Yesterday, a Maine Superior Court judge ruled that the LePage administration and the Maine Department of Health and Human Services must implement Medicaid expansion by June 11. Last November, voters overwhelmingly approved a ballot measure instructing the state to close the coverage gap for 70,000 Mainers. As a result of that measure, the LePage administration was supposed to file a state plan amendment (SPA) informing the federal government of a change in Medicaid policy. But Governor Paul LePage refused to implement the voter-approved measure, claiming that a lack of state budgeted funding prevented him taking needed steps to start the expanded Medicaid program by July 2. In the end, a legal strategy provided an important pathway to moving Mainers closer to coverage. There are a couple of key takeaways from the ruling in Maine this week – as we increasingly gain momentum to close the coverage for so many across the country.
Advocacy did not end at the ballot box.
When Mainers won at the ballot box, advocates took a moment to celebrate their monumental win. Soon after they returned to the ring – the fight for Medicaid was just beginning. Mainers for Health Care, the broad coalition of consumer health advocates in Maine, fully understood the need to review the landscape, keep up the momentum and build out an advocacy strategy to get the program up and running by July. The governor was and continues to be a vocal opponent to expanding Medicaid. Despite strong voter approval for extending needed health services to 70,000 Mainers, it was clear that the administration would obstruct efforts to implement the program. The ability of advocates to regroup, plan and collaborate on message, strategy and activities was key. They did this through continuing to generate a positive Medicaid narrative in the media, educating and supporting knowledge building among state legislators about the true cost of expansion and maintaining grassroots support for the ballot initiative through numerous activities, educational events and rallies. Broadly, advocates focused on an accountability strategy, calling on constituents to urge to key legislators to complete the work of voters by including Medicaid expansion in their budget process to prepare for July enrollment.
Consumer stories continued to be central to the work.
As with any campaign, stories are at the heart of the work. Maine advocates continued to collect and amplify the stories of everyday Mainers by communicating that closing the coverage gap is really about transforming lives. Advocates committed significant staff time and capacity to collecting stories and helping individuals tell their stories to media, legislators and other audiences to keep up the energy and movement building. By dedicating staff and resources to story collection, Mainers for Health Care was successful in communicating the importance of Medicaid through moving media stories like this on PBS NewsHour. This story work culminated in a day of action at the state house providing consumers an opportunity to show up and be seen and flood their elected representatives with calls and visits carrying the message: Get it done or get a new job.
Diversity in strategies was a key to success.
As the saying goes, it takes a village. A diverse broad-based coalition was pivotal to advancing a campaign to close the coverage gap in Maine. Advocates were and continue to be nimble in employing legal, administrative and legislative strategies to advance their shared goal around access to care. Right after the LePage administration failed to file the SPA by the April deadline, advocates launched their Countdown to Coverage campaign that included press conferences and provided an ongoing tool to engage consumers and media alike. They used the campaign to direct attention to and put pressure on legislators while their legal partners worked on a legal challenge.
This most recent win handed down from the Superior Court illustrates how a legal strategy can complement advocacy strategies around events, stories and public awareness. Building and sustaining a coalition diverse in scope and skillset is helpful – so remember, use all the tools in your toolbox because together we can win.