The Challenge

With the passage of the Affordable Care Act, the federal government provided states an opportunity to draw-down additional matching dollars, provided states increase the number of people eligible for Medicaid (the federal insurance program for the needy); this created a political firestorm because conservatives felt this forced states to adopt “ObamaCare.”

The difference for Arizona was that the voters of the state already passed an initiative 13 years prior (Proposition 204) requiring approximately the same coverage. So the question became, have Arizona reject this ability to utilize this law, and have the state cover the full amount of this population (moreover, this population greatly added to the uncompensated-care problems of hospitals and rural healthcare clinics) or secure over $2 billion in new federal resources: In FY 2016 this equates to over 15,000 jobs.


Molera Alvarez was hired by the Arizona Business Coalition (a consortium business group that included the Arizona Chamber of Commerce and Industry, the Arizona Hospital Association, Banner Hospital System, Dignity Healthcare, Greater Phoenix Leadership) to head-up a multi-million dollar public outreach initiative to steer public-opinion in favor of this effort. As part of this assignment, Molera Alvarez worked hand-in-hand with Governor Jan Brewer’s Administration to develop the lobbying strategy and communications strategy.


The Arizona Legislature not only passed this proposal into law, but by the end of the public outreach campaign over 68% of Arizona voters supported the Governor’s proposal. Moreover, many political pundits predicted GOP legislative members would be defeated in the 2014 primary due to conservative backlash: Not one Republican member who voted on this Medicaid expansion lost in the primary.