Local Politics-

Local elections are boring, undynamic, long, tedious, drawn out affairs that make sitting through an economics class seem like a day at a nude beach. This is coming from a chronic pain and arthritis patient whose first degree is in Political Science and has experience running local political campaigns too. Most local elections rely on the generosity of volunteers and the local political party infrastructure for support. Unless your candidate has been in office for 200 years or has some sort of recent DUI conviction chances are the only press you will get will be from a local voter guide or local collegiate newspaper. There will be no West Wing show about District 24 in Idaho for example, even though District 24 has incredible power.


The current Senator from Idaho’s District 24 is Senator Lee Heider. Senator Heider is the Chair of the Idaho Senate’s Health and Welfare Committee. This committee will be where any changes to Obamacare will happen. Senator Heider will be in charge of implementing Trumpcare if that should happen. Are you beginning to see the power local elections have? While a Trump or Clinton campaign are based in passion and ideology, local elections are where that zeal becomes a day-to-day reality. You will get tired of me saying this, local elections matter.


As a one time local political operative, I thought it might be useful to run through the math of a local campaign before we get into possible actions for us chronic patients. After all, we have very limited energy and resources already; we don’t need to be spreading ourselves thin. In the interest of fairness, I will admit that local Idaho Democrats trained me in the art of political operative. Now, I would argue that the math is going to be the exact same for Republicans so the following should apply to any party identification. I would also argue that in local politics, politics actually plays a very small role, it’s all about the numbers. Show me the numbers!


District 24-

For those of you not familiar with Idaho, District 24 is around Twin Falls area, or south central Idaho. It has a population of around 44,000 people whom are mostly lower to middle class on the economic spectrum. Since 2010 it has average around 35,000 registered voters with just over 19,000 that actually turn out to vote. If you just look at the history, District 24 would be considered heavily in the Republican column. A quick look can be wrong though so lets actually tackle the specific numbers of Senator Heider’s past races.


Any respectable campaign political operative will look at the numbers of a district before even getting into a candidates platform. Despite what we all thought in high school, it is time to use math. First, we would want to look at least three previous races in order to build and accurate forecast. This gets somewhat tricky because one of these three races will include a Presidential contest. Presidential races always raise turnout, which needs to be weighted in your formula in order to reflect the increase in voters a Hilary and Trump bring for example.

















No Candidate

Heider %





Challenger %






For the interest of simplicity and boredom prevention, lets look at the last 3 election cycles without weighing 2016 due to the Presidential race. As an operative, I would immediately point out that Senator Heider has an electoral floor of 64.1%. To put it another way, the Senator would probably get 64% of the vote in 2018 if all he did was place his name on the ballot and answer whatever local newspaper voter guides are available to him. The power of incumbency, however, that doesn’t mean a well-financed challenger couldn’t disrupt District 24. The question is, how many votes are still available in District 24?


As I mentioned earlier, there are roughly 35,000 registered voters of which 19,000 regularly turn out to vote. This means there are 16,000 “votes up for grabs”. In 2016, the Democratic challenger lost by 4,694 votes or would have to convert approximately 30% of the votes up for grabs in order to be competitive in 2018. Although converting 30% of the voters up for grabs seem doable, it actually isn’t.


First, remember that Senator Heider has a political floor of 64.1%. That means that if 5.9% of the “votes up for grabs” that a challenger tries to get end up voting for Senator Heider there is no mathematical way to win in the district. Next, to convert a voter usually takes between 5 to 7 touches from a campaign. A touch means a piece of literature, phone call, flier, or a face-to-face contact with a voter. At a minimum, it will probably take 3 face-to-face meetings with the voters up for grabs crowd before they will consider voting for a Democrat in this case. All of this is before the 3 to 5 touches the 35% of the challengers’ political floor will need in order to continue to vote for a Democrat 2018. Long story short, unless a Democrat with millions of dollars to spend of constant TV ads decides to run, mathematically speaking this is a solid red or safe Republican district for Senator Heider.


Advocating Locally as a Chronic Patient-

Contrary to popular belief, there is a way to advocate for an issue without having to become hyper partisan. Once again, it revolves the 2 common themes of this post; show me the numbers and local elections matter. Unlike a national campaign, local elections can and do get personal. A Trump or Clinton simply don’t have the time to know every individual on a district level which is unlike a local candidate who lives, works, plays, vacations, and has roots in these districts. Even if they don’t get a vote, chances are they know about the Jone’s kid with Rheumatoid Arthritis or that the Smith’s kid is heading to Boise State University to pursue a degree in engineering.


