Ohio recently became the 25th state (plus DC) to expand Medicaid under the Affordable Care Act. This is a tremendous victory for the more than 275,000 low-income Ohioans who will now have affordable coverage – some for the very first time. It’s also a much-needed boost for the state’s hospitals and overall economy, which will benefit from the billions of federal dollars flowing into Ohio to pay for this coverage.

This victory would not have been possible without the dogged persistence of Ohio’s Republican governor, John Kasich. What’s remarkable about Governor Kasich’s role in this expansion isn’t just that he’s a Republican. At least 10 other Republican governors have embraced expanding Medicaid, including Jan Brewer of Arizona and Rick Scott of Florida, neither of whom have exactly been poster children for Medicaid or the Affordable Care Act.

But Governor Kasich didn’t merely support the expansion—he championed it and didn’t stop fighting until he got it done. After months of trying in vain to move it through Ohio’s heavily Tea Party-influenced legislature, he instead sought permission to move ahead from a little-known state budget board with authority to make certain budget decisions for the state, including accepting the federal funds needed to pay for Medicaid expansion.

So what made Gov. Kasich an unexpected Medicaid champion? There has been a lot of speculation about the political calculus behind his decision. The Governor made extensive public statements on the need for expansion – citing mental health needs and the moral imperative to care for others as particular reasons why Ohio should move forward. But it wasn’t just the Governor alone who made this happen—advocates and stakeholders brought their passion and dedication to ensure Medicaid expansion became a reality for Ohioans.

Championship Advocacy

Community Catalyst was fortunate to support Ohio advocates in the critical role they played in securing support from Gov. Kasich and moving Medicaid expansion across the finish line.

The Ohio Medicaid victory is a great example of an effective “system of advocacy”, in which advocates partner with a variety of stakeholder groups and weave together their capacities and strengths to achieve their goal.

Ohio advocates sprang into action immediately following last year’s U.S. Supreme Court ruling upholding the ACA but leaving it to the states to decide whether to expand Medicaid. Advocates crafted a campaign that incorporated a variety of strategies—what Community Catalyst calls the “six capacities” that support a successful system of advocacy—and launched an effective and successful campaign.

Strategies included:

  • Fundraising – The SCOTUS ruling led to an immediate change in agenda and priority for health advocates. Advocates had to launch a campaign for something they originally thought would be a “given” part of the ACA. The support from Ohio’s philanthropic community was critical to the effort. Community Catalyst’s ACA Implementation Fund also supported this effort.
  • Build Coalitions and Engage Stakeholders– Health advocates immediately educated the broader health and human services community on the benefits of the expansion and reached out to stakeholders about how to work together. Advocates supported the formation of the Alliance for Health Transformation, a coalition convened by a representative of different stakeholders who helped bring together Chambers of Commerce, providers and insurers. Advocates representing consumers, the behavioral health community, legal services, women, people with disabilities, housing, faith, social justice organizations and others completed the multi-stakeholder Alliance. Given the tricky politics of Ohio, the coalition made strategic decisions about which members of the Alliance should amplify their voice and when.
  • Policy Research and Analysis Advocates quickly identified the need for a nonpartisan report on the impact of the expansion on the economy. The Health Policy Institute of Ohio released an analysis of what expansion would mean for the state’s economy and budget.
  • Communications and Messaging – A number of questions framed the debate: the impact on the state budget, the effect on the state’s economy, and the impact on the uninsured. The Alliance’s communications goal was to create broad-based support and feature different messengers. Messages emphasized the low costs to the state and the positive economic impact of the federal funds. A key strategy was collecting and sharing stories from individuals and families who would benefit from the expansion. In particular, Governor Kasich made the case that the expansion would boost treatment of mental illness and addiction, and advocates organized media opportunities for behavioral health providers, judges, and law enforcement to share stories.
  • Generate Grassroots Support – Coalition members trained story tellers, generated phone calls, legislative visits and mobilized clergy to speak out on behalf of Medicaid expansion. Advocates helped organize a rally with several thousand people and also had 1,000 people hold hands around the Statehouse before a key vote.

The Ohio advocacy community, in partnership with the Alliance coalition, executed all these strategies at different strategic moments to build a strong case for Medicaid expansion. Their smarts and savvy – combined with the commitment from Governor Kasich and some ingenuity – created the opportunity to expand Medicaid in the Buckeye State.

At the time of this blog post a lawsuit has been brought against the state and the state controlling board to stop the Medicaid expansion.