October 16, 2011 | Read Time: 5 minutes
On August 13, 1935, America became a better place to live. Opponents said what happened that day was socialism. They said it would devastate the economy, undermine individual freedom, and dangerously expand government’s power.
But 80 years later, Social Security is widely recognized as an invaluable resource that allows hard-working Americans to build better lives and helped create the most powerful engine of economic growth and equity in history: the middle class.
On March 23, 2010, President Obama enacted America’s health-care law, the Affordable Care Act.
That date may be remembered generations from now as another historic step toward a better, more prosperous, and more just America.
To ensure that happens, the George Gund Foundation and the Nathan Cummings Foundation are part of a growing trend in American philanthropy: investing in state-based advocacy groups that are working to see that the Affordable Care Act fulfills its promise.
State groups approach this goal in ways tailored to their own states’ circumstances, but they often take common approaches:
- Translating complex medical and legal provisions into plain language so consumers can more easily understand what is in the new law (and, just as important, what is not).
- Reaching out to patients with diverse racial and ethnic backgrounds so they can understand the law and learn how to advocate for their needs.
- Communicating with the news media and urging fair, accurate, and robust coverage of the law.
- Educating state and local public officials on the law’s provisions while urging them to take actions that protect consumers’ interests.
More foundations need to join the action, and not just those that support health groups.
Making sure that states apply the health-care law in the smartest way possible is vital to helping the nation’s most vulnerable while beginning to deliver better value and contain costs for everyone in the rapidly growing health-care sector, which represents more than 17 percent of our economy.
Many of the decisions that will determine whether the law successfully meets the needs of real people will play out in the states. For instance, choices made by state officials will determine whether health-care consumers can easily navigate the system; whether the new law’s health-insurance-exchange marketplaces will have the power to negotiate the cost of coverage with insurers; whether local providers can experiment with new ways to deliver better care, not necessarily more care; and how thoughtfully existing safety-net programs will be integrated with the health-care law’s new structures.
State advocates understand how their states’ residents will benefit from the law and how best to inform and involve them in public-policy efforts. They understand the best policy options and the most dangerous threats. They have relationships with agency officials and the lawmakers and governors who influence them. What’s more, they offer credible and powerful local voices to counter extremist attacks and ensure that news-media outlets get both sides of the story.
Many of these groups are already making a difference. Consider a few examples.
In Ohio—a perpetual political battleground—the advocacy groups we support have built a productive partnership with key state officials. As a result, they are influencing critical decisions, like the design of Ohio’s new health-insurance-exchange marketplace. Consumer advocates now have a seat at an exclusive table where decisions will be made about key parts of the new health-care law, such as how to receive more and better primary care and how to pay providers.
In Florida, state officials made a political decision to reject millions of dollars in federal grants offered as part of the new law, even though the state has been facing major budget woes. State advocates supported by Nathan Cummings started a publicity campaign to hold policy makers accountable. Lawmakers then reversed themselves and accepted $3.4-million in federal grant money that pays for nurses and social workers to make home visits to help prevent child abuse and neglect.
And in states like Virginia and Washington, advocates are holding public events and reaching out to the news media to educate residents about benefits already in place under the new law, including the option for parents to cover young-adult children on their family policies up to age 26. Census data show that nearly a million young Americans have already gotten coverage under the new law.
Like other philanthropies, our foundations have invested in the work of state advocates because the stakes are too high, the threats too real, and the opportunities too great to remain on the sidelines. State advocates can even the odds and help state leaders see that they will not be alone if they make the right choices.
If the provisions of the Affordable Care Act are effectively applied, some 30 million uninsured Americans will finally get access to health care. And it will provide better choices for tens of millions more whose insurance doesn’t actually deliver the care they need.
Beyond health, the law can make real gains on critical economic and social-justice issues. It will free many families from the crushing burden of medical debt, the leading contributor to personal bankruptcies. And by helping to bring health-care costs under control, it will help small businesses compete and reduce the costs of putting America back to work.
Because the health and economic consequences of being uninsured or underinsured weigh heaviest on American women, minorities, and people with low incomes, the law can make real progress in reducing poverty and advancing gender and racial fairness. And for every American, it will deliver more value for every health-care dollar by expanding delivery and improving quality.
But only if states make the right decisions. Political opponents and those who benefit from the status quo will continue to press their influence with state leaders. Their efforts are well financed and well planned. Effective state-based advocacy can balance the scales and give progress a fighting chance.
If the Affordable Care Act were only a health-care law, it would still justify an investment in advocacy. But it is also America’s best opportunity in generations for gains in economic equity, poverty reduction, and racial and gender fairness. Those of us who dedicate our work to those goals must act.
The Affordable Care Act offers a chance to build a better country. Whether generations from now we look back on that date as a missed opportunity or the beginning of a historic period of progress is up to us.
