The COVID-19 pandemic has mobilized philanthropy more broadly than any event in recent years, prompting organizations across the sector to respond with emergency grantmaking and speedily developed funding programs to address the human services, frontline medical care, and scientific research needs of this global threat. For the Robert Wood Johnson Foundation, the pandemic demonstrates above all that it must increase the pace and intensity of existing policy and advocacy work, which is organized around the vision of building a culture of health in the United States.
Inside Philanthropy spoke last week with officers of RWJF—including President and CEO Richard E. Besser, Senior Policy Advisor Katherine Hempstead, and Senior Policy Officer Giridhar G. Mallya—to get a sense of how the country’s largest health-focused philanthropy is responding to the coronavirus emergency, and how they see the crisis influencing healthcare and other policies at the local, state and federal levels.
A Validating Crisis
“One thing that stuck with us in a big way is how (the pandemic) shines a spotlight on the issues of health equity we’ve cared about as a foundation,” said Besser. “We’re a society of haves and have-nots. For some people, sheltering in place is very inconvenient—for others, it’s a life and death issue.”
Among the many facts and figures that the pandemic has brought into particularly sharp focus for RWJF is this one: the 28 million Americans without health insurance. “This serves as an example of why everyone in America should have access to high-quality, affordable healthcare,” said Besser.
Lingering healthcare policy debates will likely heat up now, said Hempstead, including whether the Affordable Care Act (ACA) will be expanded, or if the 14 states that have so far resisted Medicaid expansion will eventually opt in. The sudden loss of jobs nationwide puts millions more at risk of losing their health coverage: Research cited by RWJF showed that states that did not expand Medicaid experience larger jumps in the uninsured as workers become unemployed. Recently implemented Medicaid policies such as block grant and per capita caps could further result in people losing coverage or benefits, and also place states at risk for the costs of expanded Medicaid enrollment—highly likely, given the sudden economic downturn.
Hempstead, whose focus includes healthcare coverage, said coverage advocates were disappointed that the federal government did not reopen ACA enrollment in light of the pandemic. That move, along with the Trump administration’s lawsuit to strike down the ACA, she said, may well provide additional momentum in the push to protect the millions of Americans without insurance during the worst health threat in decades.
“This makes a strong case for the importance of coverage,” said Hempstead. “We see how much of a problem it is when financial barriers keep people from getting care.” Policy advocates will have to address some of the gnarly complexities in the country’s healthcare system that have paralyzed coverage reforms.
Policy Through a Lens of Equity.
In 2009, prior to joining RWJF, Besser was acting director of the CDC during the H1N1 influenza outbreak. “I know as a long-term public health professional that there are certain communities that get hit hardest in a public emergency,” said Besser. “We need to do everything to make sure their needs are met.”
In fact, today, RWJF announced $50 million in short-term relief funding to help families and communities grapple with challenges exacerbated by the pandemic crisis, including food, housing and income. The funding targets stressed communities such as lower-income workers, communities of color, indigenous communities and people with disabilities. Organizations receiving the emergency funds include Feeding America, Meals on Wheels, National Domestic Workers Alliance, One Fair Wage, Catholic Charities, National Day Laborers Organizing Network, NDN Collective, and Disaster Housing Recovery Coalition. RWJF is directing $5 million to organizations in its home state of New Jersey.
Meanwhile, RWJF is supporting its grantees in Washington who are “doing analysis of policy through a lens of equity,” Besser said. The foundation has ramped up its policy team, he said, including the recent hiring of Avenel Joseph, a longtime Capitol Hill legislative professional, as RWJF’s vice president for policy. He said the foundation was keen to help its grantees shape policy decisions at the federal and state levels. Giridhar Mallaya explained that one of those grantees, State Health and Values Strategies, based at Princeton University, has been providing advice to state health officials—for example, looking at how Medicaid and CHIP can be used to provide emergency support to families. The foundation’s grantees and expert staff are also looking at other issues, like expanding provision of SNAP benefits and the implications of the pandemic in an era of mass incarceration.
Like many funders across the country, RWJF has moved to change its grantmaking procedures to better support nonprofits. The foundation recently told its grantees during a virtual town hall meeting that it will boost the flexibility of its grants to enable grantees to continue their work without interruption during the emergency.
Among RWJF’s early financial responses to the coronavirus pandemic was $1 million in late January to jump-start the CDC Foundation’s Emergency Response Fund, according to Mallya. Beyond its new $50 million commitment, the foundation is continuing to look at what other new money it can deploy.
Besser didn’t rule out an increase in payout from RWJF’s endowment amid growing calls that foundations do exactly that to meet the demands of an unprecedented emergency. “We learned a lot following the financial crisis of 2008,” he said. “That allowed us to be more nimble, and not have as many worries about cash flow. By law, we’re required to pay out 5% of assets, but in a time when needs are increasing, we recognize that that’s a floor and not a ceiling.”
Ultimately, whatever its next moves, RWJF will continue to press forward on broader equity causes and its culture of health strategy. “We are more than ever committed to this framework,” said Besser. “The issues of equity are right in front of us in just about every conversation about this pandemic. There is an opportunity for people to learn that health is about more about healthcare.”
