The Fairness Project bolstered its track record to 6-1 on Tuesday when Missourians voted to approve expanding Medicaid with the ballot initiative there capturing 53% of the nearly 1.3 million votes cast.
The group has executed its strategy of bringing issues straight to voters, circumventing state legislators reluctant to expand health coverage to low-income people.
Next up: Florida.
But Jonathan Schleifer, executive director of the D.C.-based advocacy group, is calling on organizations, especially those set to benefit from expansion, to help fund the ballot work as the group targets new states.
“We had strong local hospital support in Oklahoma, Idaho and Missouri, but there have been no national hospital chains or associations supporting this work. Although insurers have put money behind the ballot initiative strategy, it is far from commensurate with the benefit they will get. As we consider additional states, we would love to have them invest in this work,” Schleifer said in an interview with Healthcare Dive on Wednesday.
The Fairness Project itself is a nonprofit, but does not disclose its donors. Though Schleifer confirmed at least one major union is a backer and they have more than 6,000 online donors, including industry stakeholders.
The American Hospital Association, which has backed Medicaid expansion as a policy matter, declined to comment for this story. Typically, state hospital associations have funded local initiatives, though.
But some national players have stepped up, at least on the payer side.
In Missouri, the initiative garnered financial backing from Centene, which is based in the state and also operates one of the three Medicaid managed care plans there. Centene, the nation’s largest Medicaid managed care organization, contributed an aggregate of $250,000 to the campaign, according to a July 15 disclosure report with the state. And the Missouri Hospital Association contributed a total of about $2.2 million, according to a July 27 disclosure report with the state.
That’s not always the case in other states. In fact, in Utah, the local hospital association was reportedly opposed to expansion, according to a 2012 report from The Salt Lake Tribune. However, the association contended they supported expansion conditioned on using the private insurance market for the newly insured.
“You need to build a long runway,” to produce a victory in these states, Schleifer said. It takes time and resources to talk to residents about healthcare and disrupt the partisanship and cut through politics.
“I think what we’ve seen over and over again is voters want more healthcare, not less,” Schleifer said.
In the cases where voters expand Medicaid, there is the question of whether the state legislature or governor will stand to block or impede the implementation, which is set to go into effect July 1, 2021, in Missouri.
In Maine, then Republican Gov. Paul LePage famously said he would rather risk going to jail then putting the state in the red. The measure was only adopted after he was succeeded by a Democratic governor who took office in 2019.
However, it seems Gov. Mike Parson will not stand in the way of the program’s expansion in Missouri. “Amendment 2 [Medicaid expansion] is now a part of Missouri’s Constitution, and we will find a way to move forward,” Parson said in an email statement from his office.
Still, the Missouri Hospital Association noted there is likely to be pushback when it comes to hammering out the fine details of the program, which is estimated to bring coverage to 230,000 Missourians.
Dave Dillon, a spokesman for the state hospital association, characterized Tuesday’s victory as more apt to reaching a milestone than reaching a destination.