Philanthropy Ohio recently submitted comments to the director of the Ohio Department of Medicaid, stating its opposition to the waiver the state will be asking the federal government to approve. The waiver, which the Ohio General Assembly required in its last budget bill, and our reasons for opposing it, are more fully explained below.
Philanthropy Ohio is a statewide membership association serving private and community foundations, corporate giving programs, government agencies, United Ways and other public charity grantmakers as well as individual philanthropists. Our mission is to be the leading voice and premier resource for philanthropy across the state, particularly serving our over 210 members who collectively awarded more than $4 billion in grants last year. We have been engaged with the department as well as the Office of Health Transformation in recent years, through our member-driven Health Initiative that focuses on the state’s health policy reform efforts. We hope that our comments in opposition to the waiver, based upon the initiative’s principals and endorsed by our Board of Trustees, provide insight into philanthropy’s perspectives on the waiver being submitted.
Ohio, with the second largest number of health-focused foundations in the country, has philanthropic organizations with deep experience and commitment to improving the health of residents and working with government to do so. In an average year, Ohio’s philanthropic organizations invest almost $300 million in grants related to health. While these numbers pale in comparison to government resources, they are nevertheless important supports in countless communities across Ohio.
Philanthropy Ohio supported Medicaid expansion, testifying at hearings and signing on to the amicus brief submitted to the Supreme Court defending Governor Kasich’s expansion. We did so because of our deep belief – based upon research – that access to care through health insurance is key to improved health outcomes for what then were about 1.5 million Ohioans without health insurance. Our engagement in education and outreach activities during open enrollment periods has been extensive, supported by our members both financially and in leadership, and we have been very pleased that so many Ohioans now have insurance that can provide them with access to the kinds of services they need to get and stay healthy.
It is for this reason that we oppose the Healthy Ohio Waiver, believing that it will ultimately result in the loss of access to insurance and care for thousands of people who are dis-enrolled. Ohio has made such great strides under the expansion by covering more than 600,000 Ohioans: why would we choose to go backwards?
When thousands of Ohioans lose access to medical services – if the waiver is approved and implemented – to whom will they turn? Philanthropy, which cannot possibly fill the resulting gap. Its resources pale in comparison to what would be needed to assure continued access to cost-effective primary care. While many of our members support health clinics in their communities, we know from that history that these clinics often operate on thin financial margins and will not be able to cover growing amounts of uncompensated care if coverage is weakened. Inevitably, there will be high use of emergency departments, which analysis from the Ohio Office of Health Transformation and Ohio Department of Medicaid (ODM) highlights as the most expensive and least efficient avenue of care.
With ODM’s estimate of the waiver affecting 1.66 million Ohioans, a conservative 15 percent figure would result in nearly 180,000 people being dis-enrolled. Indeed, other states that implemented premiums saw much higher rates of drop-off, such as Oregon with 77 percent and Vermont with 30 percent. Losing coverage due to non-payment of premiums has significant, serious, potential results:
- creates churn within the Medicaid system, with accompanying administrative impacts;
- disrupts continuity of care for patients as well as providers;
- puts individuals at higher risk for negative health outcomes; and
- increases economic insecurity.
Additionally, the implementation of premiums has potential negative consequences for Ohio’s health care providers. The mandatory collection of co-pays, for instance, will be neither administratively easy nor cost-effective and interruption of care for those with chronic conditions makes the job of clinicians more difficult. The waiver, if implemented, would also likely reverse Ohio’s cost containment of Medicaid, an issue of critical concern to the legislature and administration. Continued enrollment has been shown to increase the health of the population and lower costs of care, so the churn likely created by disenrollment until premiums are paid, would be counterproductive. And, the development of a complex system of establishing and managing thousands of Buckeye Accounts – complete with financial transactions, monthly statements, contributions and the point system for health behaviors (yet to be defined) – will be a cumbersome and costly venture.
The waiver also creates hardships for those Ohioans living on very limited incomes, as nearly half of Ohioans who earn less than $15,000: either totally lack or have limited banking access necessary to pay premiums and monitor accounts; often lack financial literacy; may have credit problems compromising their eligibility for accounts; and would have problems paying fees to access or maintain accounts.
