Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times’ Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes “Insurance — public or private — provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health.”Column/Op-Ed Read Post
Senator Baucus made headlines recently when he predicted a “train wreck” for Obamacare. David Brooks predicted “chaos” in a recent column. In a news conference, the President offered a different perspective. “There’ll still be, you know, glitches and bumps…. That’s pretty much true of every government program that’s ever been…Policy Insights Read Post
Drew Altman, President and CEO of the Foundation, and Larry Levitt, Senior Vice President, co-authored a Washington Post op-ed that examined how the economy affects the nation’s health spending. It concludes that the record slow growth rate of recent years stems largely from economic factors beyond the health system, with the…Column/Op-Ed Read Post
Today’s discussion of the Affordable Care Act (ACA) is focused on immediate implementation milestones leading up to 2014 when the law’s major provisions are set to kick in. This is a critical period when the foundation for the ACA is being established and key building blocks such as the state…Policy Insights Read Post
Lately conservatives have been feeling like losers in health care and complaining loudly about it. They don’t like Obamacare or the increase in the government’s role in health care or the federal spending it brings with it, even if those things result in coverage for more than 30 million uninsured…Policy Insights Read Post
The Kaiser Family Foundation’s Role in Today’s Health Care System Drew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014 Follow Dr. Altman on Twitter: @DrewAltman Also read Drew Altman’s essay on Kaiser and the Affordable Care Act. This essay discusses the choices we have made about our…Read Post
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In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." New York Times: "Poor People Have the Same Needs as Others" [post_title] => Poor People Have the Same Needs as Others [post_excerpt] => Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times' Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => poor-people-have-the-same-needs-as-others [to_ping] => [pinged] => [post_modified] => 2013-05-08 20:25:41 [post_modified_gmt] => 2013-05-09 00:25:41 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=71636 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw )  => WP_Post Object ( [ID] => 70869 [post_author] => 48572675 [post_date] => 2013-05-07 09:00:20 [post_date_gmt] => 2013-05-07 13:00:20 [post_content] => Senator Baucus made headlines recently when he predicted a “train wreck” for Obamacare. David Brooks predicted “chaos” in a recent column. In a news conference, the President offered a different perspective. “There’ll still be, you know, glitches and bumps…. That’s pretty much true of every government program that’s ever been set up,” Obama said. “But if we stay with it, and we understand what our long-term objective is, which is making sure that in a country as wealthy as ours, nobody should go bankrupt if they get sick, and that we would rather have people getting regular checkups than going to the emergency room because they don’t have healthcare, if we keep that in mind, then we’re going to be able to drive down costs.” There are always problems in big government programs and unintended consequences that could not be predicted in advance of implementation. The longer term question is not whether there will be problems – there will be glitches and there will be even more successes as people gain coverage and insurance is reformed – but whether the political system today has the capacity to learn from implementation, adapt and make improvements. In the history of domestic programs there are few if any examples of “train wrecks” or “chaos”. Yes, Medicare Catastrophic was, well catastrophic, but it was never implemented. Social Security, Medicare, and Medicaid were all implemented reasonably smoothly. In the ACA, like Medicaid or welfare, states bear a lot of responsibility for implementation and administration and there will be substantial variation in performance across the states. Some view that as a problem and some see it as a strength. One under-appreciated aspect of the ACA is how fundamentally the Supreme Court changed the law when it made the Medicaid expansion a state option. Many governors also waited for the outcome of the election to decide what they would do. The result is that the program being implemented is, in important respects, not the same as the one originally envisioned in the statute. There is no doubt states will make adjustments as implementation proceeds and they learn what is working and what is not in their exchanges and Medicaid expansions. Right now only seven states are planning “active purchaser” exchanges that, among other things, more aggressively try to control premium increases among plans offering business in their exchanges. One prediction I will make (it could be wrong) is that over time more states running their own exchanges will move away from the passive Expedia.com model exchange towards