We’ve Only Just Begun

I’ve been writing about collective action in philanthropy. But what happens when it ends?

Health Care for American Now (HCAN) is the entity set up to manage key elements of the campaign to pass the Affordable Care Act, aka Obamacare. Atlantic Philanthropies, among others, made heavy investments of time, talent, and treasure, in helping HCAN achieve its goals. And achieve them it did – against long odds, the ACA was passed. And then a couple of years passed while bureaucrats talked about what the rollout would look like.

Then came October 1, 2013. And all of a sudden, Obamacare was a mess. The initial rollout of healthcare.gov was a complete disaster, and even now, the site is plagued by myriad problems. As I’ve written before, it’s important to remember that part of the reason so many people hate the government so much is not primarily ideology or having the wool pooled over their eyes, but the low quality of their day-to-day interaction with government services, whether the IRS or the DMV. The fiasco of healthcare.gov was this grievance on an epic scale.

In the midst of the recovery from the bungled initial rollout, HCAN has, according to its plans, shut its doors, as of December 31, 2013. “It may seem a funny time,” writes former national campaign manager Richard Kirsch, :with the current fracas over the implementation of the Affordable Care Act, but that is the point. The organization’s campaign mission was to win passage of a law, a mission extended to include ‘win and secure’ the ACA.” But wait! What about implementation?

There’s a lesson here for philanthropy: It’s not enough to get the policy passed. It has to be implemented well for the change to truly stick. Where’s the coalition for effective implementation of healthcare reform? HCAN did its work superbly well, and is to be commended. But where was the planning for the implementation phase?

We have the opportunity to learn from this experience. If comprehensive immigration reform happens this year, it won’t be enough. There have to be plans in place for effective implementation. The 11 million people who could be on a path to citizenship, like the tens of millions potentially covered under the ACA, deserve no less. Lift your sights up higher, funders, and see the true horizon.

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