Health CareLocal Organizing

Expand VA Medicaid Die-in Planning Guide

Table of Contents:

  1. Status Update
  2. Goals, Strategy, and Tactics
  3. What is a Die-in?
  4. How to Plan a Die In
  5. Media
  6. Day of Action

Die in at Rep. McSally’s office via @Indivisible_SAZ
Die in at Rep. McSally’s office via @Indivisible_SAZ

Status Update on the Fight for Medicaid Expansion in Virginia

Virginia is one of 19 states that has not expanded Medicaid under Obamacare, even though 83% of its residents support expansion. Expanding Medicaid would allow individuals with incomes of up to 138% of the federal poverty level to receive health insurance through the Medicaid program, and would lead to new coverage for 400,000 Virginians. Many of these currently uncovered individuals live right on or just above the poverty line and are in the “coverage gap”—meaning that they are not currently eligible for Medicaid in Virginia but also ineligible for premium subsidies. By not expanding Medicaid, Virginia is leaving federal dollars on the table; Virginia forfeits $142 million of federal funding every month and has missed out on over $10 billion since 2014. Medicaid expansion is a hugely popular issue in every single state legislative district in Virginia. A recent report shows that support for expansion is 66 percent in the median House of Delegates district and 67 percent in the median state Senate district.

Having seen the results of the voters’ wrath firsthand in the November 2017 elections, the House of Delegates voted by an overwhelming margin (69-31) to include Medicaid expansion in their proposed budget, with 20 Republicans voting yes. Meanwhile, it appears that Senators in Virginia have been living under a rock for the past year. They blatantly disregarded the will of the voters by omitting expansion from their proposed version of the budget and rejecting a floor amendment for expansion on a party line vote (21-19), with all Republicans voting against expansion.

Unable to reach consensus, the General Assembly adjourned in March without passing a budget and returned on April 18th for a special session. Since then, two key Republican Senators have indicated a willingness to vote for Medicaid expansion. Winning this fight is more possible than ever before, but the Senate needs to hear that this is a priority for constituents!

Goal, Strategy, Tactics

Health care was the #1 issue for voters in the November elections that swept Democrats to #BlueWave victories. Expanding Medicaid in Virginia is the first follow-up to those victories and this is a hugely impactful and winnable fight.

Our goal is to hold Virginia State Senators accountable to their constituents and get them to vote to expand Medicaid in Virginia this year.

Our strategy is to publicly pressure state senators by demonstrating the strong constituent support for Medicaid expansion.

As our tactic, we are planning a die-in, similar to those we held during the Affordable Care Act fight last year, at the State Capitol in Richmond on May 14th, when the Senate reconvenes to debate and discuss the budget.

What’s a die-in?

A die-in is a form of nonviolent direct action protest where participants publicly pretend to die to highlight a deadly problem, like the lack of health care for folks who need it. This is a tactic designed to attract attention from passersby and people in positions of power, and can be used to disrupt business as usual at a problematic institution. It holds most power if media attend the event and/or if photos and video are shared to social media.

Since most state senators in Virginia don’t have in-district offices, this tactic will be most powerful when done at the state capitol on key dates, or at a public/private event at which the Senator is in attendance. Indivisibles will hold a die-in on May 14th at the Bell Tower at the State Capitol in Richmond, VA. Other great candidate locations for die-ins are the variety of Republican fundraisers that state Senators have been spending their time holding instead of working on the budget to expand Medicaid.

How to Plan a Die-In

Call an emergency team meeting.

The fate of 400,000 Virginians will be decided in the next two months. We are close to expanding Medicaid but we need constant constituent pressure to make it happen. Call a meeting of your Indivisible group to strategize your action!

    • Secure a venue for your meeting
    • Send an email to your list
    • Put an event on Facebook and register at
    • Write an agenda for the meeting (see section below on “At your meeting”)

Before your meeting:

At your meeting:

  • Have everyone sign in!
  • Thank everyone for attending on short notice and remind everyone why we’re here:
    1. Give the VA Medicaid expansion status update;
    2. Explain our overall goal and strategy for the campaign, as well as what a die-in is and why we’re doing it.
  • Tell everyone the time and location of the die-in.
  • Pass around a sign-up sheet, collecting the contact information of everyone who is available to participate in the event, and who is willing to “die-in.”
  • If your group is attending the May 14th die-in, ask folks to write down if they have a car and are willing to drive others or if they need a ride so that you can set up carpools to Richmond.
  • Designate key roles:
    • Main speaker (will speak into bullhorn or microphone and introduce storytellers)
    • Someone to give a signal that it is time to die-in
    • A responsible person who will make sure the art makes it to your location
    • Photographer/videographer (this is really important; without photos and video, the die-in might as well not have happened)
    • Social Media coordinator
    • Media Liaison
  • Ask the room who has a story that they would be willing to share at the event, illustrating how people in your district rely on Medicaid. If you have someone in your group who is in the coverage gap, ask them if they would be willing to tell their story of how Medicaid expansion would help them.
    • One leader from your group should take these people aside and lead a storytelling exercise, where everyone writes out their stories. Try and keep these to 500 words or less. Shorter is always better for media coverage, although of course be sensitive to people in this moment of pain.
  • Those who will not share stories, cannot make it to the event, and those who will attend but cannot die-in should begin the art efforts.
    • Be creative!
    • Some suggestions:
      • Make cardboard tombstones for every dead constituent in the action.
      • Make a banner that can be seen from a distance. Use bold colors. If you want to make it look professional, use a projector to project letters or a picture onto your surface, then trace your image in pencil and paint inside the lines.
      • If anyone has sewing skills, they can make a grim reaper costume. These are also pretty easy to find at costume shops.
      • Make tissue paper wreaths or bouquets for the deceased constituents.
      • Make enough picket signs so that there are no empty-handed participants in the die-in.
      • Make sure that your art calls out your MoC by name wherever possible (this will make your target clear in photographs of the action!).
      • Be creative and don’t underestimate the power of humor and theater in direct action.
  • Those who will die-in should be asked to stay an extra 20 to 30 minutes at the meeting to practice.
    • Decide together how everyone will know it is time to lie down.
      • Will someone raise a hand? Some other nonverbal cue?
      • Will one designated person announce that it is time?
    • Practice sharing stories and lying down when the signal is given. Have someone roleplay as a disgruntled staffer, a Trump supporter, a confused bystander, or anyone else who might throw you off. Is everyone still lying down on time and at once?
    • Write/practice your chants! Try to project your voice.
      • For example: “Expand Medicaid NOW!”
    • Make sure everyone agrees on how long you will stay on the ground. No one should be forced to stay longer than they are comfortable with, but everyone dispersing at random could compromise the effectiveness and appearance of the action.


To change the narrative in your Senator’s home district, it’s critical to get media attention at constituents events like a die-in. Get started with our local organizing explainer, “How to Get Press to Cover Your Event.”

On the day of the action

  • All people in key roles should meet 45 minutes in advance. Bring snacks and water, assemble any art pieces that need assembly, test any technology, make reminder calls to everyone who signed up to attend, and begin to get in position.
  • Meet in the designated location. Once everyone has gathered, the Main Speaker should state clearly why you all are there, and that many people in your district will be affected by this vote.
  • The Social Media Coordinator should record, live-tweet and/or Facebook-live the entire experience.
    • Make sure that you are recording and taking photos horizontally, not vertically. It really helps the video get shared and makes it usable for press.
    • Be sure to tag your state Senator.
    • Be sure to tag @IndivisibleTeam on Twitter.
    • Post photos of the action.
  • Storytellers should stand in a line next to the speaker, so they can easily pass the microphone or bullhorn to share their stories. You may want to start with some group chanting.
  • At the appropriate time, someone will give the signal and participants will die-in and stay in place as long as possible (or for the agreed upon period of time). You may wish to have a 30 second moment of silence while people are on the ground; after that point, people who are “dead” should remain silent but the Speaker/Storytellers should start speaking.
  • Anyone who is unable to lie down should stay standing during the die-in, holding signs and, when appropriate, participating in chants.
  • When the die-in ends, everyone should clean up and leave quickly. You may also wish to end with some chants. The mood is somber, so be aware of media and social media coverage before you assume things are finished. But do regroup off-site and congratulate yourselves!
  • Leaders should plan a debrief meeting.
  • Send your stories, pictures, and best practices to


  • Bring a bullhorn or portable microphone.
  • Agree on a dress code. Wearing the same color creates a strong visual impact, makes it clear you are together, and looks great in photos.
  • Collect all of the constituent stories that you can, and deliver them in a package to your MoC. This is a great way to incorporate the stories of folks who couldn’t attend.
  • Make funeral bouquets or wreaths out of tissue paper.

Note: Familiarize yourself with our resource A Note on Police Encounters in case you are stopped by the police at your event.