a more active purchaser model. HHS will also have the ability to make changes through administrative authority, waivers, and new regulations. The question is the Congress. Typically the process of learning from experience culminates in Congress with new legislation. Welfare reform legislation, for example, began in the Reagan years but was revisited comprehensively in the Clinton years. And both Medicare and Medicaid have been substantially modified through successive waves of legislation over the years. Laws are changed as we learn what works, as needs and circumstances change, and as political support for needed changes coalesces. Can today’s hyperpartisan, largely paralyzed Congress agree on legislation to improve ACA as we learn from implementation? Would Republicans agree to anything Democrats want? Would Democrats open up the ACA for legislative tinkering? It is not easy to envision agreement on ACA-related legislation any time soon. One thing that could change the picture somewhat is the current negotiations occurring between several states and the administration over the Medicaid expansion. If HHS and these states can successfully negotiate arrangements that give the states the flexibility they want and at the same time provide adequate protections for beneficiaries, it will bring more red states and their governors into the fold and create a much more bipartisan base for the ACA in the states than it has had in Washington, as well as a broader constituency for changes to improve the law over time. This will not happen overnight. Another factor that will affect the ability to learn and adapt as implementation proceeds is media coverage. If journalists focus on both what is working well as well as what is not, they can make a real contribution not only to public judgment about the ACA but future efforts to improve it. If they focus only on gotcha outlier horror stories that do not reflect general experience with the ACA, their reporting will do more to fuel political partisan debate than inform future policy. Of course the Congress itself could change in coming years, but with only thirty to forty seats up for grabs in the House of Representatives and the others mostly safe districts that lean right or left, redistricting has baked a certain degree of polarization into Congress for the immediate future. As implementation unfolds there are as many questions about the ability of our political system to learn from implementation and respond intelligently to the ACA as there are about the ACA itself. [post_title] => Can We Learn From ACA Implementation and Improve the Law? [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => can-we-learn-from-aca-implementation-and-improve-the-law [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:34 [post_modified_gmt] => 2014-03-04 16:14:34 [post_content_filtered] => [post_parent] => 0 [guid] => http://kaiserfamilyfoundation.wordpress.com/?post_type=perspective&p=70869 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw )  => WP_Post Object ( [ID] => 68482 [post_author] => 36622400 [post_date] => 2013-04-22 19:00:49 [post_date_gmt] => 2013-04-22 23:00:49 [post_content] => Drew Altman, President and CEO of the Foundation, and Larry Levitt, Senior Vice President, co-authored a Washington Post op-ed that examined how the economy affects the nation’s health spending. It concludes that the record slow growth rate of recent years stems largely from economic factors beyond the health system, with the economy explaining 77 percent of the slowdown, and more rapid growth expected in coming years if the economy strengthens as expected. The op-ed was based on a related Foundation Issue Brief. [post_title] => We Still Have a Health-Care Spending Problem [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => we-still-have-a-health-care-spending-problem [to_ping] => [pinged] => [post_modified] => 2013-05-09 18:55:04 [post_modified_gmt] => 2013-05-09 22:55:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://kaiserfamilyfoundation.wordpress.com/?post_type=perspective&p=68482 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw )  => WP_Post Object ( [ID] => 68402 [post_author] => 5093470 [post_date] => 2013-03-22 09:52:28 [post_date_gmt] => 2013-03-22 13:52:28 [post_content] => Today’s discussion of the Affordable Care Act (ACA) is focused on immediate implementation milestones leading up to 2014 when the law’s major provisions are set to kick in. This is a critical period when the foundation for the ACA is being established and key building blocks such as the state Medicaid expansions, exchanges, and a host of regulations about other elements of the ACA being produced by HHS are getting our attention. But there is also an ACA horse race mentality threatening to take over: Is this or that regulation on time or late? How many states have committed to the Medicaid expansion so far or to one kind of exchange or another? Will every element of the ACA be ready to go in 2014 as envisioned in the legislation? Is the ACA succeeding or failing? Everybody is keeping score. In a partisan Washington with a gotcha media, it’s easy to get lost in the weeds. Here are five big picture questions to keep in mind about the ACA.
