lend me a team of nurses, I would hold health fairs at each of nine senior centers in remote villages, and the Rio Arriba Health Commons (the clinic where I am located). I'd announce the free clinics repeatedly at town halls and on the radio using each opportunity to brag about the quality of care at the Hospital and clinics.

Brenda asked if I could complete the series of outreaches prior to early voting.

I could.

LouAnnSanchez, NM Department of Health, readies a vaccination in Dixon, NM
LouAnn Sanchez, NM DOH
I called up my buddy LouAnn Sanchez from the Department of Health and asked her for vaccine. She graciously agreed. She supplied nurses, too. I called Lore Pease, the Executive Director of El Centro Family Health. She agreed to supply staff to conduct heart and diabetes screenings. (Unfortunately, I don't have a usable photo of Lore whose clinic has done much to raise immunization rates in our community.)

Beginning in 2014 thanks to the ACA, hospitals will be heavily incented to reduce 30-day readmissions, and heavily penalized if they don't. One of my evaluators had examined 30-day hospital readmission data and noticed that the most common causes of ER readmissions for Medicare recipients in our community are contraindicative medications (that make patients ill when taken together), and joint pain. I invited Marlene Engleman from Gino's Gym to teach Silver Sneakers Classes at the fairs. These classes are specially designed for seniors to lessen and prevent joint pain. And I asked the hospital nursing team to conduct "brown bags:" events where seniors bring in everything in their medicine cabinet so a professional can examine them to make sure they are not contraindicative.

Congressman Ben R Lujan (D-NM) and Constituent
Congressman Lujan and a constituent in front of my house
Then I called up Congressman Ben Ray Lujan's office to invite him to participate in the fairs.
"I'd like the Congressman to explain to the public that we need lots of people to call the governor to ask her to opt into Medicaid expansion. We've figured out that the way substance abuse is spreading in Rio Arriba (we remain first in the state for drug overdose deaths) from one generation to the next, is that most of our able-bodied adults leave the county during the daytime to work, and we have few supervised afterschool activities for kids.

Drug dealers and gangs take advantage of the hours between 3 and 7 pm to recruit, offering kids drugs and alcohol.

But 25% of our wage economy is made up of health care jobs. It's our largest economic sector.

We have great health degree programs at Northern New Mexico College. If we can convince enough elders to seek services at the hospital, we'll receive $1.8 million in Medicare subsidies available to us, which equals about 40 local jobs. In many of our small rural villages, the local clinic is the only local employer. If we create meaningful jobs, we give kids a reason to finish school.

If Governor Martinez expands Medicare, she'll make people healthier and she'll bring jobs to our small villages, helping us to combat our drug problem. It's a win, win, win, win, WIN!"

A few days later, Ben Ray's office informed me he'd be holding Congress on Your Corner at our first health fair in mid-August. He would also address the Council and public about the ACA.

I called the press to alert them. The story generated statewide attention. In addition to numerous health screenings and immunizations, and Congress on Your Corner, we held a farmers' market, a jazzercize class, a jobs fair, cooking demonstrations and a canning class. You can listen to Elaine Baumgartel's feature on the event on KUNM, New Mexico's public radio station.

Then we took the show on the road, visiting senior centers in isolated mountain villages. Each site manager found restaurants, farms or other vecinos to donate food. They held farmer's markets, car shows, art fairs, dances, concerts and other activities to attract the public. The last fair, conducted at and organized entirely by the hospital to celebrate the opening of a beautiful new wing, was the largest. Students from the college helped to immunize over 800 people and 200 kids in tuxedo tee shirts swarmed the event to line dance.

Here are a few of the videos I shot of some of the fairs.

In Truchas, a tiny little town in the mountains, an entire farm family trooped in to be immunized. A daughter was expecting a baby and they wanted to make sure they didn't contract whooping cough. Even though the family lived next to a clinic, they couldn't afford the co-pays. I interviewed the grandma:

In Dixon, LouAnn, Brenda and I went to the home of the town's oldest resident who was 101 to give her her shots. I captured the event on video:

By the time we were finished, we'd administered 1470 immunizations, an increase of 18,300% (25,888% if you add the 561 immunizations we administered last year)!

Take that, drunk Nate Silver!

According to our local newspaper, which likes me and my department less than it likes moldy diapers, Rio Arriba was the only county in the state to increase voter participation compared to 2008.

In an editorial entitled Rio Arriba Turnout Much Better Than State, National, the Rio Grande Sun stated that 76% of Rio Arribans turned out to the polls compared to a statewide rate of 62%. The author went on to note that the mill levy was voted on by an unusually high number of people.  

It appears that in fiscally impoverished Rio Arriba, where many people have to negotiate dirt roads to vote, 15,239 registered voters cast their ballots for President, with 73% supporting Barack Obama.

The hospital mill levy passed with 68% voting for, 32% against; 13,326 people cast their votes even though it was the last item on a very long ballot. (I seem to recall that the last time the mill levy came up for a vote eight years ago, only three or four thousand people participated.) On the average only 11,958 persons voted for each of the eight constitutional amendments and bonds that preceded the mill levy.

Sixty-three percent of Rio Arriba residents voted for Martin Heinrich.

Eighty-one percent voted for Congressman Ben Ray Lujan.

I can't possibly claim credit for inspiring all this voting. Jennie Chamblee, Mary Parsaca, Jim Beverwyk and all the other local Organizing for America volunteers have been energetically knocking doors for a year. But all politics are local. I hope that making myself and my provider friends useful (and incidentally reminding people to vote for our local hospital mill levy) helped. The data seems to indicate that immunizing elders is an effective GOTV strategy.

Shucks, before the election, even the owner and publisher of the paper had to grudgingly endorse the mill levy towards the end of an editorial gratuitously slamming me and other county officials for supposedly buying votes with County Indigent Funds.

However, the paper's endorsements appeared to matter less than face-to-face contact. While it endorsed some bond issues and panned others, all the bonds and constitutional amendments passed with an average of 65% of the vote regardless of endorsement.

Hilariously, in last week's editorial, the bemused publisher, who couldn't understand why his advice about the bonds had been ignored, concluded in a local sort of way that Rio Arriba's enthusiasm for voting was because people here want free stuff.

We’re also going to continue to fund Rio Arriba County health services in all its facets, including giving free health care to whomever has the proper connections in the County administration.
So the bottom line is, we drove up voter turn-out in Rio Arriba by promoting a health care tax!!!!!!! And we did it, by providing actual care.
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