Think the debate over health care reform is over? Not a chance— and not just because Election Day is fast approaching. President Obama signed the Patient Protection and Affordable Care Act (PPACA) in late March after nearly a year of debate and deliberation. But the real work is only just beginning: Implementing the law at both the federal and state levels.
And so, Grantmakers in Health has called upon foundations to ramp up funding for public education about the legislation, as well as to build local capacity to implement it. Working to generate and sustain public support over the next few years will be critical if the law is to withstand efforts to repeal or undermine it before it has had a chance to take effect, according to Implementing Health Care Reform: Funders and Advocates Respond to the Challenge.
Moreover the Grantmakers alliance says that the issue should concern even those funders working outside of the health and heath care area. For starters, the report explains, the law touches on issues beyond health and health care, incorporating issues about workforce, income security and equity among racial and ethnic populations. But perhaps the most important reason the report argues that non-health funders should play a role in health care reform: the success— or failure— of the law could affect other public policy issues in the future. As the GIH publication puts it, the bill’s high profile and broad reach means that successful implementation could help restore public trust in government and demonstrate government’s positive role in improving lives. Wouldn’t that be something?
Although the focus—and controversy—has been on provisions expanding health insurance, the PPACA encompasses significant changes affecting virtually every aspect of the health system, from information technology to training to delivery system. The aim is to restructure the health care delivery system to make it more focused on prevention and primary care, reduce costs and improve quality. Indeed, it’s more complex and broader in scope than Medicare or Medicaid, and will be enacted in stages over the next four years, with many of its provisions requiring extensive planning and preparation.
Based on interviews with 43 funders and advocates, the GIH publication reports on foundations’ early implementation activities and plans. It also offers recommendations for further engagement and support. The organization will further discuss the report and hear from several funders engaged on the issue in a Sept. 8 conference call for members at 2:00 PM EST. (Email to register.) The report suggests that funders should work harder to coordinate and collaborate their efforts, within a state or on a regional level, learning about what their colleagues are doing. In particular, funders could work to create pooled funds for specific issues, activities or localities. And larger funders could seek out small, community and nonhealth funders, soliciting their expertise or advice on education, poverty or workforce issues as they relate to implementation.
More specifically, the report calls on philanthropists to fund efforts to explain the law in ways that people— including grantees— can understand, overcoming skepticism, as well as to target groups who might benefit from the early provisions, such as the uninsurable, seniors with prescription drug costs and small businesses. Another critical need is for philanthropists to help state government officials take on the local tasks of implementation. The latter will be a particular challenge, as states are constrained by budget deficits, staff reductions and anticipated turnover due to the fall elections. So foundations could identify ways to partner with local or state government, according to the report—if not direct funding for personnel or programs, then helping them apply for federal grants or support data collection and evaluation.
“Never before has there been such a national framework in place for major health systems change,” GIH reports.
The potential is certainly there—now, to make it real.