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Towards Transformative Change in Health Care: an Update 1 by Terri Langston and Jennifer Ng’Andu NCRP’s QuarTERLY JOURNAL Responsive SPRING 2012 Philanthropy IN THIS ISSUE Towards Transformative Change in Health Care: An Update 1 BY TERRI LANGSTON AND JENNIFER NG’ANDU Lessons for Grantmakers from the Battle for Health Care Reform 3 BY SEAN DOBSON How to Change Behavior in Philanthropy: Factors and Barriers that Influence Foundation 6 Practices BY SPENCE LIMBOCKER A Message from the Executive Director 2 Member Spotlight 11 A rally outside the Supreme Court during Florida v. HHS, which challenged the Affordable Care Act. Photo cour- tesy of Health Care for America Now (HCAN). Towards Transformative Change in Health Care: An Update By Terri Langston and Jennifer Ng’andu EVERYTHING States as well, that’s what is required Centers for Medicare and Medicaid What’s going on now with health re- and that is what is largely happening. Services. Recent evidence includes the form? There’s a simple, one-word an- Space prohibits covering “everything” 644 pages comprising the final rule on swer: “Everything.” When Dr. Don in this article; however, we will high- health insurance exchanges (the state Berwick asked Göran Henrik how light a few broad areas of work as we “marketplaces” for millions of Ameri- Jönköping County in Sweden was im- enter year three of the Affordable Care cans in the individual and small group proving total health system perfor- Act (ACA) implementation and then re- markets). CMS received and reviewed mance, he answered, “Here’s the se- iterate five critical principles that must more than 25,000 public comments cret: We do everything.”1 In the United underlie the work of philanthropies. about the preliminary ruling. CMS con- siders its rule a “blueprint” for estab- GOVERNMENT lishing exchanges and leaves the states As has often been said in recent months, much flexibility. Both consumer repre- health reform has much to do with the sentation and prohibitions on conflicts role of government. No less than stellar of interest are parts of the governance service can characterize the work per- provisions, and “Qualified Health formed by the staffs at the Department Plans” must have an adequate number challenging grantmakers of Health and Human Services and the of community (continued on page 9) to strengthen communities NCRP STAFF Meredith Brodbeck A Message From the Communications Associate Samantha Davis Executive Director Field Assistant Sean Dobson Field Director Aaron Dorfman Executive Director Dear Readers, Kevin Faria Development Director Earlier this spring, the Supreme Court heard arguments about the constitutional- ity of the Affordable Care Act, and a ruling may be issued soon. I’m pleased, Niki Jagpal Research & Policy Director therefore, that this issue of Responsive Philanthropy looks at philanthropy and health care reform. Health philanthropy expert Terry Langston and Jennifer Kevin Laskowski Research & Policy Associate Ng’andu of the National Council of La Raza look at the continuing role of phi- lanthropy in the implementation of the ACA. Anna Kristina (“Yna”) C. Moore Communications Director Also in this issue, Sean Dobson reviews Robert Kirsch’s recent book, “Fight- ing for Our Health: The Epic Battle to Make Health Care a Right in the United Lisa Ranghelli Director of Grantmaking for States,” and offers some lessons for grantmakers looking to maximize the effec- Community Impact Project tiveness of their philanthropic dollars on issues they care about. The fight for health reform was strengthened with serious community orga- Christine Reeves Field Associate nizing, much of it funded by foundations. Spence Limbocker writes about what it takes for foundations to influence each other’s grantmaking practices. He Beverley Samuda-Wylder Senior Administrative Associate answers the questions: What makes a foundation decide to fund community or- ganizing? What prevents grantmakers from supporting these kinds of activities? Finally, we feature the National Council of La Raza in this issue’s Member Spotlight. NCLR is the largest Hispanic civil rights and advocacy organization in the country. Tell us what you think of this and previous editions of Responsive Philanthro- py. We look forward to hearing your comments, suggestions and story ideas that Responsive Philanthropy is the make RP the go-to resource on important but underreported issues in philan- quarterly journal of the National Committee for Responsive Philanthropy. thropy. Contact us at [email protected]. 