1. As Republican governors slowly come on board, can the ACA make the transition from an ideological and partisan war zone to a more bipartisan effort to benefit people, with more traditional tensions between Washington and the states over money, flexibility and control?Governors, historically more pragmatic than ideological, may be reverting to form and could give the ACA the bipartisan support on the ground it has not had in Washington. It is still too early to say if the Republican governors will actually change the politics of the ACA. Conservative legislatures in some states, including Florida, are putting up resistance to their governors' decisions. Some governors are also putting their own twist on how their Medicaid expansions will operate, to distance themselves from Obamacare at the same time as they embrace the Medicaid expansion and substantial federal funding for it (though not necessarily the exchanges and the rest of the law). More of this two-step - embracing while distancing - may be necessary to bring conservative state legislatures along. It is possible that the governors, pushed by providers in their states and local government and their own sense of pragmatism, will slowly transform the ACA from a partisan conflict to a more typical federal-state program with more traditional state-federal tensions over money and control. To be clear, it is the federal money and the potential to provide coverage for their citizens which is moving the Republican governors, not some overnight conversion to Obamacare, but the longer term result could be a much more bipartisan complexion for the law.
2. Will there be a rush to judgment in 2014 when there are inevitable early implementation stumbles and enrollment builds more slowly than expected?It may be time to recalibrate expectations about timetables set originally to pass legislation to reflect new realities. Since the ACA passed, the Supreme Court effectively made the Medicaid expansion a state option. Many governors and legislators also waited for the outcome of the election to decide whether or not to move forward on ACA implementation. As a result, the ACA being implemented now is no longer exactly the same health reform law that passed the Congress, and the circumstances affecting implementation have changed. Already the Congressional Budget Office (CBO) has adjusted their enrollment projections. It will take time for enrollment to build up as new systems and outreach efforts gear up. Our newest tracking poll shows that the public remains confused about what the ACA does, including groups like the uninsured who will benefit most. This is not surprising, since mostly what the public has heard for three years is partisan bickering about the ACA. Only now as we head for implementation of its key provisions in 2014, is the ACA beginning to be introduced to the public for real. This transition point from political talking point to reality is both a challenge and a critical opportunity for the law. To be clear, implementation deadlines should not be changed. People have waited long enough for the coverage and other benefits the ACA will provide; and if they are changed, the implementation effort will slow accordingly. Quite the contrary, now is the time for an all-out implementation effort. But expectations may now need to be adjusted to reflect post Supreme Court realities and the uncertainties of current federal budget debates.
3. Will there be a backlash to the individual mandate and the law in general if some people find the policies they are now required to buy unaffordable, especially those who will not be receiving premium subsidies in the exchanges?Policies available in the exchanges will provide far better value than those offered today in the largely broken non-group market. Even so, the affordability of bronze and silver plans as perceived by people who buy them, not by experts calculating their actuarial value in advance of implementation, will be a critical moment for the ACA. And people will be required to buy these policies. The mandate worked smoothly in Massachusetts, the only place where it has been tried. The citizens of the state like the program and by all accounts no one ran from Massachusetts for Rhode Island or New Hampshire because of the mandate. Does that mean the ACA’s mandate will work smoothly in the rest of the country? The vast majority of people buying policies in exchanges will like the deal they are getting but some may not. How will the press handle a relatively small number of people experiencing rate jitters? How will policymakers respond?
4. If, as I suspect, costs begin to rise again when the economy strengthens, will that be blamed on the ACA?It should not be. The ACA supports important Medicare payment and delivery experiments. It also has provisions (medical loss ratio thresholds and rate review) that put downward pressure on premium increases in some parts of the market. And it is entirely plausible (to me) that the ACA has precipitated a market response beyond its own Medicare pilot projects resulting in changes in payment and delivery and at least temporary cost moderation, just as the mere threat of health reform legislation has done in the past. But the ACA is neither the cause of nor the ultimate solution to the larger problem of rising health care costs. The causes of the recent slowdown in health costs are a much bigger topic that we will be addressing in a forthcoming analysis. We have seen slowdowns in health costs before and they have always been followed by upticks. It is important to understand when the slowdown started, how much of it is due to the effects of the weak economy on utilization or, potentially, to changes in health delivery and financing, and what the future outlook might be.
