Case Studies

Care4Carolina
Case Study

Reframing & Reenergizing

THE SITUATION

North Carolina had long faced stiff political opposition to expanding Medicaid. This left approximately 600,000 North Carolinians – many of them employed – struggling to secure insurance. It also left significant federal funding on the table.
 
Even if supporters of expansion could persuade opponents of the idea’s merits, another question remained: could the state actually enroll newly eligible North Carolinians en masse, especially those in hard-to-reach communities. 

RLF’S APPROACH

Working alongside GBW Strategies/RLF Communications, the Care4Carolina (C4C) coalition reframed the debate. With political baggage weighing down the term “Medicaid expansion,” C4C pivoted to talking about “closing the health insurance coverage gap.”
 
Strikingly visual, the new term was easy to remember and use. It put people – those trapped in the gap – ahead of policy jargon. And it positioned the issue as an important mission that folks of all political stripes could help execute.
 
The reframe opened new streams of research-backed advocacy.  C4C and GBW/RLF worked with broad coalition of health, business, and faith organizations to secure endorsements and moving personal stories. These included grassroots testimonies, such as that of a working family whose matriarch died due to lack of insurance, and grasstops support from figures like a former NC Secretary of Commerce and the retired CEO of the state’s largest insurer.
 
The outreach connected closing the coverage gap to critical issues like the opioid crisis, veterans’ healthcare, and the financial struggles of rural hospitals. C4C and GBW/RLF also shared statistics illustrating the healthcare needs of all 100 counties and how closing the gap would help.
 
Reframing the issue, reenergizing the discussion and extending a cooperative hand to all set the stage for major change.  

TACTICS

RESULTS

In May 2023, North Carolina Senate leader Phil Berger made news around the country when he publicly endorsed Medicaid expansion, making a powerful case for supporting working families in a financially sustainable way. This paved the way to legislative approval and to Gov. Roy Cooper signing expansion into law. The headline of a national A.P. story typified coverage: “NC approves Medicaid expansion, reversing long opposition.”

Following the policy victory, the focus turned to enrolling eligible residents, leveraging its network of champions to reach target communities. By May 2024, over 450,000 North Carolinians had enrolled, with nearly 900 media articles covering the campaign’s success. The number has since reached 600,000.

Gov. Cooper and NC DHHS Secretary Kody Kinsley credited C4C for its instrumental role in both expanding Medicaid and helping to enroll thousands. In May 2024, the coalition dissolved, but its legacy continues through the ongoing work of its leaders in other states, the bipartisan relationships forged and the lives transformed in North Carolina.