Can foundations be agents of change in health policy? Lessons from efforts to expand and preserve health insurance coverage

This study examines the commonalities as well as the distinct interests, resources, and strategies of foundations that consciously participate in health policy matters. Based on document review and in-depth interviews conducted in 2002 and again in 2007, we compare the activities of twelve national, state and local foundations in the area of expanding or protecting health insurance coverage. This research describes and analyzes foundations' choice of issues, audiences and partners, jurisdictions, and stages of involvement in the policy process. It identifies some clear patterns in the allocation of resources and examines what those patterns suggest about foundation preferences and capabilities for improving health insurance coverage. The longitudinal design of this study provides a unique opportunity to: (1) understand how changing political, economic, fiscal, and organizational conditions affect foundations' priorities, program design, implementation and evaluation, and program impacts; and (2) assess how foundations learn from perceived successes and failures in making determinations concerning future program development and allocation of their resources. The study also draws several lessons from these foundations' efforts, suggesting how they might better leverage their potential impact as policy actors.