- The 2010 U.S. health reforms expanded health insurance access to millions of Americans, mainly through an unprecedented expansion of Medicaid eligibility to those with low incomes. Not all states chose to expand their programs, resulting in disparate health-benefit access nationally. This study uses quantitative and qualitative analyses to explore the statelevel politics of welfare policy expansion, focusing on the shifting nature of political support and rhetoric around beneficial social policy in the states following the implementation of Medicaid expansion. A key question is whether program expansion translated to greater electoral support for the Democratic Party as the party responsible for health reform. Another considers how pro-expansion advocates framed the issue of Medicaid expansion and built interest-group coalitions supporting recent statewide ballot initiatives. Findings point to negligible rewards for Democratic candidates, conditional on favorable state-level partisanship, and surprisingly broad-based penalties for Republicans from expanded Medicaid coverage. Furthermore, a content-analysis of pro-expansion campaigns in Oregon, Utah, and Maine finds successful issue-framing tailored to these states’ unique and very different partisan-political context resulted in all three adopting (or readopting) Medicaid expansion. Framing in more conservative contexts, specifically of expansion’s beneficiaries and policy rationale, managed to challenge and overcome longstanding anti-social welfare ideologies in Utah and Maine. Thus successful pro-expansion advocacy aligned rhetoric with a state’s political values while directly engaging opposition ideas and arguments vis-à-vis the public. Finally, a protective policy discourse and robust coalition-formation in Oregon suggest the onset of considerable policy consolidation in existing expansion-states with strong progressive traditions.