MacKenzie Scott Backs Community Health Centers as Another Path to Advancing Equity

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Aside from a brief overview of the process, MacKenzie Scott famously doesn’t disclose how or why she chooses a particular organization or cause to support. And she backs a breathtaking array of both, as Mike Scutari outlined in a summary of her latest giving spree. It’s hard to keep up, but IP has covered Scott’s giving for everything from social justice and climate to early care, K-12 education and the arts.

Equity overall has been a recurring theme in Scott’s philanthropy, as the Center for Effective Philanthropy concluded. And the list of 2023 grantees on Scott’s Yield Giving website reveals that health equity was a powerful priority last year — in particular, small community health centers that play an outsized role in the American healthcare system. 

The centers that received gifts from Scott last year are peppered throughout the country, and have names like People’s Community Clinic (Texas), Asian Pacific Health Care Venture (California), Cherokee Health Systems (Tennessee), and Urban Health Plan (New York). Community health centers like these promote health equity by providing culturally responsive care to patients regardless of their ability to pay; they also work to eliminate barriers to access like language and geography. In a similar strategy, Scott has previously provided gifts to health conversion foundations that promote health equity in rural areas of the country where health infrastructure is often lacking.

The centers themselves are often small in size, but they have a major collective impact on healthcare in the U.S., as Sofi Bergkvist, the president of the Center for Care Innovations (CCI), pointed out. “Community Health Centers serve 1 in 11 Americans — more than 30 million people — and that is increasing,” she said in a recent interview. “They are the largest providers of primary care in the country.”

Driven by service, changing lives

Community health centers have their origins in both the civil rights movement and the war on poverty, and provide a healthcare safety net for Americans experiencing poverty and other barriers to healthcare. 

Given their emphasis on equity and their local roots, community health centers are also well positioned to address the social drivers of health: environmental and social factors that influence an individual’s health (many health experts favor the term “drivers” over “determinants” of health, arguing that the former is more accurate). CCI’s Sofi Bergkvist pointed out that 80% of health and wellbeing is determined by factors outside the clinic or hospital, that is, by social drivers of health.

“It is very rare that a family experiencing trauma has just one challenge,” she said. “They have multiple challenges, and they need services to address those drivers of health. The community health centers can connect families to those services because they have relationships with other local organizations, and their patients trust them.”

The Center for Care Innovations, which is based in Oakland, California, works closely with community health centers and other safety net institutions to “spark, seed and spread innovations that strengthen the health and wellbeing of historically underinvested communities,” according to the organization’s tagline.

“A common misperception is that the care that community health centers provide is poor quality, but on many quality indicators, they are far above the national average,” Bergkvist said. “So if you're looking at blood pressure control, for example, many community health centers are having 70% blood pressure control, and the national average is 40%. I think one reason is the trust the centers have with community members. It's also the people who work in the centers: They are there because they deeply care for the community and the people they serve. They are really driven by service.”

A snapshot of local news reports on Scott’s giving around the country underscores the critical role health centers play in treating those on the margins of the system — and the impact of these gifts. 

In Oregon, a $1.6 million gift from Scott will help the La Pine Community Health Center almost double the number of low-income residents it treats each year by adding a new facility and four more providers. “It’s awesome when people make donations that change lives,” Dean Dyer, a patient at the health center told Central Oregon Daily News. “That’s what it’s gonna do, it’s gonna change lives.”

The $2.6 million that Southside Community Health Services received from Scott amounts to about 40% of the donations the small Minneapolis health center typically receives each year. Ann Cazaban, who directs the center, told the Star Tribune that when she got the news, “I about fell out of my chair. We don't get a lot of good surprises like this.”

Last November, staff at the Siouxland Community Health Center in Sioux City, Iowa, learned that MacKenzie Scott had awarded them $5 million. The health center has three locations, each serving about 35,000 people. Eighty percent of center patients are at 100% to 200% of the poverty level, and 17% are uninsured. “Last year, we had 52 different languages spoken at the health center, which speaks to the diversity of the people that we serve," the center’s CEO Mari Kaptain-Dahlen told Iowa Public Radio. 

Raul Garza, the president and CEO of Aunt Martha’s Health and Wellness, didn’t immediately return the call from the organization representing MacKenzie Scott because he thought it was a scam. The center treats over 105,000 patients, many of them foster youth, at 30 locations throughout Illinois. Ninety-six percent of Aunt Martha’s patients are low income; 85% are people of color. Garza apologized when he finally returned the call a week later.

“On the other side of the phone, Scott’s representative laughed and said that happens a lot with donor recipients,” Garza told Block Club Chicago. When Garza gave the center’s CFO the news, he burst into tears. The $9 million gift is the largest in Aunt Martha’s 51-year history. 

Patching the safety net

Community health centers face chronic underfunding, despite the vital services they provide. For one thing, federal Medicaid reimbursements cover just a fraction of actual costs. A 2023 report by the African American Research Collaborative, with support from the Commonwealth Fund, found that “inflation-adjusted federal funding for centers has decreased over time, while the number of clinics, total patients served, and operating costs have all increased, stretching limited funds even further.” 

Philanthropy has often stepped in to supplement federal funding, but funders traditionally provide restricted grants, which limits what health centers can do. “These health centers have incredible potential for innovation, but they don't have the funding model to take it forward,” CCI’s Sofi Bergkvist said. “The fee-for-service model is just not enough money. And a lot of the grant funding is too restricted. That means that this incredible pot of innovation is not getting funded. That's where MacKenzie Scott comes in: She is really meeting the clinics where they're at.” 

Bergkvist believes that to strengthen community health centers, philanthropy can provide more than dollars. “Funders can empower health centers and help give them a voice at the table with larger players in the system, like managed care plans and the larger health systems,” she said. “Funding is important, but so is opening doors and advocating for the community health centers and giving them a platform.” 

CCI itself received a gift from MacKenzie Scott in 2023 (the organization has not disclosed the amount), so Bergkvist knows first hand what a difference it can make. “It literally means I sleep better at night,” she said. “I can show up as a leader. That’s one reason for the huge turnover in nonprofit leadership: the way the sector is funded. The needs are enormous and you want to make sure that staff are compensated and you want to innovate. You want to take the work forward but you're at the mercy of unpredictable funding.” 

Bergkvist wishes more philanthropists would follow Scott’s example. “So many people are waiting for the call, and it is still only her. No one is waiting for anyone else to call. I hope that will change.” 

While health centers that serve those in need operate on a shoestring, the U.S. continues to spend far more for healthcare than any peer country, according to another Commonwealth Fund report, which also tracked the country’s dismal health outcomes: “The U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.”

There are many things wrong with this picture — perhaps first among them our failure to adopt a national system to make healthcare available to everyone who needs it. As long as that’s the case, we’ll continue to depend on out-of-the-blue gifts from MacKenzie Scott (and, hopefully, more philanthropists like her) to patch our tattered safety net.