The time is now: How grantmakers can help preserve health access for millions of Americans

Written by: Richard Kirsch

Date: February 01, 2017

Updated 10/25/2017 to fix error in Richard Kirsch’s bio.

Editor’s note: This is the first of several blog posts highlighting health advocacy efforts in the first 100 days of the new presidential administration. NCRP will share additional health advocacy resources during the next several months in response to this urgent issue. 

“The Affordable Care Act overall has likely saved hundreds of thousands of black lives, and it has certainly produced one of the most significant advances in racial equity on record: By the end of 2014, in just one year’s time, it had entirely erased the disparity in health coverage between white and black kids.”   Kai Wright, The Nation

Any grantmaker that wants to end poverty, advance racial equity, or promote the wellbeing of children, the elderly, disabled or other underserved groups has a stake in what happens to federal health programs this year.

Legislative attacks on the Affordable Care Act (ACA), Medicaid, Children’s Health Insurance Program and Medicare would take coverage away from tens of millions of Americans, cut $1 trillion from state funds for Medicaid, replace Medicare with a limited voucher for private insurance and raise the cost of health coverage for almost everyone. These attacks would leave families across the country with no or unaffordable health coverage, wreck state budgets, undermine urban and rural hospitals and jeopardize millions of health care workers.

Foundations can play a critical role in preventing this from happening

Just as winning passage of the ACA required a powerful, aggressive grassroots campaign based in states and communities throughout the country, turning back the new attack on health security will require that same effort. And more.

Thanks to the leadership of a handful of grantmakers in 2010, most notably Atlantic Philanthropies, Health Care for America Now (HCAN) and its partners built a national organizing infrastructure rooted in local communities. Those organizations continued to work on ACA implementation. And on four days’ notice, that infrastructure was quickly reassembled after the 2016 election. Within 10 days, 36 events were held in 19 states, garnering extensive press coverage, under the banner “Don’t Take Away Our Care.” The events were organized in conjunction with, whose members organized an additional 44 events. In the past month HCAN’s local partners have continued to organize thousands of constituents to turn out to voice their concerns around the country.

We are now preparing for a multi-year fight on many fronts to keep the promise of health security for all Americans. The first year of the fight is crucial. But the fight will not be over in one year and may become even more protracted if we don’t marshal the widespread community support for these health care programs.

The factors that made HCAN so successful, which are still relevant and needed today, are:

  • Its state member groups are almost all multi-issue organizations. These organizations have rich histories of engaging inclusive coalitions and constituencies at the state and local level. These multi-issue organizations can dramatically expand the base, adding to organizations primarily focused on health care.
  • It organizes diverse constituencies in urban, suburban and rural communities; in majority White communities and in majority or substantial African American, Latino, Asian and Native American communities, providing them the capacity to mobilize the most impacted people.
  • Its state partner groups have substantial experience in running strategic issue campaigns. They have relationships with state and local press and elected officials. They understand power relationships. And they are well coordinated with national efforts.

Both public and private foundations can contribute to these coordinated local, state and national efforts. Strategies include public education, community organizing, narrative building, media advocacy and, in some cases, lobbying, all of which are permissible 501c3 activities. Foundations that can fund 501c4 activities have an important contribution to make as well. In particular, grantmakers can help by:

1. Immediately, and for the next two-to-three years, fund the capacity of local organizations and their affected constituents to participate, particularly grassroots and multi-issue groups that don’t already participate in the traditional health care advocacy infrastructure.

2. Support a major social media campaign that will generate widespread social media activities and identify people who will lose their health coverage, including connecting them to organizers on the ground.

3. Help amplify state activities in the national media so that we create an echo chamber at the state and national level around a shared narrative that influences the policy debate in helpful ways.

Government programs to provide secure, affordable health coverage affect virtually everyone, from birth to death. People care deeply about their health coverage and pay much more attention to public policy on health care than almost any other issue. If we stop the onslaught against health coverage, we can protect the health and livelihoods of hundreds of millions of Americans.

This is a contest that will not be won in Washington; it will be fought in communities around the country. Working with national and state allies, our collective advocacy and grassroots engagement will be as essential to defending Americans’ health care as it was in securing the passage of the Affordable Care Act.

Richard Kirsch was the national campaign manager for Health Care for America Now. He is the Director of Our Story – The Hub for American Narratives. He wrote Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States. For more information, Mr. Kirsch can be reached at rkirsch[at]

Photo provided by Richard Kirsch.