BFD: What Foundations Can Learn From Health Reform Battles

Seven years after a hot mic caught Joe Biden’s colorful take on President Obama’s signing of the Affordable Care Act (ACA) into law, the ACA is in peril and the implications for health funders can’t be ignored.

The passage of the ACA was indeed a historic moment in the decades-long effort to improve our seemingly intractable health care problems. But in an era of hyper-partisanship, the legislative “win” was just the start of a long fight that seems far from over. 

The new law remained vulnerable to oppositional efforts in the years since, despite surviving a Supreme Court case and more than 60 attempts to repeal some or all of its provisions. 

Those oppositional efforts have reached a crescendo in recent weeks, as the new president and his allies in Congress push for passage of the American Health Care Act as a means to undo much of what the ACA aimed to achieve.

Recent news reports highlight that while some foundations are doubling down on advocacy support around an ACA defense, others are questioning how or even if they should get back involved in that kind of policy fight. 

According to an article in the Chronicle of Philanthropy, some health funders are "leery of stepping too far into the debate on particular pieces of legislation.”

This is not a new challenge for foundations. However, it does illustrate how funders sometimes view policy fights on a finite timeline and concentrate solely on the win, when in fact the win is just one point along the ongoing political process in which those fights take shape.  

That reality is why funders that engage in advocacy and policy work can’t just aim for the win, they also have to prepare for and shift to how that win plays out in its implementation. 

Last September, as part of the Atlas Learning Project, journalist Michael Booth penned a Health Affairs article that wrestled with some of these same questions. Key funders and advocates were asked what they would do differently to support advocacy efforts beyond a legislative win if they knew then what they know now. Though these conversations happened prior to the 2016 election, the insights still shed some light on the episodic and often temporary relationship that many funders have with policy battles like the ACA.

For progressive health funders, defending the ACA and defeating its demise could amount to exactly the kind of lasting change that so many foundations seek.

As some funders ask themselves whether they should get back into supporting advocacy efforts around the ACA, a better question might be this: should they have ever gotten out in the first place? 

Check out Michael Booth's piece in Health Affairs here: Could Foundations Have Mounted a Better Defense of the ACA?

Read the ORS Impact brief on policy implementation here: Beyond the Win - Pathways to Policy Implementation