Let’s start with the hardest advocacy attempt, getting a legislature or governor to spend a dime. Much like asking mom and dad for $40 so you can go to the movies and dinner with friends, asking a politician for money can be incredibly hard and awkward. In the interest of fairness, our elected officials are not spending money that they work for like our generous and loving parents; they are spending hard earned money from all of us (at least in theory).


There is a trick, create your own fiscal impact form (so them the numbers!). We have a tendency to try explain the need for money in grandiose terms, i.e. It’s for National Defense, It’s for Job Creation, It’s to fight Terrorism. All of these are ideas that are near impossible to say no too politically without having some kind of ill consequences. These are big time sexy issues with huge public profiles, everyone understands National Defense. By contrast, almost no one understands the life of a patient with Chronic Pain or Arthritis. Regrettably these are not big time sexy issues with huge public profiles.


How do we create a fiscal impact form? First, very specifically define what you are trying to accomplish. For this example, lets say we want to give every adult Idaho arthritis patient, who currently falls into the Medicaid gap, a tax break for 2 hours of flotation therapy a year at $65 per hour. In order to accomplish this we need to first figure out how many arthritis patients are currently in the Medicaid gap. 





Adults with Arthritis



311,000 projected Adult Patients

Forecasted Growth


262,000/284,000 = 9.2%



311,000 Projected Patients in 2015/1,654,930 Idaho Population in 2015 = 18.80% of Idaho’s Population as Arthritis


Patients in Idaho Medicaid Gap 78,000 x 18.80% = 14,664 potential arthritis patients in the Medicaid Gap


In Boise, I pay $65.00 per hour of floating therapy. Using the $65.00 an hour as a base, we can then calculate the total potential cost for Idaho for allowing 2 hours of flotation therapy for arthritis patients in the Idaho Medicaid gap.


14,664 potential arthritis patients x $130 for 2 hours of flotation therapy = $1,906,320.00.


I would suggest rounding on your Excel Fiscal Impact form to show a cost of $2 million, better to have a little extra left over than have to ask for more money later. Although asking for $2 million seems like a lot, Idaho had a budget of $7.6 billion in 2015. With Idaho’s arthritis population growing at a rate of 9.2% every 2 years, a one time $2 million expenditure for patients without any insurance while elected officials sort out the Medicaid gap is not a big expenditure. Once again, this isn’t about politics, it is about helping a portion of Idaho’s population that is currently caught in a political mess caused by hyper partisan of a few. Also, since District 24 falls in the low to middle class category, changes are good many of Senator Heider’s constitutes would benefit from this idea since they are likely the ones in the Medicaid Gap.


Another technique for local advocacy would be bringing Senator Heider, the AARP, and the Arthritis National Research Foundation together in order to inform Idahoans between the ages of 50 and 85 of a potential tax break for participating in a research study conducted by the Arthritis National Research Foundation that is deep in the ACA for example. Creating a brochure or letter addressed to everyone in District 24 or Idaho that meet these parameters, with everyone’s name and logo on it, to inform this group of the potential tax break is another great advocacy technique. The best part of this technique is it involves no numbers or politics; it is almost straight informational-based advocacy.



“Despite the enormous role that local government plays in our daily lives, the constitution makes not one mention of it.” Anthony Albanese


Local government does not make for great TV, passion, interest, debate, or intrigue. Discussing future trips to Mars makes the imagination wonder, discussing future water plant locations makes the imagination desire Starbucks through an IV. The government with the quickest, most direct path to our daily lives seems to have the least interest and participation. As a chronic patient, I’m here to tell you this has to change now.


With the election of Trump, chronic patients are in for a hard ride! Right now it looks like the President Elect is more interested in appointing ideologues and extremists interested in building the power of Republicans instead of problem solvers and designers to his cabinet. The only way we can fight this is by going local. We need to embolden our local leadership to stand up for what is best for the people, not for whatever is best for the Republican Party. As patients we can’t compete with the money lobbyist have, however, we have the power of our patient stories and a lifetime of designing for solutions that help us immediately. We must use our skills now in order to prevent our lives from being in danger because of stupid politics.


Per our Constitution, President Elect Trump won because he went local to where the most electoral votes were located and won those few areas that got him to 270. Hilary lost because she ran a campaign on a national level with the idea of getting the most votes possible. Using voters, our country did not want President Elect Trump by a record margin. As chronic patients, we need to understand and use these numbers to our advantage. There is still hope for us, we just have to leave the national stage for awhile and go local with a passion and swiftness that will make everyone from President Elect Trump to Idaho’s District 24 take notice! It is time to become #chronicstatesman!  


P.S. Information for the post comes from the Idaho Statesman, CDC, and Idaho Medicaid. If you would like more information about where I got my numbers from, please ask.