5. In the hyper-partisan political system we have with today’s media, is there the capacity to learn from implementation so health reform can continue to be reformed and improved?The idea that you pass a law, write regulations, implement it, and then judge its success or failure bears little relationship to how programs do or should work. Not everything can be anticipated when legislation is written, and much that goes into legislation is designed to win enough votes for it to pass rather than for it to work optimally in the real world. This legislation too was passed without the normal reconciliation between House and Senate plans, which offers opportunities to fix problems in the law and choose the best of both approaches. Circumstances also change as programs are implemented. Reflecting this, Medicare and Medicaid have changed substantially over time. Can adjustments to the ACA be made in this Congress? In the states? By our current largely frozen political system? The kinds of changes often made to improve legislation do not seem possible in the current Congress. In 2014 there will be an ample supply of both early ACA success stories and stumbles. It will take years for scientific evaluations to measure the impact on access and financial burdens and other outcomes. The year 2014 is merely the date when major ACA provisions begin, and it will take years beyond 2014 before it is clear how many states undertake Medicaid expansions or what the ultimate mix of state versus federal exchanges is and how many people ultimately benefit from the ACA’s coverage expansions. While no doubt some will try, 2014 is not the right time to declare success or failure for the ACA any more than 1966 was the right time to do the same for Medicare or Medicaid. [post_title] => Questions for 2014 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => questions-for-2014 [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:34 [post_modified_gmt] => 2014-03-04 16:14:34 [post_content_filtered] => [post_parent] => 0 [guid] => http://kaiserfamilyfoundation.wordpress.com/?post_type=perspective&p=68402 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw )  => WP_Post Object ( [ID] => 71223 [post_author] => 36621681 [post_date] => 2013-01-21 09:34:54 [post_date_gmt] => 2013-01-21 14:34:54 [post_content] => Lately conservatives have been feeling like losers in health care and complaining loudly about it. They don't like Obamacare or the increase in the government's role in health care or the federal spending it brings with it, even if those things result in coverage for more than 30 million uninsured Americans and new protections from the worst abuses in the health insurance industry. Actually, conservatives are winning at least as much as they are losing in health care, even if they don't know it or won't say it, because out in the real world of health insurance, beneath the politicized debate about Obamacare, the vision of health insurance they have always championed -- high deductible plans that give consumers lots of "skin in the game" -- is steadily prevailing in the marketplace. Moreover, the conservative vision of "skin in the game" insurance could actually get a boost from the health reform law. Half of all workers in small firms now pay deductibles of $1,000 or more a year, and the percentage of workers in all firms paying big deductibles has tripled in the last six years. In the last five years the average deductible for single coverage has gone from $616 to $1,097 in all firms that have deductibles, and from $852 to $1,596 in small firms. Estimates are that in the basic plan offered in the health insurance exchanges under the Affordable Care Act, deductibles could be over $4,000 for individual policies and over $8,000 for family policies. These are big deductibles by any standard. Yes, the minimum coverage people will have to buy under Obamacare will be just the kind of "skin in the game" insurance that conservatives have always favored. But from start to finish, the health care reform debate has not been about facts but about ideology and partisanship. Conservatives are certainly not happy that the Affordable Care Act has survived a Supreme Court challenge and an election and will now be implemented and will not be repealed. But even as they continue to vilify the law, they must take solace in the fact that many states are still balking at implementing major provisions that conservatives do not like, such as the law's insurance exchanges or its Medicaid expansion, which the Supreme Court made optional. Only 18 states and D.C. have chosen to implement their own insurance exchanges, and only seven are planning exchanges that are active purchasers, the more aggressive kind of exchange that liberals and consumer advocates would like because they weed out plans with high premiums. The success of the Affordable Care Act now hinges on implementation, and more than any other single factor, the fate of the law will depend on what states do and how well they do it. The federal government will step in and operate exchanges in states that choose not to do so, but there is no federal fallback on Medicaid; if a state like Texas or Florida does not opt to expand coverage under the ACA, it will not happen. It will behoove the Obama administration and advocates of the law to actively nurture pacesetting states so that they have tangible success stories to point to in 2014 and models that other states can learn from and emulate. If even a relatively small number of states can show that uninsured people are being covered in large numbers, that federal funding is flowing as promised to the states and to individuals who qualify for insurance subsidies, that the new health insurance reforms are working as planned and that coverage is affordable and, as in Massachusetts, the public is accepting the individual mandate, then other states will take notice, whatever the ideological predispositions of their governors or legislators. It is already clear that the test in 2014 will not be whether the law is working perfectly everywhere (there isn't time for that to happen, and it won't be) but whether it can work as intended. If a handful of states can demonstrate that, then the others will want to follow. [post_title] => On Health Care, Conservatives Protest Too Much [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => on-health-care-conservatives-protest-too-much [to_ping] => [pinged] => [post_modified] => 2014-03-04 11:14:35 [post_modified_gmt] => 2014-03-04 16:14:35 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=71223 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw )  => WP_Post Object ( [ID] => 65685 [post_author] => 48572675 [post_date] => 2013-01-01 17:55:11 [post_date_gmt] => 2013-01-01 22:55:11 [post_content] =>
