For nonprofit groups and foundations that have spent years, even decades, urging America to remake its health-care system, the overhaul plan that President Obama signed into law last month offers only a breather. Many steps remain, they say, to turn the complicated new law into an effort that serves those who need help.
“In some ways, the work now begins,” says Ron Pollack, executive director of Families USA, a prominent health-care advocacy group. “It’s a different kind of work.”
Mr. Pollack is setting up a new charity, provisionally called Enroll America, that will help ensure that people who are eligible for expanded Medicaid coverage and health-insurance subsidies under the new legislation actually get it.
The Henry J. Kaiser Family Foundation is also retooling for the post-Congressional-debate era.
Drew E. Altman, the foundation’s president, says the organization is developing a new Web site that will explain the law and track the way it is being carried out across the country.
“The initial challenge, as this remains so contentious and so politicized, is just to make the facts clear,” he says. The operating foundation did not take a stand for or against the overhaul legislation but conducted research and produced materials to educate the public on the issues involved.
Indeed, not everyone is thrilled with what opponents call “ObamaCare.” FreedomWorks, a small-government advocacy group that organized high-profile rallies against the health-overhaul plan, says it will continue its fight against what it calls “an enormous overreach of federal power that encroaches on state sovereignty and our freedoms.”
Grant makers, meanwhile, are pondering ways to rejigger their spending as policymakers shift their focus to the nitty-gritty work of drawing up the policies that are needed to meet the law’s goal of offering health insurance to an estimated 32 million people who would not have it otherwise.
The Robert Wood Johnson Foundation, which devotes all its roughly $300-million in annual grants to health-care projects, has awarded $334,000 to help Mr. Pollack develop a business plan for the operations of Enroll America.
Risa Lavizzo-Mourey, the foundation’s president, says the organization plans to extend to the new law the approach it has taken with other federal health programs, like the Children’s Health Insurance Program, often called CHIP, and Medicaid—that is, offer grants for projects to help get the word out to people who qualify for assistance.
“One of the things we’ve learned through our work with the CHIP program is that many parents who are eligible for free or no-cost health insurance don’t know it,” she says.
Ms. Lavizzo-Mourey says she hopes grant makers will work together to help states develop “innovative solutions” to carry out new laws, which will take effect over a period of years.
“I don’t think we’ll see a huge impact immediately,” says Wendy Wolf, president of the Maine Health Access Foundation. “But I do think there’s an opportunity to help those boots on the ground plan prospectively.”
She says her organization is mulling ways it can support education, advocacy, and outreach projects to promote a smooth transition in Maine.
It played a similar role after the federal government added prescription-drug coverage to Medicare, she says, providing grants to the state health and human-services department and to nonprofit groups that worked together to explain the new benefit to older people.
Philanthropy also has a big role in helping track the results of the changes, says Sarah Iselin, president of the Blue Cross Blue Shield of Massachusetts Foundation and a former Massachusetts health-care commissioner. Her state in 2006 adopted a health-care overhaul that shares some elements with the federal plan.
For example, Blue Cross—along with the Robert Wood Johnson Foundation and the Commonwealth Fund—hired the Urban Institute to conduct an annual survey to track how many people in Massachusetts gain access to health coverage and care through expanded Medicaid coverage, subsidized health insurance, and other measures.
The Atlantic Philanthropies perhaps had the most at stake in the Congressional debate on health care. It pumped $26.5-million into Health Care for America Now, a coalition of more than 1,000 liberal advocacy groups and labor unions.
At times, the health-care legislation appeared dead on arrival—for example, after protesters stormed Congressional town-hall meetings last summer, complaining about intrusion into medical decisions and the cost to taxpayers.
“There were very low moments,” says Gara LaMarche, Atlantic’s president. “But we were determined that we give it the best shot possible, and if health care failed it wasn’t going to be for some decision we made to have cold feet.”
Because it is incorporated in Bermuda, Atlantic is not subject to restrictions that bar U.S. foundations from giving money to groups to promote or criticize legislation.
However, Mr. LaMarche hopes the lessons it learned from the advocacy campaign will be valuable to other grant makers—for example, its ability to create a new movement that united coalitions in a common cause.
He says Atlantic plans to publish an evaluation of its support for the advocacy network, “warts and all,” in a few months.
Health Care for America Now—which was created before the 2008 presidential elections and kept up a drumbeat of advertising and rallies—has not yet decided what role it will play going forward, says Jacki Schechner, national communications director. But “we will be around in some capacity,” with a focus on public education, she says.
Families USA now plans to sponsor a “health reform road show”—featuring policymakers, federal and state lawmakers, and administration officials—to explain to people across the country how the new law will affect them, Mr. Pollack says. “Every effort will be made by the opposition to repeal this legislation,” he says. “We want to protect that from happening.”