We are also particularly concerned about potential implications the waiver has for Ohio’s most vulnerable – its children. Much of our members’ work has concentrated on ensuring the next generation of Ohioans, our children, have the greatest opportunity to be successful educationally and economically, which means they need regular access to health care. Healthy Ohio creates potential disruptions in care for children, including foster children and low income children with special needs. The potential disenrollment of parents means low-income children will face another barrier in becoming more successful.
It is for these reasons that Philanthropy Ohio believes the waiver does not advance the best interest of Ohio and its most-at-risk population.
Claudia Y.W. Herrold
I played the violin from elementary school through my first year in college, and rather enthusiastically, I might add. I didn’t play well, but I loved it. Let me clarify, what I really loved was the beautiful sound of a well-played violin… and that was rarely mine.
But as I said, I played enthusiastically, often in the last seat in the last row, but hey, someone’s got to sit there.
Finally, in college, our conductor took me aside and asked if I would consider putting soap on my bow rather than rosin. Soap, you see, would render me silent. I could still be part of the orchestra and still learn and perform the music, but I wouldn’t be the odd squeak heard too often in rehearsal.
At first, I was indignant, and I was determined to practice more. Never would I put soap on my bow, I would quit first. I huffed and puffed to a good friend who was classically challenged (he only listened to music with words and a beat you could dance to) and he actually laughed at me … he’d heard me practice.
But then he said, “You aren’t a music major, why is this so important?” That was the quintessential question that stopped my tirade and the answer became perfectly clear: I wanted to be a part of something bigger, not just a listener.
But in reality, listening was what I did best, not playing.
This is one of my first recollections of letting go of that need to be a member of the orchestra group, or of any group for that matter, and of finding peace listening. It was humbling to learn that in letting go, I could play to a strength, rather than fighting a weakness.
And as I learned through many more encounters with family, friends, students, colleagues and others, it’s important to understand where you may have weaknesses. But when it comes to what you focus on, why not concentrate only on your strengths?
Because when you put emphasis on what you do best, you don’t spend so much time trying to fix your shortcomings: you use your talents, knowledge and skills – your strengths – to do great things you enjoy.
At Philanthropy Ohio this month, the staff will participate in a workshop designed around the StrengthsFinder 2.0 assessment. My hope is that by exploring how we naturally think, feel, act and perform – as a staff and individually – we can figure out what our strengths are and then build on the areas where we all have the potential to grow and flourish.
I’d love to hear about the ways you and your organization play to your strengths and what your successes have been.
And by the way, happy 176th birthday, Peter Tchaikovsky.
It’s a great day at Philanthropy Ohio,
Suzanne T. Allen, Ph.D.
As you might imagine, our recent trip to Washington, D.C., for Foundations on the Hill was abuzz with talk about presidential candidates – with not a lot of mention about our own governor – and their prospects in upcoming primaries. Panelists and speakers in various venues were happy to predict what might happen at conventions for both parties and what that might mean for the future.
And it wasn’t all focused on the race for the presidency: added to the conversation mix was the fact that 34 senators are up for election, including several very competitive races like the Portman-Strickland matchup here in Ohio. There was quite an attitude of “inside the beltway” nearly-obsessive focus on the November election, with both parties vying for control of the White House and the Senate.
That focus played out in our meetings on Capitol Hill, where elected officials and staff alike predicted that not much would get done for the rest of this year. Which has eight months left to go. One must-pass bill, we heard, is one dealing with FAA matters, and of course, there’s the budget bill or potential for a continuing resolution to fund the government if that fails to pass.
While hearing that may have dampened our hopes for moving our issues forward this year, it didn’t dampen the voice of those who spoke on behalf of philanthropy. 153 regional association foundation staff and trustees trekked the Senate and House office buildings to accomplish a few common goals:
- Thanking those who voted for the PATH Act, which made the IRA Charitable Rollover permanent: after years of asking for reauthorization, there is no certainty for those donors aged 70 ½ or older to use their retirement assets for gifts to qualified charities without being taxed;
- Asking them to support a further improvement to that provision, to allow donor advised funds (DAFs) to receive the IRA assets: HR 4907 and S 2750 both would make that change for this fast-growing charitable vehicle (Ohio’s community foundations hold 5,095 DAFs that made grants of more than $193 million in one year; and
- Asking them to support a simplification and reduction of the private foundation excise tax: the current, two-tiered system that assesses tax on a private foundation’s net investment income is a complicated calculation that, if changed to a flat 1 percent as proposed, would provide more dollars for grantmaking.