The Kaiser Family Foundation’s Role in Today’s Health Care SystemDrew E. Altman, Ph.D., President and Chief Executive Officer. Updated: August 2014 Follow Dr. Altman on Twitter: @DrewAltman Also read Drew Altman's essay on Kaiser and the Affordable Care Act.This essay discusses the choices we have made about our mission and operating style. It is a revised version of an essay published in the journal Health Affairs in 1998. Of course, I believe deeply in what we are doing at Kaiser, but I offer this and update it every few years for interested readers with the caveat that our choices are not necessarily the right ones for others. Each foundation and non-profit organization has a different set of opportunities by virtue of its history and size, geographic location, the character of its board and staff leadership, and other factors. I have always believed that our society is best served by having foundations that do different things. Organizations also evolve and change (and should). We began as a private foundation, quickly switched to a private operating foundation, and now we are a public charity, a change which signals no shift in mission or operations but gives us a status which more accurately reflects how we operate today.[post_title] => President's Message [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => presidents-message [to_ping] => [pinged] => [post_modified] => 2014-08-14 16:42:06 [post_modified_gmt] => 2014-08-14 20:42:06 [post_content_filtered] => [post_parent] => 0 [guid] => http://staging.kff.alley.ws/?page_id=54937 [menu_order] => 0 [post_type] => page [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 71636 [post_author] => 36621681 [post_date] => 2013-05-07 17:31:38 [post_date_gmt] => 2013-05-07 21:31:38 [post_content] => Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times' Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." New York Times: "Poor People Have the Same Needs as Others" [post_title] => Poor People Have the Same Needs as Others [post_excerpt] => Drew Altman, President and CEO of the Foundation, was asked to contribute to the New York Times' Room for Debate discussion on More Medicaid, More Health? In his piece, Dr. Altman concludes "Insurance -- public or private -- provides financial protection and access to medical care which low-income people need just as everybody else does. But it cannot by itself change behavior, alleviate poverty, or guarantee that the medical system is doing all it can to improve health." [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => poor-people-have-the-same-needs-as-others [to_ping] => [pinged] => [post_modified] => 2013-05-08 20:25:41 [post_modified_gmt] => 2013-05-09 00:25:41 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=71636 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 57 [max_num_pages] => 10 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_comments_popup] => [is_paged] => 1 [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => 7c57d7c38b3244df9cb9ad413c0f99b0 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => )
How Kaiser Determined Its Strategic DirectionThe modern day Kaiser Family Foundation was established in the early 1990s when KFF made a transition to an independent national organization and I came to the Foundation to implement a vision of a different kind of foundation the Board and I shared. The “founding” board chair of the modern day KFF, Hale Champion, was an especially important partner in charting the early directions for the new Kaiser. At that time we asked one overriding question: “How can we best have an impact with (then) about $30 million to spend each year in a rapidly changing, trillion-dollar health care system?” We were not large enough to try to change things through direct action — by undertaking large, multi-site demonstration programs, supporting large numbers of community organizations, or bankrolling the development of new independent national institutions — as some larger foundations did. With a $3 trillion health system now, from the question we asked over 20 years ago is even more relevant. Just as important, not only was the U.S. health care system bigger than it was in the 1980s, but it was radically different as well. When I was a vice president at the Robert Wood Johnson Foundation in the early 1980s, we saw ourselves as key players in a largely not-for-profit health care community that had great interest in working with the philanthropic community, and in the demonstration, research, and training projects that foundations funded. Those days are largely gone. Today’s health care system is dominated by large commercial interests driven by investors’ demand for profit, by non-profits almost equally focused on revenues, and by government policy decisions that are sometimes shaped by larger ideological, political, and budgetary concerns. For better and worse, health care has become big money and big politics, and health foundations initially struggled to adapt. We saw a glaring need in this changing health care system for an independent, trusted, and credible source of information that could provide facts, policy analysis, balanced discussion, and expert commentary in a field otherwise dominated by large interests, and we have tried to play that role. While foundations certainly have agendas — ours is to use information to speak for people and to be a counterweight to all the vested interests in health — it is our independence, our lack of a commercial or political interest, and our efforts to provide the most accurate information possible (both from us and others) that give us an opportunity to play a special role. 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.”
