An Underutilized Tool For Foundations—Policy Change

In philanthropy, we are driven by the causes that matter to us and bolstered by the opportunity to generate meaningful change. But how do we actually achieve that change? For years, when I was out in the community or talking with my colleagues about the work of Blue Shield of California Foundation, I would rarely start by describing us as a “policy funder.” Instead, I would say that we aim to strengthen and transform the systems that support the health and safety of California’s most vulnerable populations.

As I thought more about our programs and grant making and peeled back the many layers of “systems change,” I uncovered a policy framework upon which so much of our work relies. For us—and most foundations—strong policies are the infrastructure that reinforces our investments and makes it possible for our grantees to continue to serve families and communities across the state. With this new clarity, I embraced the role of policy funder and set out to tell the story of why and how Blue Shield of California Foundation funds policy and what it has learned along the way.

Why are we a policy funder? Because policy is an efficient way to clear numerous barriers and create sustainable solutions. Our ten-year vision is a California in which there are strong, effective, and coordinated systems of both health care and domestic violence services for those most in need. Given the long-term engagement needed to realize this vision, as well as the complexity of the issues, affecting policy has become one of our dominant strategies.

Thankfully, foundations are uniquely positioned to lead this type of long-term policy work needed to achieve ambitious goals. From funding research that can inform lawmakers, to bringing leaders and decision makers together around tough issues, to producing opinion pieces that challenge the status quo—foundations can help push solutions down the path of policy change to achieve enduring improvements in our systems, services, and society.

How do we approach our policy work? Lobbying rules often scare foundations away from pursuing policy work. Thankfully, there are many other entry-points into the policy process where foundations can still offer their expertise and relationships so as to be actively involved.

Nearly every project or initiative our staff takes on has a policy component, and we’ve been most successful in two areas: creating an environment for ideas and discussions, and supporting the successful implementation of legislation.

Blue Shield of California Foundation has also commissioned research to inform policy development and generate dialogue and new perspectives among policy makers. In addition, our support for California’s Stakeholder Advisory Committee—made up of health care providers, advocates, and advisers—has helped to ensure that multiple stakeholders and experts are involved in key state policy initiatives like Medicaid expansion and California’s 1115 Medicaid waiver application.

Through technical assistance and research grants, we’re also helping our grantees and communities put new pieces of legislation into action. For example, our funding in Los Angeles supported the planning and implementation of a local coverage program for people not covered under the Affordable Care Act (ACA), including undocumented immigrants. With this support, Los Angeles County successfully launched My Health LA, which has become a model to follow for addressing the needs of those remaining uninsured post-ACA.

These investments in nontraditional policy and advocacy efforts have not only paid off in more effective systems of care and support for low-income and underserved Californians, they’ve also strengthened the foundation’s direct grant making for projects and organizations whose work relies on local or state policies that enable our shared vision.

Given this success, I urge other foundations to recognize how a strategic policy agenda—beyond lobbying—can help advance their mission statements.

What have we learned? True systems transformation will not happen in California, or anywhere, without the backing of strong policies and the cooperation of state leaders and lawmakers. Foundations with a social change agenda can learn from other funders and develop support networks around shared issues.

For funders just entering the policy space, we have a few key recommendations:

• Define your vision. Know the long-term vision you aim to achieve and find partners that are aligned with that vision to coordinate efforts and help guide your work along the way.
• Build trust. Be transparent about what you are trying to accomplish and why so that key stakeholders understand and trust you. This will help you establish the partnerships that are needed to advance policy change. We would not have been successful in many of our policy efforts to implement the ACA if not for the partnership of other funders, namely, the California Endowment and California HealthCare Foundation.
• Choose your role. Consider the various policy roles that a foundation can play—beyond traditional advocacy. Policy work does not have to mean meeting one on one with legislative staffers. These roles can include neutral convener, unbiased researcher, speaker of truth, and asker of hard questions so as to push progress.
• Take the long view. Recognize that policy change is affected by numerous factors over which you may not always have control. This work requires diligence and patience. Not losing sight of your desired goal and being an active, but flexible, partner are key to your success.
• Acknowledge your power. Being a trusted partner in the policy arena requires a clear understanding of the power dynamics that can exist between funders and grantees. Working in true partnership with grantees and getting buy-in from those leading the work on the ground will strengthen your policy efforts and ultimately make them more effective.
• Use your tool box. Building a broad policy tool box is essential. Scan the already-available tools and approaches and use your partners to help develop a policy agenda and start new conversations that will help you engage in collaborative change making.

I hope that these insights and what we’ve learned will inspire other foundations to join me in saying proudly: “I am a policy funder!”

This blog originally appeared in Health Affairs' Grantwatch Blog on October 8, 2015