The American system divides responsibility for health care policy and many other issues between the Federal government and state governments. Therefore, your advocacy efforts may sometimes be at the state level. Much of the information in this book regarding advocacy at the Federal level also applies at the state level. However, there are important differences. State legislatures operate on a smaller scale and state legislators and executive branch officials are typically more accessible than their Washington counterparts. It may be easier to get something done, but it is important to know the people, process, and political culture of the state.