The Foundation’s StrategyFrom this basic decision about a strategic direction came most of the characteristics of the Kaiser Family Foundation today.
InformationWe are in the information, not the grantmaking business. While most foundations see their principal product as grants, we are an operating organization and ours is information — from the most sophisticated policy analysis and survey research, to basic facts and numbers, to the highest quality health journalism, to information young people can use to protect their health. We focus our work on the major health policy issues facing the nation. This means that we do not completely control our own agenda. We need to “be there” with information and analysis and timely journalism on whatever major health policy issues are on the national agenda. We have also chosen to focus on other issues that are critically important but may not decide elections or make or break budgets or appear as frequently on the national news — such as HIV/AIDS and health disparities. Overall, we try to inform discussion and debate on major issues that affect millions of people, and to elevate the national level of debate on health issues. Our approach is almost equal parts policy analysis and communications: developing new information on national health issues, synthesizing the best information from others, and helping to explain health policy issues to an understandably confused public by ourselves and with news organization partners. When you step back from our many projects and programs, we basically do four things to produce the spectrum of information that enables us to play our role: we are a producer of policy analysis on domestic and global health policy; we are a producer of public opinion and survey research, which is work for which we are well known; we are a “go to” clearinghouse, synthesizer and translator of all the best information on the issues we work on, whether we produce it or others do; and we operate a major health news service dedicated to producing the best in-depth coverage of health care and health policy called Kaiser Health News (KHN), the nation’s first not-for-profit health policy news service. KHN is a foundation program and its journalists are foundation employees, but it is also a fully credentialed news service which operates with full editorial independence. We also organize and operate large scale public information campaigns which have been recognized with multiple Emmy and Peabody awards. The most prominent current campaign is GTA – Greater Than AIDS.
Internal CultureWe are a professional organization, staffed by experts in health policy, public opinion and survey research, media, communications, journalism, and other areas in which we operate. To encourage an entrepreneurial spirit and avoid the internal “fiefdoms” that have historically been a problem in many foundations and think tanks and in universities from which many of us originally come, we do not have separate budgets for program areas; our uncommitted funds each year go to the best opportunities we can identify across all of our program interests (about half of our budget supports our expert staff). This has created an entrepreneurial environment which has generally served us well. We also have a very actively involved Board of Trustees. The Trustees provide oversight, approve spending levels and all major funding and investment decisions, and work closely with me to set directions and determine strategy. Board members serve two five-year terms. Because we are an operating organization, our Trustees have an extra responsibility; we are directly accountable for what we do. We also work to keep past Trustees involved with KFF: for example, by inviting them to retreat meetings.
