Never Say Die: How State Health Funders Are Defending Obamacare

The Affordable Care Act is still the law of the land, and state health foundations deserve some of the credit. From coast to coast, these funders did some heavy lifting over the past few months, helping mobilize advocacy drives to block repeal. Their tactics were especially persuasive in Colorado, where just one of four Republican representatives supported the House bill to repeal and replace Obamacare. 

This local pushback has been all the more critical given the lack of major national funders leading the charge to defend the ACA. Atlantic Philanthropies, which played a big role in funding advocacy to pass the law, is no longer making grants, while the Robert Wood Johnson Foundation has been treading carefully, positioning itself as more of a neutral source of policy analysis and data than as a strong advocate. 


If a revised version of repeal and replace legislation doesn't pass Congress this year, opponents of Obamacare still have plenty of chances to weaken the healthcare law. Defunding premium subsidies to buy coverage is one of them. A Medicaid spending bill later this year is another, which is worrying state-based health funders and their state governors. Many governors came out against the failed House healthcare bill because of proposed changes and cuts to an expanded Medicaid program. 

New moves to erode health coverage are also likely to run into strong opposition, and you can expect state health funders and their allies to be key players in these fights. Among those who've been in the thick of the ACA battle so far, and plan to continue fighting in the future, are the California Endowment, Colorado Health Foundation, the Pennsylvania Health Funders Collaborative, Community Catalyst in Boston, and the Health Foundations of Central and South Florida.

These funders have major skin in the game. Among other things, as we've reported, some spent vast sums to help state residents take advantage of the ACA and get health coverage, often for the first time. No funder spent more than the California Endowment in this regard—over $200 million—and no funder has mobilized more urgently to protect the law. It's set aside millions to fund defensive efforts, with an eye on protecting millions of low-income Californians who've come to rely on Obamacare. 

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But since the election, many other state and regional health funders have also spoken out in defense of the ACA, too, and encouraging the recently insured to do the same. Back in February, the executive director of Community Catalyst in Boston, Robert Restuccia, blasted GOP proposals on the ACA, saying they would "increase the cost of coverage for millions of people, make it more difficult for people to access coverage and undermine critical consumer protections."  

Community Catalyst's grant making isn't limited to Massachusetts. It focuses on nine states where it assists community groups. This consumer advocacy organization was founded on a belief that affordable quality healthcare should be accessible to everyone, and has drawn huge grants over the years from Atlantic Philanthropies and the Robert Wood Johnson Foundation. It launched a "Save Our Care" drive earlier this year, featuring a banner on its website with grassroots action steps to protect the ACA. It was releasing almost daily impact reports on how a repeal would affect older Americans and communities of color, and single mothers and children receiving Medicaid services. When the House bill failed, Community Catalyst hailed this as a victory for grassroots mobilization. It's sure to be a formidable player in New England as the ACA battle enters its next stage, whatever that may be. 

Meanwhile, leaders at the Pennsylvania Healthcare Funders Collaborative say their ACA work since November shifted with the political winds in Washington, D.C. The activities moved from enrollment and support to a defensive posture, using health and even employment data to demonstrate that the law really does work, despite the president's claims that it's "a disaster" and "failing." Pennsylvania is home to an aging population, making healthcare affordability and access to quality care paramount here.

Pennsylvania's funders tell Inside Philanthropy that their studies on the impact of the ACA show the law "virtually touching every Pennsylvanian." Among other things, the federal funding under Obamacare closed a coverage gap so that seniors in the state on Medicare who need extra help don't pay prescription drug costs above their $3,700 annual benefit.  

In Tennessee, health funders and advocates worry that the GOP attack on the ACA has already destabilized the insurance market in the state, says Michele Johnson with the Tennessee Justice Center. She believes that uncertainty since the November elections is partly to blame for Humana's decision to exit the Affordable Care Act plan market in Tennessee. The state was one of 19 states that declined to expand Medicaid, and that is why residents have fewer options for healthcare.

In Colorado, senior public policy officer Kyle Legleiter at the Colorado Health Foundation says it only wants what's best for the residents of the state, regardless of the national politicking around healthcare. The November election didn't immediately change the direction for this funder's work related to the ACA and access to care. The foundation will continue to focus on grantmaking for direct-service work and advocacy for quality care in rural areas—a big concern in this sprawling state—as well as getting Medicaid dollars for small hospitals outside the metro areas. "We would have been funding advocacy no matter the results" of the election, Leglieter told me. As for ACA commitments, he says, "We're not scaling back."

In addition, as we've reported, an offshoot of the Colorado Health Foundation, a 501(c)(4) group, Healthier Colorado, has been among the most effective state-based groups mobilizing opposition to repeal of the ACA.

Beyond the funders I've mentioned, other state health funders are also working in some way to stop ACA repeal—or at least to educate the public and policymakers on likely consequences. 

Interestingly, we haven't seen the New York State Health Foundation, or NYSHealth, in this mix. I was told by a foundation spokeswoman that this funder hadn't done any grantmaking around the Affordable Care Act since the end of 2015. It had supported the Enrollment Network, a statewide initiative to assist community-based health organizations working to educate and enroll vulnerable populations.

This funder's current priority areas include a focus on veterans' health, empowering healthcare consumers and building healthy communities in the Empire State. The foundation's decision to peel off from ACA advocacy and enrollment projects came long before November's election. The timing was unfortunate and unforeseen, given the stunning results of the presidential election.

The eight-year-long saga of the Affordable Care Act isn't over by a long shot. New battles lie ahead, even if the contours of those fights remain unclear. Expect state-based health funders to remain in the thick of these battles.