HEALTH EQUITY BRIEF

If you don’t know the implications of proposed health policy changes for your cause or community, now is the time to find out.

Abundant information is available regarding the impact of existing federal health programs and competing alternatives. A number of credible, nonpartisan organizations offer timely analysis of the various legislative and regulatory policy proposals being debated. (See resource list.) Some of the best sources for information are your own grantees and the communities they engage.

If you haven’t already done so, now is a good time to call your nonprofit partners and ask them how they and their intended beneficiaries would be affected by possible federal or state changes to the ACA, Medicaid, Medicare and proposed budget cuts to domestic programs.

You also may want to ask leaders of health clinics and hospitals in your community and health worker unions.

Philanthropy-supporting organizations such as Grantmakers In Health (GIH) and FCAA have regular opportunities through webinars and calls to learn the latest policy proposals and their implications. Several state and local funder networks have hosted informational sessions, including in New York and Tennessee.

Once you’ve armed yourself with the facts, it can still be challenging to decide whether to act, and if so, what to do.

Here are seven actions being taken by leading foundations and donors that you can take in response to possible federal or state health policy changes:

1. Give more (and more flexible) funding.

The most useful thing you can do in this unusual policy moment is free up additional flexible resources for your nonprofit partners to respond.

Tina Eshaghpour, director of organizational learning and evaluation at The California Wellness Foundation, in an interview noted that the foundation had to revamp its internal procedures to enable it to disburse grants more quickly.

“We took cues from our grantees and implemented some new processes to expedite making core operating support grants to advance and defend wellness,” said Eshaghpour. “These times demand responsiveness and creativity, so our board approved new tools to enable us to move funding out the door more quickly.”

Caring Across Generations activists testified about the importance of Medicaid and the Affordable Care Act during a Senate hearing on Rep. Tom Price’s nomination as Secretary of Health and Human Services. (Photo courtesy of Caring Across Generations.)

Advocacy networks and coalitions need more funding to ramp up their capacity in a range of areas – from constituent engagement to communications. This will enable them to defend existing policies as well as advance new ones.

During a February 10th GIH webinar on ACA repeal, the David & Lucile Packard Foundation reported that since the election it has been shifting resources to protect health access and coverage for kids. Packard set up a rapid-response funding process, expanded advocacy grants to 18 states, directed more money to communications support for state advocates, and also engaged a firm to add communications capacity for national coalitions. Packard is taking a bipartisan approach, engaging nontraditional partners such as law enforcement, military and business; it is interested in engaging with other funder partners, especially around research and analysis.

The California Endowment has committed $25 million over three years to a new Fight4All Initiative, which also will strengthen state-based advocacy.

These are both large foundations affecting tens of millions of residents, but funders of any size can find ways to support networks and coalitions at the local level. Some local funders have been providing convening space, buying food for meetings and otherwise lending support.

2. Reach out to the nonprofits you support.

You can call your nonprofit partners to exchange information on how the federal and state policy landscape is affecting their work on the ground and to find out what they need from you to respond.

California health funders were very responsive to their grantees after the election, according to Sarah de Guia, executive director at the California Pan-Ethnic Health Network (CPEHN). She reached out to all of CPEHN’s funders, and four were especially receptive: Blue Shield of California Foundation, California Health Care Foundation, The California Endowment and The California Wellness Foundation.

Judith Stein, founder and executive director of the national Center for Medicare Advocacy (CMA), also spoke with its funders and reported, “Retirement Research Foundation and John A. Hartford Foundation allowed us to redirect some funding for other efforts to the current pressing health care concerns.”

Some of the groups you support may not know how various policy proposals will affect their community, in which case you can be a resource or can refer them to other sources of information and plug them into networks and coalitions working on this issue. The Michigan Health Endowment Fund works closely with the Michigan Department of Health and Human Services to understand how proposed federal changes may impact health policy in the state. This ongoing dialogue helps the health fund shape grantmaking initiatives that address funding shifts, new best practices and emerging priorities.

3. Elevate stories of impact.

You can help the groups you fund gather stories from their constituents about the importance of federal and state health programs for their families and communities.

For example, CPEHN funds a local network of service providers to be able to testify to policymakers who want to know how their constituents are being affected by policy changes. Universal Health Care Foundation of Connecticut is supporting CMA to collect health care stories of individuals and families and is posting them on social media. The foundation also helped launch the Protect Our Care CT campaign.

Center for Medicare Advocacy founder and executive director, Judith Stein, honors Senator Sherrod Brown who presented the Senator Jay Rockefeller Lecture as part of the center’s 2017 National Voices of Medicare Summit. (Photo courtesy of CMA.)

CMA’s Stein urges other local and state-based funders to give grants to local nonprofits working with affected residents to gather their stories and funnel them to Congress, the media and to national groups such as CMA, which have longstanding relationships with legislative and administrative staff at the federal level.

(Note: Sharing human stories of a public policy or program’s impacts does not constitute lobbying!)

4. Lead with equity.

Given that proposed reductions in health access, higher premiums and other cost-containment plans will hit those facing disparities hardest, now is a good time to make sure you are studying the effects of policies using a variety of lenses such as race, gender, disability, income and geography.

The Consumer Health Foundation had already made a strong commitment to racial equity in its health grantmaking. And yet in the current environment, CEO Yanique Redwood has used her bully pulpit to exhort and educate about what it truly means to lead with equity.

While it is promising that so many health foundations have embraced “health equity” as a concept, Redwood notes that jumping on this “bandwagon” is not for the faint of heart and requires deep, tough and thoughtful work.

