Case Study: Passing the Healthy Michigan Plan

Expand Medicaid Coalition

Passing the Healthy Michigan Plan

Goal: Pass House Bill 4714 to expand Medicaid in Michigan under the federal Affordable Care Act.

Research:

One of the most important and politically difficult policy debates in recent Michigan history began in January 2013, when Gov. Rick Snyder proposed the Healthy Michigan Plan to expand Medicaid in the state under the federal Affordable Care Act (ACA). Martin Waymire was retained by the Expand Medicaid coalition to build support for the plan.

We commissioned a statewide survey of Michigan voters in early January (600-person sample) to measure opinions and attitudes, levels of support/opposition, and to test messages that might resonate with voters. We were also given access to a 600-sample survey of Michigan voters conducted by a leading GOP pollster. Both polls showed support for the plan among a majority of voters (Democrats and Independents particularly) but opposition among self-identified Republicans.

To support our messaging and to convert undecided (and even some opposing) legislators to “yes” votes on the bill, we also researched:

1. Capacity (the ability of Michigan hospitals and doctors to care for 470,000 new insured patients entering the system);
2. Cost savings (we needed research that proved the expansion would reduce uncompensated care costs passed along to Michigan employers);
3. Jobs/economic impacts (would the expansion generate more health care jobs); and,
4. Local human impact (how many people would qualify for insurance in each Michigan county so legislators, media, and other audiences could understand the local human impact in their districts).

We also worked with the Governor’s office and government relations officers of our coalition organizations to constantly monitor which legislators were undecided or “soft no” votes. Communications strategies and tactics were constantly adjusted based on this research. We also constantly monitored the activities of Americans for Prosperity-Michigan and other Tea Party-leaning opposition groups.

Action Plan & Communication Overview:

Based on the research, we developed the following messages (with extensive supporting talking points):

1. The Medicaid expansion will save the state money —almost immediately;
2. The Medicaid expansion will save lives and improve the physical, mental and emotional health of hundreds of thousands of Michigan residents;
3. The Medicaid expansion protects many Michigan employers from financial penalties they would face under the federal health reform law;
4. The Medicaid expansion will reduce health care costs over time;
5. The Medicaid expansion will support and create thousands of good health care jobs in Michigan;
6. Research affirms that Michigan’s health care delivery system of hospitals, community health centers and health plan networks has the capacity to treat the newly enrolled.

We researched, wrote, developed, and managed ExpandMedicaid.com, which became the campaign’s educational and advocacy hub. At the Governor’s direction, we placed billboards for two months in the districts of about 10 state Senators whose votes were critical to final passage. We also pushed our “Saves Money, Saves Lives” videos out via targeted Google, Facebook, and ad networks.

We managed the coalition’s Twitter and Facebook pages, using them to communicate current legislative developments, push out our videos, push out favorable newspaper editorials, and more. We posted favorable editorials on legislators’ Facebook pages too.

Evaluation:

• Every newspaper editorial board in Michigan —Republican, Democrat, and middle-of-the-road papers —that weighed in on the issue called for passage of HB 4714. In 25 years of managing public affairs issues in Michigan, we have only seen this level of editorial board support one other time.
• We completed more than 120 print and broadcast media interviews on the issue with Michigan and national media.
• It is estimated that coalition members generated more than 30,000 email and phone contacts to targeted state lawmakers (the 8 to 10 undecided legislators whose votes became critical to passage).
• We produced 11 “Saves Money, Saves Lives” short-form videos ranging in length from 1:30 to 2:30 for the website and social media channels. The videos generated more than 20,000 views.
• The videos and our other social media activities ended up pushing our ExpandMedicaid.com website to as high as second in the Google search rankings of the issue in Michigan. We ranked just behind the state’s largest news media site(s).
• And most importantly, we achieved our goal. The bill narrowly passed the House and Senate and was signed into law, making Michigan the 25th state in the nation — and one of just three states with a Republican House, Republican Senate, and Republican Governor — to approve the Medicaid expansion. The plan was expected to save Michigan taxpayers about $1 billion over the next decade, reduce cost-shifting for employers who end up paying higher healthcare premiums to cover uncompensated care delivered in hospital emergency rooms and provide insurance to about 470,000 working Michigan adults who could not afford coverage. As of April 2022, more than 991,000 Michiganders are covered through this historic program.