AudiencesWe have a clear sense of audience: policymakers, opinion leaders and the media are our core audience, and we try to reach the general public through our news service and a growing body of consumer information we produce, from cartoon animations explaining the Affordable Care Act to a widely used calculator that enables people to put in their zip code and some basic information to see what kind of deal they will get on an insurance policy under the ACA. While we produce a lot of our own research and analysis, I believe that our most important contribution to the research community is as a representative, translator, explainer and information broker. Like the adage about the tree falling in the forest, studies that are only read by those of us in the policy research community who follow a particular issue will not have much impact. Much of the most relevant and timely research in health policy is never published in journals, but can be found instead in policy reports and other publications and communications put out by a small number of organizations in our field. Entire policy debates can now play out in a matter of days or hours largely on Twitter. We need more and better and constantly updated research on health issues, but even more, we need better communication of the research and policy analysis that is done. For this reason, the Kaiser Family Foundation places a special premium on communications and uses a wide range of strategies to cut through the information overload in health. These include operating a variety of large-scale online information resources, including kff.org, our main organizational website, kaiserhealthnews.org, our free, health news service, as well as several web portals and an active social media presence for our organization as well as our experts. Our overall goal is to provide free access to the same kind of information and events insiders have to national and global audiences interested in health policy. Our philosophy has always been to integrate communications into our program activities. This means that communication is everybody’s job at our foundation and is viewed as a central part of everything we do. The job of drafting a press release, answering a reporter’s question, designing public-service campaigns or putting something on the web is not something simply handed off to a communications officer at the end of the hall or an outside consultant; everybody is involved. We take press releases especially seriously; they are the place, in a page or at most two, where we need to decide what a complex study actually says and what the "news" is.
ProfileIt is a fact of life that if policymakers and persons in the media don’t know who you are, they are not likely to pay much attention to what you do or say. Having a trusted “brand” was especially important to us given the role we play. And a clear identity was also important in our case to distinguish ourselves from Kaiser Permanente, with whom we have no connection, except for the founding family name we share and the occasional misdirected letters I get from the HMO’s enrollees — both disgruntled and pleased. In 2003 we completed construction of a new building in Washington, D.C., which has added tremendously to our ability to communicate about health issues. The building was financed with very low-interest, AAA rated tax-exempt District of Columbia bonds. It is located in downtown Washington, D.C. just a few blocks from the White House and around the corner from the National Press Club. The building is the home of our Washington, D.C. offices and Washington, D.C.-based staff; our Barbara Jordan Conference Center, named after our former Trustee, which we use to facilitate discussion and debate about health issues; a fully equipped studio with the latest in broadcasting and webcasting technology; and an interactive health exhibit lobby — a street-level space designed to provide visitors with up-to-the-minute information on our programs and information. We are making our conference and broadcast facilities available to other non-profit organizations with no facilities or technical fees charged. Thousands of events have already been held in the building since we opened it in late March of 2003.
StyleTo accomplish our goal of developing the Kaiser Family Foundation as a special and, we hope, needed information resource, we became an operating foundation and then more recently the IRS approved our switch to public charity status to better reflect the fact that in any given year, ten to fifteen percent of our operating budget comes from outside funders. They are mainly foundations and we have a particular approach to outside funding. We seek and accept outside funding only from sources who will not in any way compromise our independence or mission (and in fact may add to our work as partners), and we use outside funding primarily to support the incremental costs of time limited projects we could not otherwise undertake on our own and not to cover core operating costs which we sustain with our own endowment. As an operating organization (operating foundation or now public charity), staff direct most of our major programs and conduct much of the work in-house. For example, foundation staff direct the Kaiser Commission on Medicaid and the Uninsured, our fellowship program for health journalists, our partnerships with both entertainment media and news organizations, and KHN, which is a foundation program staffed by foundation employees, but is editorially independent. Likewise, the many national surveys and polls on health issues we conduct each year are designed and analyzed in house, sometimes with the involvement of partnering news organizations such as The Washington Post and The New York Times. We became an operating organization because doing so was inherent in achieving the most basic goal we set out to accomplish when we began to chart new directions in the early 1990s. The goal was to build an institution which itself played a special and hopefully permanent role as a trusted source of information on the national health care scene. Every operating program we create at Kaiser represents an investment in the development of this organizational capacity. Our purpose was and is to build an institution we felt was needed as a counterweight to health care’s vested interests and as a data-based voice for people in a health system driven by money and politics. Media Partnerships We have developed a broad range of partnerships with media organizations over the years, from The Washington Post and The New York Times, to NPR, USA Today, Viacom, MTV, BET, Univision, and Fox. With news organizations, we undertake joint, in-depth, special projects such as our polling projects with The Washington Post, with whom we have conducted twenty seven major survey projects. In our projects with The Washington Post and The New York Times, for example, the Foundation and the news organization pick the topics and design the survey instruments together, and then jointly analyze the results. Then, as they should, the news organizations have editorial control over the content of their reports and cover the results as they see fit, but always substantially. One of the main ways in which Kaiser Health News distributes its content is through partnerships with news organizations. KHN, which launched June 1 of 2009, now distributes stories every day through major national news organization partners, including The Washington Post, NPR, The New York Times, USA Today, and many, many more, including a new partnership to provide health reporting for the Newshour.
