Foundations, Donors and Health Policy:
Why federal health debates matter to you and how you can respond

Foundations, Donors and Health Policy: Why federal health debates matter to you and how you can respond


Written by: Lisa Ranghelli

Date: May 02, 2017

Since the November 2016 election ushered in a new political landscape at the federal level, a number of grantmakers and major donors have re-examined their thinking and priorities to ensure their strategies still make sense for achieving their philanthropic goals. This has caused some to adjust their approach to giving and public leadership.

However, many are sitting on the sidelines, taking a wait-and-see attitude. Some may be inherently cautious, averse to funding advocacy, fearful of getting caught up in divisive politics or genuinely at a loss as to how to react to a fast-moving, ever-changing policy environment. Others may believe that it’s better to conserve resources so that they can respond later to what comes down the pike.

But there is too much at stake to sit on the sidelines. The potential impacts of national and state health reforms on the goal of health equity, and community well-being more broadly, are enormous. If there is ever a time for donors and foundations to stand up for the communities they care about, it’s now.

Here are three reasons why funders like you who focus on health or underserved communities should take action to support the health care safety net:

1. Federal and state health laws are far-reaching in their impact, with ripple effects beyond health access.

Whether or not your giving focuses specifically on health issues, it is likely that the current federal and state health policy proposals and debates have implications for your causes and communities. That’s because the Affordable Care Act (ACA), Medicaid and Medicare affect so many people and systems.

Town hall

Photo courtesy of SEIU.

For example, Medicaid pays for half of all births in this country, along with the prenatal and infant care that wrap around those births. At least three in 10 Medicaid dollars provide long-term services and support for people with disabilities, enabling them to be independent, live in their own homes and go to work. The ACA has many Medicare-related components, and its repeal could affect the solvency of the program and drive up premiums and out-of-pocket expenses for the 57 million Medicare users. Larry Levitt, senior vice president at the Kaiser Family Foundation, said of the Affordable Care Act, “Virtually everyone has been touched by the ACA.”

But the impact of these programs extends way beyond the many millions of Americans who access services and care through these programs. As Richard Kirsch noted, federal health care funds contribute to balanced state budgets, the economic vitality of many communities and the livelihoods of millions of health care workers.

2. Federal and state policy changes could either jeopardize or reinforce recent advances in health equity. Disparities continue to plague the U.S., but the ACA has helped narrow the gap.

Over the last several years, many health-focused grantmakers have adopted health equity as an explicit goal and are using a “social determinants of health” lens to understand and address the many intersecting factors that promote or prevent health equity in their community. (See definitions of disparities, health equity and social determinants of health.) This is thanks in part to the equity-focused programming of health-related funder affinity groups.

Yet these efforts could be threatened if federal policies that advance equity are undone or undermined through legislative or regulatory changes or funding cuts.

Kai Wright noted in The Nation that “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.”  

Photo courtesy of SEIU.

Progress on infant mortality has been slower. The high U.S. rate relative to global peers has gradually been declining, but racial disparities remain stark. The mortality rate for black babies is twice as high as for white infants, with wider gaps in some places, including several southern states that opted not to expand Medicaid, thus refusing to cover more low-income families.

Yet the ACA has made a modest difference by allowing Medicaid funds to be used for nurse home visits. Initiatives such as the National Birth Equity Collaborative are tackling both infant and maternal mortality disparities in the most affected cities, but reductions in insurance coverage for mothers of color will harm these promising efforts.

The ACA also has enabled at least 90,000 people living with HIV to get health coverage, as reported at the Funders Concerned About AIDS (FCAA) winter convening. The law forbids insurers from denying coverage due to pre-existing conditions, a crucial provision not only for people with HIV/AIDS and other chronic diseases but also for transgender individuals, for whom transitioning has been considered a “pre-existing condition.”

These are just a few of the many signs of progress in health equity that are threatened by proposed funding cuts and programmatic changes. Given that federal and state expenditures for health care dwarf philanthropic investments, foundations and donors cannot be expected to make up shortfalls in public spending.

3. Many nonprofits are creatively engaging their constituents and allies to protect and expand policies that support health equity, but have a hard time raising philanthropic resources for this work.

Some of the very same grantmakers that have embraced the concept of “health equity” are reluctant to make grants that build community power or support advocacy. Yet these are key strategies to change the very policies and systems that perpetuate health inequity. Only one in eight domestic grant dollars directed toward health for underresourced populations supports advocacy, civic engagement or systems change.

A glaring example of this is the dearth of foundation support for engagement and mobilization of aging populations. Aging people of color, LGBTQ seniors, those with disabilities and low-income elders face disparities in access to care and outright discrimination. They represent a growing demographic that has demonstrated its interest and capacity to mobilize on public policy issues. Yet organizations and coalitions that work with these constituencies, such as the Diverse Elders Coalition and its member organizations, are hard pressed to find more than a few grantmakers willing to fund elder organizing and advocacy.

These are precisely the voices that should be heard right now at the state and federal levels. As should the voices of millions of other Americans whose health and survival are at stake.


Why act on health policy?

Learn More

Health policy changes

Learn More


Learn More


Still not sure why you should act on federal or state health policy?