Down Home NC: Campaign to Expand Medicaid
From 2012 until 2023, Republican state legislators had refused to expand Medicaid in North Carolina. That left roughly half a million people lacked health coverage because they made too much to qualify for Medicaid but not enough to be covered under the Affordable Care Act.
Down Home NC shapes democracy by building power and organizing working people in small towns and rural North Carolina. Down Home NC had several members who fell into this “Medicaid gap,” sometimes working people whose income could be between roughly $5,000 and $16,000 a year, which is currently too little to qualify for subsidies under the Affordable Care Act and too much to qualify for Medicaid. To get insurance, they would have to pay full price for private insurance, which in some cases could be as much as their yearly income.
Campaign challenges:
The first challenge was helping people understand what this gap in coverage actually is. This can be really hard to grasp, because so many of us either have health insurance through our employers or got it through the Affordable Care Act. It’s also hard to get attention in local media because, even before the pandemic, health care is politicized and outlets want to make sure they are seen as nonpartisan.
Campaign strategy:
I came on board in the spring of 2019 to leverage DHNC members’ stories to influence legislators to pass a state budget that included Medicaid expansion. I worked with DHNC’s top-priority spokespeople to hone their personal stories and prepare/train them to serve in a spokesperson role, including for several town halls.
I helped DHNC members like Lynne Pierce of Alamance County develop their stories and shared quotes like the following with news outlets” I have a master’s degree. I've had a North Carolina teacher's license. I'm the director of a food bank in rural Alamance County. And I am in the Medicaid gap. My goal is to help people not feel embarrassed and realize we can come together and expand Medicaid in our state.”
Knowing that national outlets often determine what is considered local news, we pitched an op-ed to The New York Times, which resulted in this NYT video viewed by millions of people. I also wrote and produced their 2019 report “We’re Building Our Power,” which focused on member stories of impact.
Results:
After the video op-ed was released, Governor Cooper invited the three people featured in the video to stand with him as he vetoed the state budget, citing in part a lack of Medicaid Expansion. The governor then invited other Down Home NC members to take part in round table discussions, which were then covered in local publications. After years of hard work by activists like Down Home North Carolina, Medicaid was expanded in North Carolina in 2023.
