Without a doubt, the environment for California grantmakers remains challenging as 2010 draws to a close, with the sluggish pace of economic recovery weighing heavily on the communities we support. For many foundations, the values of our endowments may have stabilized, but it will likely be several more years – at the earliest – before our grantmaking returns to the levels of 2006 or 2007. And the impact of the Great Recession – coupled with California’s budget stalemate that lasted throughout the summer and into the fall – on the region’s nonprofit sector, including the health care safety net, has been devastating.
Given the difficult economic environment and the systemic changes required to implement health care reform legislation signed into law earlier this year by President Obama, I believe the key challenge for foundations making grants in the health sector is to foster opportunities so that California will arrive at 2014 with a viable health care safety net. We need to provide grants that ensure that community clinics and hospitals can operate effectively in the “reformed” system and that access to care is preserved for those who fall outside the coverage boundaries established in the legislation. While the state must preserve its financial commitment to maintaining the health care safety net – as the cost is well beyond the capacity of private philanthropy – there are important ways that foundations can also play a role.
As I outlined at the conclusion of my August 2010 President’s message, The California Wellness Foundation (TCWF) plans to address health care reform and the health care safety net with three strategies under our Responsive Grantmaking Program, which seeks to balance a Foundation-directed approach with responses to unsolicited letters of interest. This approach allows us the flexibility to respond to changing circumstances within the nonprofit sector. More information about each of these strategies is included below.
First, TCWF will make core operating support grants to health care safety net nonprofits so they can weather the ongoing storm and sustain their important services in the years before reform takes effect. Core support funding can serve as a temporary bridge to help organizations keep their doors open while they help the economically vulnerable, including those who have joined the ranks of the uninsured. For struggling clinics, a grant of core operating support can help purchase medical supplies, cover wages for frontline staff or help defray higher utility costs. We hope to prevent nonprofits from drowning now so they will still be around when our state’s economy improves. During positive economic times, safety net providers can use core operating support to build organizational capacity, add administrative staff or transition to FQHC status.
Second, TCWF will make grants that help increase California’s health workforce and its diversity so that the safety net system has the capacity to deliver culturally and linguistically competent care to the millions of residents who will be getting coverage through reform as well as those who remain outside its bounds. For example, TCWF will provide funding for pipeline programs and scholarships for underrepresented minority students interested in pursuing health career training programs. Pursuing a college degree can be a challenge – and that challenge begins with the application process. For young people who don’t have college counselors, family members who went to college or college-bound peers, the process can seem insurmountable. Having access to these programs can provide valuable assistance for students of color and those from low-income families who are the first in their families to attend college. Budget cuts at all three levels of California’s public higher education system (the UCs, Cal States and community colleges) have limited its capacity to meet the demand among young Californians for “slots” in health care training programs. It will be important to provide grants to statewide alliances or coalitions, with the understanding that groups with broad representation – particularly when public sector voices are also included – can inform policymakers and opinion leaders about strategies to reduce shortages of health care workers by training Californians for these in-demand jobs.
Third, TCWF will make grants to consumer advocacy organizations to fund their work that informs underserved communities about the opportunities and potential pitfalls in health care reform and makes sure their community’s voices are heard during the process of implementing health care reform. For example, in September the board approved a $500,000 three-year grant to the Health Access Foundation for a collaborative effort with Consumer’s Union, California Pan Ethnic Health Network and Western Center on Law and Poverty to ensure the greatest number of Californians receive the coverage and care they need under the new law.
Along a similar line, TCWF will continue to fund an annual Field Research Corporation public opinion poll of California voters in 2011 and 2012 to assess attitudes and understanding of health care reform over time. Wide dissemination of poll results, including a briefing in Sacramento, will provide opportunities for policymakers and opinion leaders to incorporate information about constituents’ attitudes into implementation strategies and public education about health care reform.
I believe these strategies are important if we are to achieve the goal of maintaining a viable health care safety net. Since the passage of the new health reform law, we have made 47 grants totaling $8.17 million to sustain the health care safety net and 16 grants totaling $2.59 million to increase and diversify the health workforce. In addition to these grants and what we plan to undertake over the next few years, other California foundations have created new pools of grant dollars for clinics to tap, launched emergency loan programs, or designed technical assistance services related to financial management – all with the intent of helping the health care safety net bridge funding gaps caused by the economic downturn and the budget impasse in Sacramento.
I hope that other foundations and corporate giving programs that focus on health will think about what they can do to further these goals within their own funding parameters or strategies.
Gary L. Yates
President and CEO
The California Wellness Foundation