ASGE Advocacy Roadmap

The American Society for Gastrointestinal Endoscopy (ASGE) developed the following roadmap for advocacy organizations to increase colorectal cancer (CRC) screening and completion rates for uninsured patients using the state legislative process. While this model is based on ASGE’s experience in Georgia, these strategies can be used (and modified) to increase CRC screening and completion rates across the US.

Goal

Establish a sustainable source of state funding to increase CRC screening and completion rates for uninsured patients.

Step 1: Align Efforts with State’s Budget Timeline

Because the Georgia state budget originates in the executive branch, your advocacy efforts should start months before the legislative session.

July-August
Agency Engagement

Build direct lines of communication with leadership inside the Georgia Department of Public Health and the Georgia Department of Community Health. Pitch your proposal while they are actively constructing their formal budget packages.

September
OPB Submission

Secure a specific request slot within the agency budget packets that are transmitted directly to the Governor's Office of Planning and Budget.

November
Governor's Budget

Conduct targeted advocacy with the Governor’s communications and policy teams as they finalize the administration's proposed budget.

January-April
Legislative Session

Navigate the General Assembly's appropriations cycle. Track healthcare subcommittees in both chambers and push for line-item inclusions.

Last Day Of Session
Sine Die & Bill Review

Actively monitor final legislative budget negotiations through the last official day (Sine Die) and closely track the Governor's line-item veto window.

Structure your request around data-driven parameters that appeal to Georgia’s economic and health priorities.
 
  • The Target Gap: Explicitly state that the funds will be used to help a vulnerable gap population – uninsured people who do not qualify for Medicaid but cannot afford federal exchange plans.
  • Regional Disparities: Highlight regional safety-net statistics to justify your target populations (e.g., noting the gap between the CRC screening rate in rural areas [33%-53%] and the state’s overall goal of 80%). 
  • The Continuum of Care Pathway: Visually demonstrate how a state appropriation will bridge the financial gap between a patient’s abnormal CRC screening test result and a completion (aka “follow-up”) colonoscopy. 
  • The Return on Investment (ROI): Stress that CRC screening (i.e., early detection) results in a savings for the state compared to the longer-term costs associated with late-stage cancer treatment.
Achieve strength in numbers by building a statewide network of allies to support your advocacy efforts. 
 
  • Clinical Safety Net: Partner with local Federally Qualified Health Centers (FQHCs) –such as Community Health Care Systems, which serves as a benchmark for rural CRC screening models – and local free clinics.
  • Strategic Allies: Identify strategic allies and engage the stakeholders who are most affected by the issue. Work hand-in-hand with established local advocacy groups (e.g., Georgia Center for Oncology Research and Education, Georgia CRC Roundtable, Fight CRC, Georgia Chapter of the American College of Surgeons) and FQHCs and free clinics, gastroenterologists and other physicians, medical professional societies, public health experts and policy leaders.
  • Organize a core leadership group and appoint a lead coordinator to serve as the  quarterback for your overall stakeholder communications and legislative outreach efforts. 
  • Target the Executive Branch Early: Because the Georgia state budget legally originates in the executive branch, you must build strong, collaborative relationships months before the General Assembly convenes.
  • Identify Agency Leads: Pinpoint and engage the exact division leadership controlling funds within the  Department of Public Health, the Department of Community Health, the Governor’s policy and communications teams and the Office of Planning and Budget.
  • Identify Clinician Lawmakers & Cultivate Medical Champions: Recruit dedicated legislative champions in both the House and Senate chambers – prioritizing lawmakers who are practicing physicians or clinicians. And remember that lawmakers are most inclined to respond to data-driven arguments from trusted medical professionals.
  • Engage Committee Leadership: Target key leaders, including the chairs of the House and Senate health, appropriations and rules committees and sub-committees. And maintain an open and ongoing line of communications with these legislators on an ongoing basis. 
  • Host Statewide Summits: Plan structured, data-focused policy summits that feature credible, front line medical experts (e.g., gastroenterologists, FQHC/primary care physicians who care for uninsured) that are designed specifically for the state’s key decision-makers (e.g., DPH commissioners, OPB budget analysts, FQHC leaders). Of course, also invite and prominently feature your core coalition partners at these educational events. 
Develop a toolkit of communications resources to support your advocacy efforts, including: 
 
  • A One-Pager: Use this bullet point handout to highlight your state-specific, bottom-line data and messages. Distribute this resource at the aforementioned summits and other key events. And remember to include your exact funding request and contact information. 
  • Press Releases: Distribute a press release that addresses your budget request and provide updates to state and local media, legislators and other key stakeholders as warranted. Feature legislators and medical professionals (e.g., FQHC leaders, gastroenterologists) in these press releases to the extent possible.  
  • Videos: Using your phone to produce simple, low-cost, man-on-the-street-style videos that feature key FQHC leaders explaining the need to increase CRC screening and completion colonoscopy rates is a great way to support your advocacy efforts. Distribute these real-world videos to legislators and other key stakeholders. 
  • Legislator “Sign-On” Letters: Work with your champions in the House to draft and distribute a legislators’ sign-on letter to build momentum for the budget request.
  • Resolutions & Proclamations: Introduce resolutions and/or citations in the House and Senate or seek a Governor’s proclamation during Colorectal Cancer Awareness Month (March) to raise awareness – and highlight and leverage these in key stakeholder communications (e.g., social media, newsletters).
Keeping in mind that a successful initial appropriation must be leveraged to secure a permanent and sustainable funding source, remember to: 
 
  • Monitor Implementation: Once funds are allocated (e.g., previous state pilot appropriations to FQHCs), tightly track state agency distribution.
  • Track Clinical Outcomes: Gather rigorous impact data on how many uninsured patients received completion colonoscopies and how many advanced precancerous polyps or early cancers were caught.
  • Educate Year-Round: Continue sending updates, patient navigator insights and clinical milestones to lawmakers to build an ironclad case for future state budget cycles. 

Advocacy Checklist & Reminders

✅ Send notes of thanks.
 
✅ Continuously educate policymakers.
 
✅ Prepare early for future budget cycles.
 
✅ Develop a concise elevator pitch.
 
✅ Prepare a one-page summary email/handout.
 
✅ Make direct and specific requests.
 
✅ Have credible medical and health care professionals testify when the opportunities arise.
 
✅ Host periodic in-person or online updates for legislators that feature medical experts and patient navigators who can share their real-world insights.    
 
✅ Distribute press releases and man-on-the-street videos to state leaders, stakeholders and the media to underscore the need for your budget request. 
 
✅ Create a legislators’ “sign-on” letter to build momentum for your budget request.  

Key Ingredients for ASGE’s Advocacy Efforts in Georgia

The key ingredients for ASGE’s multi-year advocacy efforts in Georgia included:

✅ Early engagement with executive branch agencies
 
✅ Strong legislative champions
 
✅ Broad coalition support
 
✅ Consistent year-round communications
 
✅ Clear, data-driven messaging
 
✅ Strategic stakeholder engagement
 
✅ Persistence across multiple budget cycles
 
✅ Partnerships with credible front-line clinicians and health care professionals  

Advocacy is rarely a one-session effort. Sustainable success comes from building trust, demonstrating impact and maintaining momentum