Medicaid expansion was impossible in North Carolina – right up until this fall when it became the law of the land.
The story of how this transformative policy went from zero to hero involves a parade of intrepid characters and surprising plot turns. Through it all, communications played a pivotal role. And on that count, I can describe an overarching strategy that may prove helpful to other longshot causes. It may even renew your faith in our system of democracy.
Since 2018, my public relations firm, GBW, has worked with the statewide, nonpartisan Care4Carolina coalition – which began advocating for expansion several years before we came on board. Talk about early to the party.
Our communications strategy was multipronged, but we summed it up in one descriptive phrase: The Corner Store.
The Coverage Gap
Before opening the doors on The Corner Store approach, though, a little prologue.
Medicaid expansion debuted as a federal-state opportunity around 2012 to extend health insurance to adults in the “coverage gap.” The coverage gap swallows up people who earn too much to qualify for traditional Medicaid, but too little to qualify for a subsidy on the health insurance marketplace.
States could opt in or not. North Carolina’s legislature opted not to. Opponents of the policy were adamant that expansion was fiscally irresponsible and an undue enlargement of government. This left around 600,000 North Carolinians in the coverage gap.
Back in 2018, then, the idea of expanding Medicaid was a settled matter; it was as dead as a cicada in winter. That’s when we began rolling out the The Corner Store approach to grassroots communications.
First, imagine the picture-perfect neighborhood corner store. Feel the warmth of it. The friendly familiarity of it. I can transport to the corner store of my youth easily as it remains a vivid memory.
We wanted to conjure that reassuring feeling of being where you belong, even though – actually, especially because – we were working on a thorny issue that often led to frustration. Avoiding burnout and cynicism was critical.
And so, on Care4Carolina’s monthly coalition calls, leadership was always chatty and upbeat. We got down to business, for sure. But always with a smile and joke for the coalition members Zooming in from around the state. And as the coalition grew – from 90 to 150 to 192-and-counting members – the indomitable bonhomie remained constant.
This was also important because we were advocating for an issue about which many state elected officials were deeply ambivalent – at best. We needed to exemplify the kind of gracious spirit and sunny disposition that might actually entice a skeptic to engage in a conversation.
Familiar Faces, Meaningful Message
Facilitating informative and constructive conversations was a key mission. So think now about the kind of folks you bump into at that picture-perfect corner store. They’re people from your neighborhood. People you might recognize; share common experiences and touchpoints with.
We wanted to create these kinds of proverbial corner stores around the state. So we invited our initial local advocates to bring in more of their friends and neighbors, and for them to do the same. We were always networking.
Some folks became local town criers; dynamos constantly spreading the word. Others took more targeted routes. Clergy talked with the faithful; business people with their peers and organizations. Gradually, our figurative corner stores across the state filled with warm, familiar faces.
We collected the stories of people in the coverage gap and shared them locally in news pieces, opinion pieces and sometimes in person with legislators. The mother of a veteran who passed away after a convoluted insurance situation made it difficult to seek treatment for an illness. The rural economic developer concerned about the well-being of his regional workforce and hospitals.
Local advocates came to our corner store, educated themselves and then carried forth messages resonant with meaning to their communities.
Information and Constancy
Like a corner store stocking groceries and sundries, we made all kinds of information readily available. This shelf for the number of people in each county in the coverage gap. That shelf for all the ways in which expansion would help shore up hospitals. That corner for how expansion helps to slow the increase in everyone’s health insurance premiums.
The same went with support services. Want to do a town hall event in your town? Talk with your local officials? A store clerk would be happy to help.
Finally, the ideal corner store endures. Through winters and summers, downtimes and upturns. It’s a fixture. And so it was with the Care4Carolina coalition. For more than 10 years, it was there, doors open, as frustration turned to possibility, hope and finally, success.
Credit for North Carolina becoming the 41st state (including the District of Columbia) to expand Medicaid goes far beyond The Corner Store approach. A host of organizations also advanced the issue, including the NC Rural Center, NC Justice Center, the American Heart Association, NC Child and others. We were neighborly with all of them.
Legislators studied and patiently worked through their concerns. The governor and the N.C. Department of Health and Human Services kept the policy front and center. And the federal government provided significant incentives.
But amid all that – the powerful people and the machinations – the Corner Store, with its emphasis on local folks and a spirit of goodwill, was indispensable. Part of the secret to moving mountains turned out to be things we learned just down the street.
Billy Warden is co-founder of GBW Strategies and a multimedia writer/producer based in Raleigh. In addition to public health, his work includes economic development, destination marketing and crisis management.