A Nonprofit Push for Change

Coalition of groups band together in battle to overhaul health care

Original Source

Health Care for America Now, Families USA, the American Cancer Society and AARP are Atlantic grantees.

By Suzanne Perry

As members of Congress fan out across the country during their August recess, nonprofit groups that have been fighting to overhaul the country’s health-care system are stepping up efforts to get their cause over the finish line.

Haunted by memories of the failed effort to revamp health care during the Clinton administration, a wide variety of social-justice, patient-advocacy, consumer, religious, and other organizations are hoping that their retooled approaches will pay off this time around.

Some foundations have also gotten involved — notably Atlantic Philanthropies, which has provided $25-million to bankroll Health Care for America Now, a new coalition that unites more than 1,000 groups nationwide. “Everyone understands that this is potentially truly a historic moment and it’s essential we not squander this opportunity,” says Ron Pollack, executive director of Families USA, a charity in Washington that represents health-care consumers.

A Critical Point

The push to enact legislation to control spiraling health-care costs and cover the country’s millions of uninsured people has advanced further than at any time since the 1993-4 effort led by President Bill Clinton and his wife, Hillary. With strong support from President Obama, Democrats in both the House and Senate are crafting bills that proponents hope will be adopted before the end of the year.

But the battle has reached a critical point: Senate Democrats differ over the key question of whether to create a public insurance plan to compete with private options. Opponents have been storming Congressional town-hall meetings across the country, complaining about government intrusion in medical decisions and the cost to taxpayers. Public support for the Democrats’ approach has been dipping in the polls.

‘Not the American Way’

Some advocates are planning to fight back. A coalition of liberal religious organizations last week announced a 40-day campaign to convince lawmakers and the public that providing affordable health care to all Americans is a moral imperative. They are planning a call-in session with President Obama, advertisements televised across the country, sermons devoted to health care, and a lobby day on Capitol Hill. They held prayer vigils and other events designed to reach more than 100 members of Congress on August 11.

“Shouting people down, disrupting public meetings, and worse — we’ve seen it all over the cables. That’s not the American way,” says Katie Paris, program and communications director at Faith in Public Life, one of the sponsors. “We believe Americans want a civil discussion about this profoundly moral issue.”

AARP, the advocate for older people, started a multimillion-dollar television, Internet, and print ad campaign on August 10 to fight “myths and scare tactics” — for example, claims made by some that efforts to fix the system would lead to rationed health care, a government takeover, or euthanasia.

Grass-Roots Strategy

While the health-policy debate is now rising to the fore, many advocacy groups have been plotting a hoped-for victory since the 2008 presidential campaign season.

Through a variety of partnerships and coalitions, they have been working to develop strategies built on lessons learned from earlier defeats. Those include more conversation with each other, partnerships with former adversaries, such as pharmaceutical companies and business groups, and better attempts to educate the public.

“In the ’94 debate, there was almost a sense we were entitled to reform. There were hardly any grass-roots efforts,” says David Kendall, senior fellow for health policy at Third Way, a think tank in Washington that promotes “moderate” liberal policies. “There was not an attempt to explain the mechanics of the bill to the public.”

This time, about 200 charities, think tanks, patient-advocacy groups, educational institutions, and others coordinate their communications efforts through the Herndon Alliance, a group in Seattle that was created in 2005 to find the best ways to communicate to the public on health care.

For example, says Robert A. Crittenden, a doctor who helped start the group, studies have found that while people with health insurance generally support health-care fixes, they fear changes to their own plans. “In the past, the whole discussion was about the uninsured,” says Dr. Crittenden. “In fact, the people who vote are insured,” but would also benefit from proposed changes.

The alliance is now offering its members tips on how to handle town-hall disruptions.

The group gets more than half of its $800,000 budget from foundations, including the Nathan Cummings Foundation, the California Endowment, and the Public Welfare Foundation.

Making News

Other foundations are also helping Americans sort through the deluge of information — and misinformation — about health policy.

The Henry J. Kaiser Family Foundation, whose mission is to inform Americans about health issues, hired several prominent journalists, including former reporters from The Wall Street Journal and National Public Radio, to create a news service to publish in-depth, unbiased articles about health. Kaiser Health News started in June and its articles have appeared in The Washington Post and other daily newspapers.

