Building Power for Health: The Grassroots Politics of Sustaining and Strengthening Medicaid.

Abstract

Context: Notwithstanding an impressive corpus charting the politics of Medicaid, there is still much to learn about the contemporary politics of sustaining, expanding, and protecting the program. There is especially scant scholarly evidence on the significance and function of grassroots political actors (i.e., the communities and groups most directly affected by health policy). This article explores the role such groups play in the politics of Medicaid.

Methods: This research is based on qualitative interviews with organizers and advocates working in the domain of health policy.

Findings: The power of grassroots actors in Medicaid politics is constrained by political and structural forces, including philanthropic funding practices, racism, and partisan polarization. Nevertheless, when bottom-up actors effectively exercise power, their involvement in Medicaid politics can transform policy processes and outcomes.

Conclusions: Grassroots actors-those who are part of, represent, organize, or mobilize the people most affected by Medicaid policy-can play pivotal roles within Medicaid politics. Although they do not yet have sufficient political wherewithal to consistently advance transformational policy change, ongoing political processes suggest that they hold promise for being an increasingly important political force.