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How The Fairness Project Helped Power Maine’s Medicaid Expansion

The new organization exists to help push progressive ballot initiatives–like expanding Medicaid or raising the minimum wage.

How The Fairness Project Helped Power Maine’s Medicaid Expansion
[Image: antishock/iStock]

On Monday, November 6, Jonathan Schleifer, executive director of The Fairness Project, was sitting in his car parked on a neighborhood street in Portland, Maine, catching his breath after a busy morning of knocking door-to-door, asking people to vote “yes” on Maine Question 2 during the election the next day. Formally entitled “An Act to Enhance Access to Affordable Health Care,” the citizen-led ballot measure enabled Mainers to vote in favor of expanding Medicaid in the state–something its Republican governor, Paul LePage, has vetoed five times previously. It passed overwhelmingly.

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“Knocking on doors and talking to people, we’ve seen that they understand what’s at stake here—they can help expand Medicaid for 70,000 Mainers and bring in the federal dollars to make that investment and, in doing so, create 6,000 jobs across the state in the healthcare industry,” Schleifer tells Fast Company. Through a combination of direct funding, digital and social outreach, and strategic planning assistance, The Fairness Project partners with and bolsters state- and city-level ballot initiative campaigns that advance equitable causes. (Ballot initiatives evolve from petitions that garner enough signatures from registered voters to be brought to a public vote.) In Maine, TFP began coordinating around a year ago with the local grassroots organization Mainers for Health Care, which spearheaded the ballot initiative.

[Image: antishock/iStock]
Since $1.2 billion in federal funds were earmarked for Maine’s Medicaid expansion around three years ago, the state legislature has passed five expansion bills, only to have them struck down by LePage. “We’re seeing this narrative play out here that began in the Obama administration and has continued into Trump’s, in which certain individuals on the right, for political and ideological reasons, are fundamentally opposed to anything related to the Affordable Care Act,” Schleifer says. But the Trump administration’s multiple failed attempts to repeal or dismantle Obama’s Affordable Care Act have ironically, Schleifer adds, given voters a heightened awareness of how integral the program has become to health and well-being of lower-income Americans. Maine’s grassroots movement to override the governor’s vetoes, he says, arose in direct opposition to attacks against the program from the state and federal level.

Out of the $480,000 Mainers for Health Care had raised by early October to campaign for the ballot initiative, $375,000 came from The Fairness Project, which used its national reach to field donations from out of state, and to bring in more volunteers for door-to-door canvassing efforts. The Fairness Project also helped to develop the social strategy around the ballot initiative, and the text of the initiative itself.

Maine’s Question 2 will grant coverage to around 70,000 residents who currently earn too much (generally, over 138% of the federal poverty level) to quality for Medicaid, yet earn too little to avoid individual plans. Thirty-one states and the District of Columbia have already expanded Medicaid to adults under the age of 65. Maine is the first to take the expansion issue to the ballot, but it certainly, Schleifer says, won’t be the last; similar movements are already underway for 2018 in Alaska, Utah, and Idaho.

[Image: antishock/iStock]
Going the route of the ballot initiative is often a tricky, and not often transparent, means to political progress. The largest issue with ballot measures is that they often concern topics unfamiliar to the majority of the voting public–or at least not familiar enough to warrant the type of nuanced understanding necessary to make an informed vote. And even if they are about an important policy issue, their text is vague or inscrutable. Take, for example, this proposal from the Missouri ballot in 2014: “Shall the Missouri Constitution be amended to include a declaration that the right to keep and bear arms is an unalienable right and that the state government is obligated to uphold that right?” It sounded like the 2nd Amendment, so its presence on the ballot, according to the Washington Post, left many a voter scratching their heads as to why they were voting on it in the first place. (Answer: gun lobbyists angling to limit background checks.)

Maine’s Question 2 was more straightforward: “Do you want Maine to expand Medicaid to provide healthcare coverage for qualified adults under age 65 with incomes at or below 138% of the federal poverty level, which in 2017 means $16,643 for a single person and $22,412 for a family of two?” In this case, voters knew what they’re voting for, and that’s a tactic The Fairness Project has been adept at advancing. Its work, and that of Mainers for Health Care, has been around reminding voters in Maine that other states, even Republican-led states like Ohio, that have expanded Medicaid have fielded nothing but positive results; in an editorial in the Bangor Daily News, the publication cited a quote from Ohio Governor John Kasich, who said that the majority of Ohioans who benefitted from the state’s Medicaid expansion find it easier to keep a job and afford necessities like food and housing.

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[Image: antishock/iStock]
Though a new organization, TFP already has a track record of advancing causes that place human necessity before government intransigence. The organizations’ primary work during the 2016 election was backing successful initiatives in five states (Arizona, California, Colorado, Maine, and Washington), along with D.C., to raise the minimum wage. TFP worked with the organizations behind the minimum-wage campaigns to formulate the text of those initiatives, which was detailed and clear. Like TFP’s work around the Medicaid expansion in Maine, the minimum-wage effort was aimed at targeting a specific area of government gridlock. Even as the cost of living has skyrocketed in the past decade, the last time the federal government raised the national minimum wage was 2009.

Slow minimum wage hikes, attacks on healthcare–all of these signals from the federal government “go against what Americans want,” Schleifer says. By bringing these issues to the ballot, states and cities are exercising their recourse to raise their votes over the intransigence of their governors. “It’s really the only thing that folks can do now when Congress is as broken as it is, and when state legislatures are as broken as they are, to allow people to take up the mantel and control their own lives and organize in their communities to change laws that the legislatures or governors are failing to do,” Schleifer adds. “It allows them to take the resistance a step further.” With one success notched in Maine for Medicaid expansion via ballot initiative, TFP is already turning its sights to other states.

About the author

Eillie Anzilotti is an assistant editor for Fast Company's Ideas section, covering sustainability, social good, and alternative economies. Previously, she wrote for CityLab.

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