2012, Issue No. 1 Sincerely, Yearly subscription: $25 (free to members) ISBN: 1065-0008 © 2012 All rights reserved. National Committee for Aaron Dorfman Responsive Philanthropy Executive Director 1331 H Street NW, Suite 200 Washington, DC 20005 Phone 202.387.9177 Fax 202.332.5084 E-mail: [email protected] 2 National Committee for Responsive Philanthropy Responsive Philanthropy Lessons for Grantmakers from the Battle for Health Care Reform By Sean Dobson Over the past 30 years, as the U.S. health • Historical opponents of reform Here are the types of readers who must system fell ever further behind those of would likely be weak or neutral in devour this book right away – and why: other developed democracies in terms 2009 because the GOP was discred- • Practitioners and students of Ameri- of outcomes and cost, every reasonable ited by the disastrous Bush presiden- can politics will learn every aspect observer knew that the basic cause was cy while some special interests that of how a major reform bill becomes our country’s disgraceful lack of a gov- had played a key role in blocking law: conception, drafting, messag- ernment guarantee of health care for Hillarycare, especially doctors, had ing, coalition-building, grassroots all. Yet, during these same decades, softened their opposition due to re- lobbying, earned and paid media, most health care grantmakers ignored lentlessly rising health care costs. direct lobbying, etc. They will wit- this elephant in the room by funding ness the fascinating (and sometimes mostly service provision instead of the The reformers seized this historic unseemly) process by which Con- kind of advocacy1 that would make opportunity, coming together as Health gress and the White House grind the enactment of government-guaranteed Care for America Now (HCAN) in 2008. legislative sausage. And they will health care more likely. HCAN grew into a mighty coalition and enjoy the perfect thumbnail sketch- Finally, toward the end of George made history by playing an indispens- es, some in acid, of many of our na- W. Bush’s second term as president, a able role in enactment of the biggest tion’s most powerful leaders. group of labor leaders, nonprofit lead- progressive reform in a generation: the • Nonprofit advocates (and those ers and philanthropists realized that a Patient Protection and Affordable Care contemplating a career as such) will number of factors had created a once- Act of 2010 (ACA). learn the joys and sorrows of this in-a-generation opportunity to finally Richard Kirsch tells this amazing type of public service from Kirsch’s enact health care for all, including: story in his recently published Fighting description of his long career as an • An upcoming election in 2008 that for Our Health: The Epic Battle to Make organizer culminating in leadership would likely give Democrats control Health Care a Right in the United States of HCAN. From the detailed descrip- of the White House and both cham- (Rockefeller Institute Press, Albany, tion of HCAN’s inner workings, they bers of Congress. 2011). This book is the best account of will see how to conceive and exe- • Health care for all was a top priority the biggest domestic reform in a gen- cute a model campaign. I hope ad- for all three top Democratic presi- eration. Kirsch is uniquely well quali- vocates notice in particular HCAN’s dential candidates and therefore fied to tell the tale; he is a gifted writer, wise decision to make authentic probably of the next president. one of the nation’s foremost health grassroots organizing the center- • Unprecedented consensus among care advocates with decades of expe- piece of the campaign – as opposed progressives that had coalesced rience. As founding executive director to the all-too-frequent dependence around a reform plan that actually of HCAN, he not only witnessed every on paid media or parachuting Belt- could pass Congress and also, thanks twist and turn in this “mother of all po- way operatives into localities to try to the invention of the “public option,” litical battles,” he also played a key role to fake grassroots mobilization with hold the allegiance of most of the pro- in leading the grassroots army that out- “Astroturf” actions. gressive base of the Democratic party. mobilized the Tea Partiers while pres- • This brings me to the final audience • Progressive activists had learned suring and cajoling federal lawmakers that must read this book: grantmak- valuable lessons from the defeat of to finally take care of, in the words of ers. Obviously, health grantmakers Hillarycare in 1993–94 and were former Senator Ted Kennedy, “the great will be curious to learn how the big- ready to fight smarter. unfinished business of our society.” gest step forward in U.S. health care Responsive Philanthropy Spring 2012 3 Demonstrators during a June 2009 rally at Senate Park organized by Health Care for America Now. Photos courtesy of HCAN. in generations actually happened. • The superiority of investing in ad- Funders must overcome their Kirsch’s book will show them how vocacy over service provision. As fetish for “new,” as if that is always funding advocacy gets better return on the experience with HCAN shows, “better.” After all, the goal of invest- investment than funding service provi- such investments are even better if ment should be support of effective sion. And they will learn how to fund the grantee has a 501(c)(4) sister or- organizations, not new organiza- advocacy by observing the wise deci- ganization, in which case the (c)(3) tions.
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