Of our eight meetings with Ohio’s members of Congress – including those who serve on the all-important Senate Finance and House Ways & Means Committees – no one expressed concern about these provisions. But – and it’s a big but – no one held out much hope that either would move this year. That said, all also agreed that the bills and our meetings urging their passage, were important for setting the stage for the next congress. And that’s ultimately what our policy work is all about: being willing to stick with it (it took us 10 years to get the IRA Charitable Rollover made permanent) and acknowledge that policy work is a long-term venture and commitment.
Thanks to our Ohio leaders who traveled to Washington: Leah S. Gary, Renee Harvey, Heidi Jark, Kate Keller, Sylvia Perez, Brian Wagner and Marissa Williams.
Claudia Y.W. Herrold
The other night at dinner, I casually asked our waiter, “How are you?” not expecting anything other than, “Good, how are you?” But, the response I received took me by surprise and I’m still thinking about his unusual answer, which was, “I don’t know how I am. I’m trying to figure that out.”
It struck me – aren’t we all trying to figure it out?
And as we try, aren’t we also trying to balance the rest of life’s equation – which may include work, family, home, hobbies, sports and education as well as other time bandits? I’ve spent a lot – perhaps too much – of my mental real estate thinking and talking about work-life balance, and I’ve decided we should rename this elusive concept – because it’s not about balance – it’s about juggling.
Balance implies a stillness – think of the Crane Pose in Yoga – while juggling brings to mind clowns and circuses, swords and flaming batons, which in my life is more apt than the concept of stillness and flow. Balance is about all the elements somehow being equal or at least in the correct proportions, while juggling, according to its definition, is “to keep several objects in motion in the air at the same time by repeatedly throwing and catching them, and to do (several things) at the same time, while making changes to (something) in order to achieve a desired result.” I would add that juggling often amuses others…
So here’s why I’m more apt to use the term juggling rather than balance. Years and years and years ago (actually in another century), I had a graduate school professor who required each student to learn to juggle as a part of an organizational development class. It was quite a profound exercise and here’s what I found:
- You will fail, over and over again.
- You should pick easy, soft objects to start. Hurting yourself is not a good option.
- It’s easier to juggle three balls, than two.
- Gravity is a B*#@%!
- The secret of juggling is throwing, not catching.
- It starts to feel natural when you find a rhythm.
- Stay calm but move when you need to.
- And practice some more!
- Celebrate and yell “Yippee” a lot.
I also found this incredibly helpful as a mother, a sister, a daughter, a wife, an employee, a leader, a volunteer and a traveler trying to figure it all out. I know that I’ll always be a juggler rather than a balancer, and that I’ll fail, but I’ll also probably amuse others. And I’ll also say “Yippee” despite gravity.
Suzanne T. Allen, Ph.D.
Next month, Suzanne and I will lead a group of Ohio funders to Washington for our annual Foundations on the Hill visits. We’ll be joining over 125 colleagues from across the nation for a day focused not on this year’s presidential election but on the work that needs to continue regardless of the latest polling numbers and primaries. And, while members of Congress are also focused on their own election-year district work, they also have significant work facing deadlines in D.C. – like the federal budget, and this week’s hearing on tax reform proposals in the House Ways & Means Committee.
While we certainly will have a new president next year, many of Ohio’s delegation will no doubt be returning to Congress, and that’s why it’s important for us to go to D.C. this spring. We need to build our relationships and keep our issues in front of elected officials, whether there’s action this year or to prepare for next year’s policy agenda.
We had a recent conversation with Rep. Pat Tiberi (R – 12th district of Ohio), a senior member of Ways & Means, co-chair of the House Philanthropy Caucus and staunch supporter of philanthropy. He shared his perspectives on issues ranging from tax reform to charitable giving tax policy and as well as his own legislative priorities. In talking about our upcoming D.C. meetings, he encouraged us to share philanthropy’s impact stories, reminding policy makers about the importance and value of philanthropy, before talking about specific bills and issues.
We’ll take Rep. Tiberi’s comments to heart during our meetings next month, starting our conversations with examples of philanthropic work. We’ll also be thanking those who voted for the PATH Act, which made the IRA Charitable Rollover permanent. And then we’ll be asking them to do more: to make donor advised funds eligible to receive IRA assets tax-free and to simplify the private foundation excise tax, allowing more charitable dollars to flow to nonprofits addressing critical issues.