Drew E. Altman, chief executive of the Menlo Park, Calif., foundation, says the fund started the service because newspapers and other cash-strapped news-media companies are devoting fewer resources to covering health. While the Washington debate this year has attracted a lot of press attention, he predicted it will subside once the political battle dies down.

The Robert Wood Johnson Foundation, in Princeton, N.J., is also working with journalists to inform the health-policy discussion. This year it started supporting a national poll that asks Americans monthly about how they view the health care they receive. The results are distributed by the Associated Press to newspapers, magazines, and other news outlets, says Adam Coyne, the foundation’s director of public affairs.

Some groups see education as only part of the problem, emphasizing the need to find common ground with potential adversaries. For example, AARP, the American Cancer Society Cancer Action Network, Families USA, and other advocacy groups joined with business, pharmaceutical, health-insurance, and health-professional groups, including the American Medical Association — the kind of groups that opposed the last effort to fix health care — last year to create the Health Reform Dialogue.

They hired a conflict-management organization, worked to find areas of agreement, and issued a document listing dozens of proposals they could all endorse — such as providing subsidies to small businesses to offer health insurance to their employees, and investing in health-information technology.

Harry and Louise

In another “strange bedfellows” partnership, Families USA joined with the Pharmaceutical Research and Manufacturers of America to create an ad featuring Harry and Louise, the iconic couple who appeared in ads sponsored by a health-insurance association that criticized the Clinton plan. Today, Louise takes a different tack: “A little more cooperation and a little less politics, and we can get the job done this time.”

Some groups have stepped up their spending as the health-policy debate enters what many consider a make-or-break phase. The American Cancer Society gave its advocacy arm, the Cancer Action Network, a $2-million grant this year to push for federal legislation — on top of the $1-million the network had already earmarked for that cause, says Daniel E. Smith, the network’s president.

One result: a Capitol Hill subway station has been blanketed this summer with photos of average Americans accompanied by statements such as “Now, doctors can catch his cancer in time to save his life. Later, she could be paying off the medical debt for the rest of hers.”

Families USA — which holds weekly meetings of like-minded groups in Washington, directs a nationwide network of activists, pays for ads, and collects stories about people’s health-care problems — has tapped its reserve for about $5-million over the past year to supplement its annual $9-million budget, Mr. Pollack says, adding that fund raising is difficult in the economic downturn.

Free-Market Approach

Not everyone in the nonprofit world endorses the idea of expanding government’s role in health care.

The Galen Institute, in Alexandria, Va., coordinates a Health Policy Consensus Group, uniting analysts from organizations that promote a free-market approach including the American Enterprise Institute, Americans for Tax Reform, and the Heritage Foundation. They argue that health-care costs could be contained if consumers were given more choice among private plans, instead of relying so heavily on tax-subsidized employer plans.

“We really operate on a shoestring,” says Grace-Marie Arnett, who founded the institute in 1995, of her $700,000 budget. But she says many Americans share her group’s perspective. Policy makers should pay attention to opposition expressed at the town-hall meetings because it reflects deep anxiety about the “sweeping overhaul” favored by President Obama, she says.

If Ms. Arnett’s opponents win their battle, however, advocates of a health-care overhaul say their work will be far from done. They say they will have to monitor how the law is carried out to ensure that the changes are not rolled back.

Gene Lewit, who oversees health grant making at the David and Lucile Packard Foundation, in Los Altos, Calif., and other foundation officials say the heavy work for grant makers would come after a health-care bill is passed.

Mr. Lewit says Packard, for example, has focused on helping states enroll poor children and youth in the State Children’s Health Insurance Program. If American health care is indeed revamped, states will probably need help fitting that program into a new health system.

“Health-care reform will just present a different set of challenges and opportunities,” says Mr. Lewit.

Ian Wilhelm contributed to this article.

LOBBYING LESSONS: LEARNING FROM MISTAKES

The failure of a health-care overhaul in the 1990s persuaded nonprofit groups to take new approaches to this year’s unfolding debate. Among them:

• Forge coalitions of diverse groups, even those that have previously been opponents.
• Make sure all advocacy groups are in close touch to coordinate approaches and share information.
• Educate the public about the options policy makers are considering so they will push Congress to act.

Photo: A rally sponsored by Health Care for America Now, a coalition of more than 1,000 nonprofit groups and labor unions. (Photograph by Tim Sloan, Getty Images)