Our Stories: Health for All Fresnans

Nonprofit Coalition Saves Health Coverage for 5,000 Fresnans

On June 10th, 2016, California Governor Jerry Brown signed SB 10, which makes California the first state to ask federal officials to allow undocumented immigrants in the state to buy health insurance through its state exchange, Covered California. Immigrant rights’ advocates applauded this step towards health care for all Californians, including those who are undocumented. While this is a notable example of nonprofits in California coalescing to advocate for the health rights of undocumented immigrants, it is not the first.

The Health for All Fresnans campaign from a few years ago is a welcome reminder of the impact that nonprofits can have when they organize and advocate. That campaign showed us that mobilizing communities and residents to advocate for fair public policies is necessary to achieve systemic change and to prevent devastating impacts on underserved communities.

Fresno, California resident Juan Carlos’ health was at risk. Like so many in his community, he barely had enough money for rent, utilities, and food, and there simply was not enough money left over for health insurance.

Without Fresno County’s Medically Indigent Services Program (MISP), he would not have been able to afford surgery to repair his hernia.  Unfortunately, the Fresno County Board of Supervisors was attempting to eliminate the program. To Juan, MISP was a program worth protecting, and to nonprofit organizations and other residents in Fresno County, it was a program worth fighting for.

The Health for All Fresnans campaign, and the fight to save MISP, is a powerful example of how nonprofit organizations can mobilize communities, educate elected officials, and escalate pressure on decision-makers to ultimately do the right thing.

Fresno County, California

Fresno is a primarily agricultural region located in California’s Central Valley, is over 50% Hispanic or Latino, and suffers one of the highest rates of concentrated poverty in California. In December 2013, the Fresno County Board of Supervisors filed a lawsuit to attempt to eliminate the county’s MISP, which provides health care services predominantly to very low-income and undocumented Fresnans and their families.

A coalition of nonprofit organizations in Fresno County, ranging from service providers and legal advocates to community organizers, quickly responded to fight the elimination of the program. In addition to a legal strategy, the coalition tirelessly pursued a multi-pronged public policy advocacy strategy, including:

  • Grassroots Mobilization. The coalition held candle light vigils, press conferences, and board meetings with Fresnans to highlight the impacts of eliminating MISP. These events also earned media attention, which helped shaped the narrative about the human costs of eliminating the program.
  • Meeting with Elected Officials. The groups educated elected officials with a detailed economic impact analysis showing the savings, revenue, and jobs that would be generated by sustaining MISP, exposed many biases about undocumented residents (and immigrants in general), and corrected misconceptions, such as clarifying that many Fresnans would not be covered under the Affordable Care Act and so would be without health coverage in the absence of MISP.
  • Social Media Campaigns. The hashtag #Health4AllFresnans emerged to align with the broader statewide movement of #Health4All, and the coalition started a petition, created YouTube videos, and wrote numerous letters to the editor. In addition, powerful stories of Fresnans receiving care under MISP, including Juan’s story, were circulated widely across many social media platforms, including Twitter, Facebook, and Instagram.
  • Integrated Voter Engagement. Through door-to-door outreach and phone calls, the coalition contacted over 2,500 voters and found that 84% supported health care for all Californians. This was effective in countering the misconception held by the Board of Supervisors that Fresno county voters did not support allocating money for the MISP program.


In 2014, the Board of Supervisors struck a deal with the state to use money the county owed the state to repay a debt to instead fund the MISP Program. The escalating pressure, community-wide mobilization, and multi-faceted approach of nonprofit organizations all brought about the victory, in addition to the tireless effort of community residents. Policy debates are too often dominated by those with the financial resources to buy access and influence, and nonprofits can help even well-intentioned elected officials fully understand how communities are affected by policy choices.

At Alliance for Justice, we can help you navigate the rules of advocacy and build your advocacy capacity. Like the Health for All Fresnans campaign, with the right support and partnerships your nonprofit can create real and lasting change.