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Managed Care, Medicaid, and Public Health: Building Collaborations That Work
Matthew L. Myers, J.D., President and Chief Executive Officer, National Center for Tobacco Free Kids, Washington, DC.
Kenneth T. Segel, Director, Working Together Consortium Healthcare Initiative (sponsored by the Jewish Healthcare Foundation), Pittsburgh, PA.
The 1998 settlement between States and major tobacco firms has resulted in substantial amounts of new money for States to spend as they wish. Although 30 legislatures made decisions regarding the initial payment, almost none have made long-term commitments for these funds, preferring annual decisions. The allocations for 1999 funds varied widely among the States and sometimes included non-health-related interests.
Eleven States have not made a major decision regarding these funds: Arkansas,
Arizona, Colorado, Illinois, Kentucky, Missouri, Oklahoma, Pennsylvania, South Carolina, Tennessee, and the District of Columbia. Four States may submit the decision to a ballot initiative: Missouri, Montana, Oregon, and Colorado.
As of March 1, 2000, more than 420 bills had been introduced or carried over concerning tobacco funds for this year. Noting the unrestricted nature of the funds, Mr. Myers stressed, "Unless people from both inside and outside State governments who care about healthcare get together and fight for the money, it will go somewhere else." He added that successful efforts require planning; people who want the funds for health-related issues need to be able to make the case to legislators: "This is how this
money will pay dividends."
Some States are considering selling their rights to future payments in return for cash in the form of bond sales. The rationale behind this is the States' fear that future payments will decline as a result of reduced tobacco sales or tobacco firms' bankruptcy. Mr. Myers cautioned that these deals need to be examined carefully, as the States often continue to bear primary risk and receive only a fraction of the payment value. He also pointed out that a lump sum payment could mean no stream of money for health-related purposes over the long haul and that tax rules could require the money to be used for capital projects if the bonds are tax-exempt.
Kenneth Segel noted that new initiatives have multiple possibilities to tap for resources. These include:
- Your own organization (he noted, "You have a lot of resources but typically don't think that way").
- Business and labor, which have indirect but powerful access to resources.
- Foundations, including conversion foundations, community foundations, and national foundations.
- United Ways.
Mr. Segel offered a number of considerations and suggestions for entities seeking help from foundations:
- Think of foundations as "investment brokers" or "venture capitalists."
- Recognize that foundations can provide more than just funding (e.g., act as an independent convener, provide access to other partners and resources, support market research and planning, help in negotiations).
- Understand that foundations need your ideas. Be prepared to discuss how your initiative offers a map to community solutions.
- Recognize recent trends in philanthropy and that foundations are frequently products of health systems change.
- Realize that foundations tend to focus on population-based healthcare.
- Right now, foundations are very interested in safety net demonstrations, safety net policy, safety net advocacy, and moderating the effects of aging.
- Community foundations and United Ways may be overwhelmed by the scale and complexity of health-related issues, so they may focus on collaborations (e.g., with government, national philanthropies).
- National foundations are increasingly interested in partnering with local philanthropies.
Mr. Segel also offered some "do's" and "don'ts" in approaching private funders. The "don'ts" include:
- Assume the foundation hates everything about the "new world" or liked everything about the old.
- Ask the foundation to replace government funding or to fund ongoing gaps unless there is a long-term plan to replace these funds.
- Focus on "kiss up" relationship-building rather than demonstrating that this initiative will get something done.
The "do's" include:
- Develop relationships with funders outside of those times you're approaching them for help.
- Seek ways to integrate with ongoing funding sources, not foundation dependence.
- Recognize the foundation's desire not to "spit in the ocean."
- Look to key funders to organize other investors.
- Do the legwork to show change is possible and to demonstrate your commitment.
- Be open to the foundation's suggestions, but don't "be Gumby."
- Do your homework to find out more about the foundation you'd like to approach through foundation centers, libraries, GrantMakers in Health, the Internet, the foundation's mailing lists, etc.
- When you do approach, present an ambitious plan with partnership commitments. THINK BIG—try to come up with major solutions to problems.
Funds by state, from the tobacco settlement agreement: annual payments to each state. Ann Arbor(MI): The Center for Social Gerontology;1998 Nov. Internet address: www.tcsg.org/tobacco/settlement/totalfunds.htm
Collaborating with government agencies: findings from the GrantMakers in Health resource center. Washington(DC): GrantMakers in Health;1999 Nov.
Strategies for shaping public policy: findings from the GrantMakers in Health resource center. Washington(DC): GrantMakers in Health;1999 Nov.
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