1. Funding Makes a Difference: The Role of Philanthropy in Massachusetts Health Care Reform

2. Community Catalyst (c) 2009 Generating Momentum (1982 -1988) ENVIRONMENT –No consumer voice –Hospitals and other interests dominant –Local funders supporting community voice in housing and community development – but not in health care

3. Community Catalyst (c) 2009 Generating Momentum (1982 -1988) FUNDER SUPPORT –Villers Foundation applied approach to health care –Supported collaboration among constituency groups –Linked grassroots and policy advocates –The Boston Foundation support for stakeholder task force on uninsured –More local funder support joined by other national funders

4. Community Catalyst (c) 2009 Generating Momentum (1982 -1988) OUTCOMES –New voices utilized diverse tactics – policy advocacy, direct action and grassroots organizing –Improved Medicaid access to physicians and eliminated Medicare balance billing –New Health Care For All coalition won public process and a seat at table in hospital payment negotiations –Passage of 1988 “Universal Health Care Law” –Sympathetic political leaders and smart advocates

5. Community Catalyst (c) 2009 Generating Momentum (1982 -1988) LESSONS LEARNED –Infrastructure for collaboration among grassroots and policy advocates creates momentum –Support individual organizations and the coalition –Local foundations with inside knowledge are valuable partners for national foundations

6. Community Catalyst (c) 2009 Changing Times (1989-2002) ENVIRONMENT –Severe economic downturn and state budget deficit – political leaders abandoned support for health reform –Hospitals and businesses also abandoned the deal –Some coverage programs moved forward but the “pay or play” provision kept being postponed

7. Community Catalyst (c) 2009 Changing Times (1989-2002) FUNDER SUPPORT –Pushed advocates to organize affected constituencies and build stronger base of support –Supported organizing people who could benefit from existing programs (helpline and enrollment) –Brought issues forward Treated community questions about hospital community benefits as credible Held Forums Policy Reports –Supported formation of new coalitions with stakeholders

8. Community Catalyst (c) 2009 Changing Times (1989-2002) OUTCOMES –Hospital Community Benefits efforts resulted in Attorney General guidelines and new relationship with community –New stakeholder coalition with doctors, hospitals, some HMOs led to major children’s health coverage expansion and senior pharmacy assistance –Gains consolidated by building infrastructure and engaging in implementation Outreach and enrollment Local and national support

9. Community Catalyst (c) 2009 Changing Times (1989-2002) LESSONS LEARNED –Necessary to support base-building during times of retrenchment –Tolerating tensions among stakeholders when new voices come to the table leads to stronger working relationships and improved policymaking –Outreach and enrollment efforts connect policy change to affected constituencies

10. Community Catalyst (c) 2009 Reaching A New Milestone (2003 – 2008) ENVIRONMENT –Another period of retrenchment with budget cuts –Balance of power now incorporated consumer voice –Pressure from Medicaid waiver (could lose $385 million over two years) –HCFA convened new coalition of hospitals, health plans, faith groups, etc. to move major health reform

11. Community Catalyst (c) 2009 Reaching A New Milestone (2003 – 2008) FUNDER SUPPORT –Ongoing investment in consumer advocacy and organizing infrastructure –Consolidated earlier lessons – provided policy analysis; boosted investment in organizing; convened stakeholders –Supported implementation – heavy investment from enrollment to research to advocacy to tackling unaddressed issues

12. Community Catalyst (c) 2009 Reaching A New Milestone (2003 – 2008) OUTCOMES –442,000 newly insured –Strong public support (70% three years after passage) –Significant cost challenges

13. Community Catalyst (c) 2009 Reaching A New Milestone (2003 – 2008) LESSONS LEARNED –Continued investment in building advocacy capacity pays –Effective implementation requires the same - or even greater - level of advocacy Outreach Enrollment and engagement of affected constituencies Continued research and analysis of law’s impact Consumer engagement in regulations Develop new policy to address unfinished issues

14. Community Catalyst (c) 2009 Community Catalyst, Inc. 30 Winter Street, 10th Fl. Boston, MA 02108 617-338-6035 Fax: 617-451-5838 www.communitycatalyst.org Community Catalyst is a national non-profit advocacy organization dedicated to making quality, affordable health care accessible to everyone. Since 1997, Community Catalyst has worked to build consumer and community leadership to transform the American health care system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers and foundations, providing leadership and support to change the health care system so it serves everyone— especially vulnerable members of society.. We gratefully acknowledge the Blue Cross Blue Shield of Massachusetts Foundation's support in researching, writing, and publishing “Funding Makes A Difference.” Community Catalyst appreciates the thoughtful insights offered by colleagues in the foundation and advocacy communities. Sustainable progress in health care reform requires relationships based on openness and respect. Sharing the lessons learned is key to strengthening the important partnership between foundations and advocates that is helping to create a health care system that works for all people.