A recent article published by the American Journal of Public Health (AJPH) affirms what is at the core of Community Catalyst’s mission: a strong, organized consumer health advocacy movement is critical to moving states to extend health coverage to low-income people. The authors Timothy Callaghan, MA, and Lawrence R. Jacobs, Ph.D., found that the prevalence of a well-organized consumer advocacy infrastructure in a state moved it closer to the closing the coverage gap—regardless  of partisan control in state legislative and executive offices. They cite research suggesting that despite operating under challenging political environments, consumer health advocates influenced decision makers through tactics such as effective grassroots mobilization, media engagement, letter-writing campaigns and voter engagement initiatives.  Within our network of consumer health advocates, we’ve seen examples of advocates maximizing opportunities to influence coverage gap decisions in their state.

Advocates drive progress in closing the coverage gap

The authors found that after the Supreme Court handed down its decision making Medicaid expansion an option rather than a mandate, states either immediately took action, tepidly moved forward or remained obstinately opposed. According to their research, when a state in the latter category finally does close the gap, it is often because of a strong, coordinated and vocal group of advocates working to put consumer interests first.

In Louisiana, with a Governor ardently opposed to closing the coverage gap term-limited out of office, a real discussion around Medicaid expansion began to take shape in early 2015. Advocates visited parishes across the state, met people in the coverage gap and elevated their stories. Advocates hosted a gubernatorial candidate forum on health care and by Election Day, all major candidates had agreed that expansion was necessary, though they differed on how to go about it. Ultimately, Democrat John Bel Edwards won the Governor’s race and within hours of taking office, signed an executive order expanding Medicaid.

In Montana, a multi-year campaign to close the coverage gap commenced in 2013, where advocates implemented strategic grassroots organizing efforts elevating consumer voices.  Advocates conducted public education events, implemented letter-writing campaigns, canvassed targeted districts, and engaged thousands of volunteers to elevate the stories of people in the coverage gap. After directing 11,000 calls to legislators and generating 8-10 earned media pieces each week, advocates were able to successfully pressure lawmakers to approve legislation triggering the state to seek federal approval to close the gap. In November 2015, CMS approved Montana’s proposal to extend health coverage to over 70,000 Montanans.

Even in states that still have coverage gaps, advocates continue to keep the conversation relevant, holding lawmakers accountable for the harms their constituents face from their failure to close the gap. Following the failure of Governor Haslam’s Insure Tennessee plan to pass through a key committee last year, Tennessee advocates organized a strong, grassroots and media engagement campaign keeping lawmakers accountable. This response moved lawmakers to take Insure Tennessee back up again in committee last year, and kept the coverage gap conversation alive in the state. In Alabama, advocates worked behind the scenes to make sure Governor Bentley’s Health Care Improvement Task Force understood how essential closing the coverage gap is to Alabama’s health care infrastructure. Advocates were persistent in moving Governor Bentley to shift his stance on expansion and begin exploring options for closing Alabama’s gap. One thing is certain for the remaining coverage gap states: the persistence and dedication of advocates can and will make a difference.

Community Catalyst is working hard to provide leadership and support to state partners pushing decision makers to expand Medicaid. We have built, and continue to build, systems of advocacy across the nation to close the coverage gap. We provide resources and technical assistance, and help guide advocates leading state campaigns to learn from each other. Given the challenges inherent with influencing decision makers in remaining non-expansion states’ political environments, we help share the most effective tools, ideas and strategies across state lines to ensure advocates are best-equipped to push decisions makers to support expansion. AJPH’s article just confirms what we’ve known all along: well-organized state consumer health advocates are critical to ensuring the 3 million people still caught in the coverage gap will one day gain coverage.