Last week, Kaiser Family Foundation (KFF) released the results of a survey they’d conducted, asking people how their lives have been impacted by the Affordable Care Act. It wanted the good, the bad, and the ugly. And it got it. Thirty-seven percent of Republicans say they’ve been hurt by the law. Twenty-six percent of Democrats say they’ve been helped by the law. But regardless of party, six in 10 Americans say the Affordable Care Act has had no net effect on their life. Cue the whomp, whomp…
Of course, the Kaiser Family Foundation, which has no affiliation with Kaiser Permanente, was just doing its job: it isn’t an advocacy group, or a big ACA enrollment pusher. It’s essentially a research group, conducting its own, independent and unbiased policy analyses of national health issues and the U.S.’s role in global health policy. It was founded in 1991, and gets by mostly on managing its own endowment and accepting contributions from other foundations with a vested interest in accessible, accurate health news and information. “We maintain a steadfast commitment to never take a position on a policy issue or to become a combatant ourselves on one side or the other in the ‘health care wars,’” says KFF President Drew Altman.
Well, okay for KFF. But what about those groups at the forefront of the ACA push? What about the Blue Shield of California Foundation, and Kresge, and the Robert Wood Johnson Foundation? What about the California Endowment, which spent $200 million to help Californians get covered? If “not affected by the ACA” turns out to be the general public’s take on the healthcare law, how might ACA advocacy, and health policy advocacy in general, change down the road?
Maybe it won't change at all. If the public's attitude toward the ACA is a big shrug, then eventually the ideological attacks on the law will lose steam and the battle over the law will fade from the headlines. That will leave funders to grind away year after year to realize the law's potential by boosting enrollment and improving it through incremental changes. A good analogy here is the EITC or SCHIP, where funders have quietly invested a fortune over time to get more low-income people to take advantage of these benefits.
Public nonchalance about the ACA will also help the push by funders to get more states to accept Medicaid expansion, which we've written about here. As the hysteria around Obamacare fades, the decision by states to turn away free healthcare dollars will seem all the sillier and the tide of that battle should start to turn.
Finally, once the public sees that the ACA is not so scary after all, the stage will be set to start pushing for another round of healthcare reform.
Making policy changes is a long game, and foundations have an advantage here with steady income from their endowments and insulation from external pressures. Ideological movements, in contrast, can lose steam quickly, as we're seeing with the Tea Party in this election cycle.
In short, once Obamacare is no longer a lightning rod issue, the field will be clear for funders to push long-term strategies to make the ACA really work.