First, you need to ask the right questions about a proposed policy, then fund the groups best equipped to advance an equity agenda related to that policy.

Eshaghpour at California Wellness noted that developing a shared understanding of equity internally created the conditions for the foundation to make bold external statements challenging executive orders.

Funding with an equity lens also requires an openness to embracing the intersections of issues and identities.

Caring Across Generations convened an Organizing for Care event in Washington, D.C., in June 2016. It brought together field partners and members to discuss innovation and progress in the care movement. (Photo courtesy of Caring Across Generations.)

Organizations such as Caring Across Generations unite diverse constituencies across multiple concerns to advance wellness. Funders with a narrow focus have the opportunity to think outside their usual box. Breaking out of these silos to fund where the greatest disparities exist and where the greatest opportunities for united action are found can lead to greater impact.

Beth Uselton, program director for advocacy and access at The Healing Trust in Tennessee observed, “This is a prime organizing opportunity to align urban people of color and the white working class, many of whom are in rural areas that have the highest cost health plans. People’s shared experience of health care access, cost and coverage – or lack thereof – provides a unique opportunity to find common ground and move the conversation into one about health equity and shared outcomes.”

5. Use your reputation.

In your position as a trusted leader on health issues, you can educate your peers, partners and the public.

At a recent Philanthropy New York forum on the ACA, David Sandman, CEO of the New York State Health Foundation, said, “Don’t overlook the opportunity to do basic public education. That’s a role for philanthropy, even if you aren’t a policy wonk.”

Sandman has been using his leadership perch to blog regularly in The Huffington Post. In a December 13, 2016, post, his three wishes for 2017 included “stable and affordable health insurance coverage for all New Yorkers.” He laid out in clear, stark terms what is at stake if the ACA is repealed and concluded, “All these hopes can be reality if we don’t just wish but also take action … Keep a close eye on the implications of federal action – and inaction – on the ACA for our state and what we can do to protect health insurance for New Yorkers.”

Foundations that don’t have the ability right now to expend more resources on flexible grants can exercise leadership in other ways.

For example, the Northwest Health Foundation (NWHF) “was not in a position to do anything more than modest additional investments through discretionary [grants] at the end of last year,” reported Suk Rhee, vice president of strategy and community partnership. However, the NWHF has helped other funders identify organizations and communities for increased or rapid response investment and has “lent our presence, name and people where it is needed, e.g., in response to the travel ban, protests, moderating and speaking in public forums, etc.”

These were roles that the foundation was already comfortable playing. If you or your staff are new to these roles, they can look to peers for guidance on how to effectively support health equity movements and coalitions in your community.

6. Weigh in with policymakers.

You can reach out to state lawmakers and regulators to weigh in on proposed federal or state policy changes and their impact in your state.

The Health Foundation of South Florida has been talking to “community groups, state lawmakers and anybody who’ll listen to stress that children’s well-being depends on access to quality health care,” according to Inside Philanthropy. CEO Steven Marcus is alarmed about the potential negative effects that federal policy changes could have on 1.5 million Florida kids.

Don’t forget about state insurance commissioners and state public health officials, who can be important sources of data as well as influencers. (Note: Educating state regulators and legislators does not constitute lobbying under federal law if you do not explicitly ask them to vote a particular way on a particular piece of legislation.)

On an FCAA advocacy call, a policy expert noted that insurance commissioners want stability in the health insurance marketplace and can be urged to share their data with their state’s congressional representatives.

Uselton noted several states that did not take advantage of the state options under the Affordable Care Act – like running their own marketplaces, designing their own benefit standards, piloting delivery system reforms or expanding Medicaid – have few legislators or state officials well versed in health policy issues. Foundations, donors and nonprofits can be critical sources of information to help state policymakers understand potential impacts of federal or state policy decisions. They can also support health care advocates who have special expertise in this area to work with policymakers.

7. Organize within philanthropy.

Funders have been coming together to issue joint statements increasingly over the last several years, including a full-page ad urging “hope” in The New York Times and other major papers last summer.

The Groundswell Fund recently helped organize an open letter from 29 philanthropic signatories urging grantmakers to support reproductive justice organizations led by communities of color. Women of color will be one of the hardest hit populations if Medicaid is cut and if access to reproductive and sexual health services is curtailed. The letter urges solidarity with local- and state-level organizations working on these issues.

Health Justice Fund provides support to grassroots advocacy organizations working to protect health programs serving marginalized populations. (Photo courtesy of Pennsylvania Health Access Network.)

Pooling funds is another way to organize your peers to maximize impact. Community Catalyst has a $5 million Health Justice Fund that supports grassroots organizing to protect the health care safety net, with support from seven foundations and several anonymous donors.

John Barnes, executive director of FCAA, indicated that a new collaborative is forming among his members in response to the changed federal policy environment. The new fund will focus on southern U.S. where FCAA data shows “roughly $59 per person living with HIV (PLWHIV) in the region, as compared to $116 per PLWHIV allocated nationally.” The goals of the new fund will be: to strengthen prevention care and treatment services; enhance advocacy with a focus on developing cross-movement connections between HIV advocates and other social justice movements; and strengthen and diversify the leadership pipeline to ensure that the leaders in HIV services and advocacy are reflective of the communities they serve (such as people of color and LGBTQ individuals).

Proteus Fund has launched the Rights Faith & Democracy Collaborative to combat efforts to expand religious exemptions designed to circumvent equal protections/equal access, mostly around LGBTQ and sexual and reproductive health and rights issues.