News and analysis
March 23, 2010

Advocates Plot Next Steps Even as Ink Dries on Health-Care Overhaul Law

Richard White/The Chronicle of Philanthropy

Demonstrators organized by the group Health Care for America Now gathered in Washington on March 9 to push for an overhaul of the nation's health-care system.

The landmark health-care bill that won President Obama’s signature Tuesday is not everything that advocates wanted. It took longer than expected to get through Congress, and at times it looked like it was dead on arrival.

But the nonprofit groups that have been fighting for years to get legislation to overhaul the country’s health-care system are breathing a sigh of relief­—while also plotting their next steps.

“This is the culmination of decades of work,” said Ron Pollack, executive director of Families USA, just before he left for the signing ceremony at the White House. “It’s both thrilling and emotional.”

Mr. Pollack said the battle is not over, however. He is working to set up a new charity, Enroll America, that will strive to ensure that people who are eligible for expanded Medicaid coverage and health-insurance subsidies under the new legislation actually get it.

Delayed Gratification

Advocacy groups started a concerted effort to revive the health-care debate—which had been in a political wilderness since the Clinton administration—before the 2008 presidential elections. After President Obama was elected, the campaign gained momentum and several bills got through Congressional committees. But the effort stalled after “tea party” protesters stormed town-hall meetings last summer, complaining about government intrusion in medical decisions and the costs to taxpayers, and again after Republican Scott Brown won election to the Massachusetts Senate seat the had been held by Edward M. Kennedy, depriving the Democrats of their 60-vote “supermajority.”

But on Sunday, the House approved a health-care overhaul that had earlier won approval in the Senate, sending a separate bill to the Senate to reconcile some differences between the two bodies.

“Our campaign was always about comprehensive affordable health care in 2009,” said Jacki Schechner, national communications director for Health Care for America Now, or HCAN, a coalition of more than 1,000 liberal advocacy groups and labor unions. The group did not meet its target date, and it lost a battle to include a government insurance plan to compete with private options.

But, Ms. Schechner says, “It’s very hard on the day after it passed in the House to complain about anything,” she said on Monday. “It’s a good day.”

The coalition—which has kept up a drumbeat of advertising and rallies—has not yet “sussed out” exactly what role it will play going forward, she said, but “we will be around in some capacity.” She said health-care advocates now want to focus on public education, letting people know that “this was not only a good vote politically, but good for them personally.”

The legislation, which will take effect in stages, aims to expand health coverage to more than 30 million people now without it. It requires most individuals to purchase insurance and penalizes employers that don't cover their employees under some circumstances, offering subsidies to lower-income individuals and tax credits to small businesses and charities.

It sets up state exchanges, or insurance marketplaces, to offer coverage to small businesses and people who don’t get insurance from their employers, and it bars insurance companies from practices like refusing to cover people with preexisting medical conditions.

$26.5-Million Gamble

For Atlantic Philanthropies, the grant maker that pumped $26.5-million into HCAN, the new legislation represents a gamble that paid off. Gara LaMarche, Atlantic’s president, said the organization originally intended to cap its spending on HCAN at $25-million, but added another $1.5-million in December as Çongress continued to wrangle over its approach.

“There were very low moments,” Mr. LaMarche said. “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.”

Mr. LaMarche praised President Obama and Congressional leaders for achieving what previous administrations could not. Atlantic’s money, he said, also helped ensure that “the progressive side was not as outgunned” as it had been during the Clinton years by industry groups opposed to the legislation.

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 specific legislation. However, Mr. LaMarche hopes the lessons it learned from the HCAN 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 said Atlantic plans to publish an evaluation of its support for HCAN, “warts and all,” in a few months.

'Road Show’

Families USA worked closely with Congressional leaders to craft the strategy for getting the health-care overhaul passed. Mr. Pollack says the group 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. “Every effort will be made by the opposition to repeal this legislation,” he said. “We want to protect that from happening.”

The Herndon Alliance, a group in Seattle that advises charities, think tanks, patient-advocacy groups, and others on the best way to communicate about health care, will also be shifting its emphasis to explaining the legislation’s benefits, says Robert A. Crittenden, a doctor who helped start the group. “We have to talk about it so people believe they are real.”

Mr. Crittenden said Herndon—which gets money from the Nathan Cummings Foundation, the California Endowment, and the Public Welfare Foundation—will also focus on the way the new measures are applied at the state level. “Our work for the next few years is making sure things get implemented right,” he said.

Mr. Pollack, of Families USA, is working on his own effort to set up Enroll America, the new charity. The health-care legislation allows more people to qualify for Medicaid and provides subsidies to help lower- and moderate-income people buy health insurance on the new state exchanges. Mr. Pollack says Enroll America will work with a wide range of groups—nonprofit organizations representing groups like children or people with disabilities, community health centers, pharmaceutical and health-insurance industry representatives, and medical personnel—to set up state consortia to work with government officials to create user-friendly enrollment systems for those benefits.

“We want to make sure the applications are simple, not cumbersome,” he said.

Mr. Pollack received grants from the Robert Wood Johnson Foundation and the California HealthCare Foundation to create a business plan, but is seeking money from both foundations and industry groups to keep the project running. “Ultimately, our goal is to raise literally tens of millions of dollars per year for the next five or six years for this operation,” he said.