Cafaro served on the Trumbull County Senior Services Advisory Council and was a State Policy Liaison for Ohio with the National Patient Advocate Foundation.[5] She was also a State Advocate Representative for the National Committee to Preserve Social Security and Medicare and served as a councilor for the Medicare Rights Center.[5] Cafaro has also acted as an Economic Policy Associate for Global Action on Aging, an NGO with consultative status at the United Nations.[5]
As a political novice, Cafaro won a surprise victory in the 2004 Democratic primary for Ohio's 14th congressional district, topping a five-candidate field,[2] which included 2002 nominee Dale V. Blanchard, columnist Herb Hammer, U.S. Marine Charles L. Wolfe, and Ohio state Rep. Ed Jerse (who received the endorsement of the Akron Beacon Journal newspaper). Cafaro polled 54% of the vote, while Jerse, the second-place finisher, managed 19%. In the general election, however, she lost to RepublicanSteve LaTourette.[6]
As of 2017, Cafaro was the Executive in Residence at American University's School of Public Affairs and gave commentary on political events as a contributor on Fox News.[7]
One year after becoming a member of the Ohio General Assembly, Cafaro secured a leadership position as the assistant minority whip for the Senate Democrats.[9]
In 2008, Cafaro was elected to her first full term after running unopposed in the general election. Soon after, she was elected Minority Leader by her colleagues for the 128th General Assembly.[10] Cafaro again served as Minority Leader in the 129th General Assembly.[11] Cafaro would serve as Leader for three years until she stepped down and was replaced in 2012 as Ohio Senate Minority Leader by Senator Eric Kearney. She won a second full term to her Senate seat in the 2012 general election, defeating Republican Nancy McArthur 67% to 33%.[12]
Cafaro played a prominent role in the Medicaid expansion efforts in Ohio,[13] and has sought to codify the expansion permanently in Ohio law.[14] She has offered legislation numerous times to do so.[15]
Cafaro did not seek reelection to the Ohio state senate in 2016 due to term limits.[16]