There’s still time to join us in DC – we are stronger together.
Claudia Y.W. Herrold
At two launch events last Monday, access to healthy, affordable food became one step closer to reality for many of Ohio’s food deserts. A public-private partnership has created a pool of nearly $10 million – with more dollars possible – that will provide loans and grants to develop retail groceries in low-income, underserved communities across the state.
The pooled dollars come from a variety of sources, including a $2 million state budget allocation as well as from the federal government and individual banks. Through a competitive application process overseen by the Finance Fund, grants and loans will be available “for costs associated with land acquisition, predevelopment, construction, equipment, infrastructure and related expenses as well as credit needs not typically filled by conventional financial institutions.” The Finance Fund anticipates funding 5 – 10 projects that will overcome the barriers of opening or developing retail stores. Ohio joins 10 other states with similar projects.
The fund grew out of the Ohio Healthy Food Financing Task Force that mapped nearly 1 million Ohio residents – including one-quarter of a million children – living in areas without sufficient access to healthy foods. See the report.
U.S. Representative Steve Stivers, who spoke at one of the launch events, applauded the partnership and its potential to impact areas like Vinton County, which has not had a grocery store since 2013; county residents must travel 30 miles to Athens to get fresh food. “I hope this program will help not only Vinton County but also other food deserts,” Rep. Stivers concluded.
Echoing his remarks, Ohio Representative Ryan Smith – who was instrumental in getting state funds allocated to the project – said “Access to healthy food is important to battle chronic disease, healthier Ohio citizens and a positive driver in workforce and economic development. I feel confident this program will be successful.”
Philanthropy played a strong role in getting the project to this exciting new stage, including funding reports and serving on the task force. David Ciccone of Central Ohio United Way co-chaired the task force, and these other Philanthropy Ohio members served and supported its work:
- The Cleveland Foundation
- The Columbus Foundation
- The George Gund Foundation
- Interact for Health
- Ohio Association of Foodbanks
- Ohio Children’s Foundation
- Saint Luke’s Foundation
- Sisters of Charity Foundation of Cleveland
- United Way of Greater Cincinnati
- United Way of Greater Cleveland
In addition to contributing to the funding pool, philanthropies could also think about how to partner with retailers to fill other needs, such as nutrition education, and for sustainability of local food stores. More information, along with pre-application materials, are available online.
Claudia Y.W. Herrold
We are pleased to introduce Laura Smith to the Philanthropy Ohio team. Laura will work out of the Columbus office, serving as a regional director of programs. She’ll be developing and delivering educational and professional development programs, particularly in Central and Southern Ohio. She’ll be out and about meeting members in both areas, getting to know them and learning about their work and impact.
Laura comes to Philanthropy Ohio from a background that includes corporate philanthropy. She was the senior program officer for Harvard Pilgrim Health Care Foundation in Massachusetts, managing regional grant programs addressing healthy food access and healthy aging. A native of the Dayton area, Laura earned her bachelor’s degree from Ohio University and a Master of Public Affairs degree from Brown University in Providence, Rhode Island. Laura has an affinity for all things French and loves to travel, but enjoys nothing more than a walk with her family or scoring a window seat at a local coffee shop.
I asked Laura to tell us a bit more about her.
Best advice I’ve ever received:
I’ve received great guidance over the years, but a recent favorite is to bring your “whole self” to work; don’t check a part of yourself at the door. It creates a more authentic environment and contributes to the success of the organization and your own happiness.
Three goals for 2016:
Get settled – we recently relocated back to Ohio from Boston, so we have a lot of exploring (and unpacking) to do;
Declutter the various email inboxes on my smartphone. It’s a pretty sad state of affairs in there; and
Meet and engage with our members, particularly here in Central and Southern Ohio.
What’s surprised me so far:
It isn’t a surprise, but I’ve been consistently amazed at the many talents of my new colleagues and our members and the warmth with which they welcomed me to the team.
What I do when I’m not at work:
Go on low-key hikes (aka walks in wooded areas on well-maintained paths), cook up fun recipes and attempt “Pinterest Fail”-worthy crafts and activities for my toddler.
What I’m reading:
Next up is Oran Hesterman’s Fair Food.
Who I’m following on Twitter:
Claudia Y.W. Herrold