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Posts Tagged ‘Grantmakers in Health’

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.

—Jane Wales

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If Congress were to double or triple the private foundation excise tax, asks Joel Orosz of Grand Valley State University, “does anyone truly think that there will be a groundswell of support for foundations” that resist? In a March 10 guest post to the Center for Effective Philanthropy blog headlined “Déjà vu (or 1969) All over Again?”, Orosz suggests it’s too late for foundations to react effectively to stem a possible backlash against the sector. Still, the philanthropy professor counsels foundations to take steps on their own to improve practices, including training employees to be more professional and more accountable to nonprofits.

Orosz is just one of several commentators recently suggesting that a growing populist fervor in society isn’t just anti-government, but anti-institution—and a threat to philanthropy, one that can’t be summarily dismissed and should propel changes. For example, in Small Change: Why Business Won’t Save The World, Michael Edwards wrote that foundation leaders will vociferously resist and complain about the many suggestions he makes in the book calling on Congress to require more transparency and accountability from foundations. But Edwards, a senior fellow at the think tank Demos and the leading skeptic of philanthro-capitalism, says that public and political pressure will eventually build and force changes in the sector. Similarly, in a February 25 Chronicle of Philanthropy opinion piece, the Hudson Institute’s William Schambra argued that philanthropy’s increasingly business-minded approach is at odds with the populist mood of the American public on both ends of the political spectrum. He thinks the tide is turning against foundations.

To help improve the situation, Thomas David of the Community Clinics Initiative argues that foundations should show they’re making sacrifices in this economy along with everyone else. It should not be a time of hunkering down, cutting grantmaking, trimming staff and expenses or focusing on re-growing endowments. Instead, David writes in an essay published by Grantmakers in Health (GIH) that foundations should make some big bets, ease up on control of grantees and practice mission-related investing. In other words, take risks that put them on the line in ways that might tangibly, not just symbolically, benefit nonprofits in a time of need. More specifically, David advises foundations to increase their grantmaking this year—even if they’re one of those already exceeding 6 percent payout. He complains that over the past couple of decades, foundations have evolved to become more risk averse than ever; they’re so focused on assets that growth is their priority, not giving.

David’s hard-charging essay is just one of several included in Taking Risks at a Critical Time, released in March in tandem with GIH’s 2010 annual meeting. Foundations hesitate, according to this publication, in part because of an over-reliance on proven practices, unwarranted anxiety about engaging in public policy and avoidance of failure of any kind, despite the fact that a healthy proportion of failures in a grant portfolio is a sign that a foundation is successfully venturing in new territory. The lead essay includes examples of “risk taking in action,” efforts to improve health.

Tom David is not optimistic, however. He essentially calls foundations fair-weather friends to nonprofits: “It is at times like this that nonprofits, who like to think of foundations as allies in their struggles, have learned not to count on their friends when they need them most.” I wonder. It is not the role of foundations to support nonprofits based on need, but rather based on merit, because doing so fits a larger strategy—one that produces a social benefit. I have a good deal of faith that foundations will do their best to achieve that end. But the way in which they do it must take into account the public mood, and even distrust that these observers so powerfully describe. No institution is being given a pass, particularly one that is seen as opaque while claiming to advance the public good. “Trust us” has never been an adequate response to doubters.

—Jane Wales

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