Assessing Kaiser’s RoleI am often asked how we know whether our efforts are having an impact. In some cases, it is relatively easy to judge. For example, it is clear that the Kaiser Commission on Medicaid and the Uninsured has become an authoritative source of analysis and information on health care for low-income people and has played a significant role in debates about these issues, or that our Daily Health Policy Briefing on KHN is widely read and valued or that our monthly Tracking Poll is a widely respected barometer of public opinion on health. Everyday we are in the press and we can see how we are characterized and we are playing the role we want to play. But success or failure is definitely a difficult thing to assess in our world. Foundations are not accountable in the traditional sense. They do not make a profit or a loss that can be evaluated by investors. Unlike government agencies, they are not constantly scrutinized by the press or by legislative bodies that must approve their programs and budgets, though in a world of instant feedback on the web and in the blogs, outside scrutiny has certainly increased. This difference gives foundations their freedom to take risks and to try new things not generally possible in the commercial or public sectors. But it also means that accountability is essentially self-imposed; the evaluation of performance and impact is a judgment call that must be made by a foundation’s board, CEO and staff. The Kaiser Family Foundation is trying to play a special role as an independent, trusted source of information and analysis on the national health care scene, and we evaluate our performance against that objective. We believe that role is sorely needed in the health care system today, and, based on the reception our work receives; we are convinced that we are on the right course for us. It bears noting, however, that choosing to be an information provider has real implications. First, information is costly. Analysts, policy and media and polling experts, web experts and journalists staffing a full-fledged news service all need to be paid, and it takes a real investment in in-house staff expertise to know what information to produce, how to organize it, and how to get it into the right hands. Second, even the best analysis and most balanced report can be unwelcome by those who have a special interest or an ideological point of view. We are, I would like to believe, influential and respected. But we may not be appreciated in quite the same way traditional grantmakers can be, because it is in the very nature of our mission to sometimes be inconvenient to all sides. In terms of the potential for both attention and criticism, there is a big difference between funding the work of others, and being the source of information and analysis and front page stories yourself. It is the difference between direct and indirect accountability. For foundations interested in moving in a direction similar to ours, the willingness to invest in staff capacity and expertise and an understanding that the role by its nature can bring criticism from time to time are necessary preconditions for success and peace of mind. Finally, a philosophical comment on foundations and their role in health. An insiders’ debate has been bubbling just beneath the surface for years between those who believe that foundations should be quiet charities that support the good work of others and those who believe that foundations should play a more proactive role in whatever areas they choose to work and with whatever operating styles they chose to have. I believe that the nation is best served by having a strong independent sector and that foundations should take leadership in that sector. Nonpartisan does not mean timid or invisible, and there is no way to play a meaningful role in today’s health care system without occasionally raising someone’s ire. I also believe that society is best served by having foundations of different kinds, with different philosophies and program agendas. Foundations can be liberal, or conservative, or eclectic. But in my judgment the country is best served when they are independent and not tied to organized political or commercial interests. The need for an aggressive independent sector and for a strong foundation role is perhaps greater in health than in any other area. In no field is there a greater need for an independent voice that is not driven by the desire to make money or to win votes. In no field would a role as simply a charity be less useful; foundation funds are a drop in the bucket in today’s $3 trillion health care system. That realization led us to become an operating foundation with a very targeted mission, and in our latest change in status, a public charity. But whether we were a private foundation in the very beginning, or a private operating foundation, or now a public charity, our mission and the core elements of our operating style have not changed. At the same time, it is also important to be realistic about what foundations can and cannot achieve in today’s health care system. During the years I have both worked in the foundation world and viewed it from the outside, I have often felt that foundations are overly impressed with their own importance. In health, the challenge to foundations is to understand that they are bit players in a giant health care system, but also that foundations can have a unique and vitally important role to play if they make wise choices.