Tuesday, April 16, 2013

A Funders View of Medicaid Extension

Since our inception in 1996, the Sisters of Charity Foundation of South Carolina has invested more than $46 million in direct grants, supporting programs to help poor and underserved communities. In the past 10 years, foundations across the state collectively have invested more than $1.2 billion in philanthropic dollars to improve the health and well-being of individuals, families and communities struggling to overcome impoverished conditions.

As private funders, our work has taught us many lessons about the poor. Generational poverty is not a personal choice but a set of complex challenges that cannot be fixed instantly. Several factors have pushed many middle-class South Carolinians below the poverty line, including unanticipated job losses and a struggling economy. South Carolina’s No. 1 contributor to health disparities is poverty, and it has been for a long time. Individuals and families living in poor communities often lack a health-care provider, which can result in overlooking chronic health problems until they become acute, and then patients must make critical health choices without the necessary resources.

It is not unusual for a poor family to have to choose between buying food, paying the electric bill or purchasing medicine. I remember one woman I met whose family spiraled into homelessness because both of her children had chronic health conditions. The mother was not eligible for Medicaid. Because of the demands of taking care of her children’s medical needs, she lost her job, and as a result she lost her home and quickly fell into poverty.

S.C. politicians, health-care professionals, hospital representatives, businesses and individuals are debating whether our state should expand the Medicaid program under the Affordable Care Act. Had that expanded health coverage been available, that family would have been eligible for Medicaid. That mother would have remained an employed, taxpaying member of our society. That family would not have lost everything.

South Carolina’s philanthropic and nonprofit sector is doing its best to improve the health of the poor in all 46 counties. Our mutual goal is to care for the most vulnerable members of our communities and to promote and defend human dignity.

It is a sad reality that the voices of most people who will be affected by Medicaid expansion are not being heard in this debate. They simply listen to others with more power and influence voice their opinions. Many others who ultimately will benefit from Medicaid expansion are gainfully employed and contributing members of society; they just don’t have the health coverage they desperately need.

Foundations across South Carolina have invested millions of dollars in programs to provide opportunities for children to reach health-care providers, developed much-needed oral-health programs, supported free medical clinics, promoted healthier eating habits and helped families learn how to deal with and prevent illnesses. These efforts are important but pale in comparison to what Medicaid expansion could do for hundreds of thousands of people in the state.

Without an expansion of Medicaid, we will see a new coverage gap. We can argue forever about financial responsibility and the federal government’s role vs. the state’s responsibility. It is the belief of most of us working in philanthropy that there is not a policy decision that has more potential to improve health access and to also improve the health status of our state than extending Medicaid coverage. We have a moral obligation to help the many uninsured families across the state to ensure their voice is heard.

Thursday, April 11, 2013

Everyone Has a Story: A Reflection on 2012 Listening Sessions


Sometimes we meet people whose expressions and face momentarily stop us in our tracks, but we ignore the quiet invitation in their eyes to empathetically listen to their story. In the nonprofit and philanthropic world, this can too often be the case. Our tireless push to meet endless need, pressing deadlines and other urgent tasks which enable us to serve can pull our attention away from giving the person in front of us our undivided attention. Unfortunately, many people who experience poverty every day face marginalization within the various systems they encounter. Not only can this make them feel “invisible” when their voices are missing or intentionally overlooked, the organization loses out on important insights that can strengthen the effectiveness of their work. A recent Stanford Social Innovation Review Spring 2013 article Listening to Those Who Matter Most, the Beneficiaries states, “The views and experiences of the people who benefit from social programs are often overlooked and underappreciated, even though they are an invaluable source of insight into a program’s effectiveness” (p. 41).

Since 2010, the Sisters of Charity Foundation of South Carolina has listened directly to the voices of individuals and families through Listening Sessions. Our Listening Sessions engage families experiencing poverty by listening directly to their stories in the supportive presence of community stakeholders that walk alongside them each day. Structured differently than a grantee site visit, Listening Sessions create a collective space to engage individuals served with the primary focus on their perspectives. In 2012, three Listening Sessions were strategically designed to uplift the stories of individuals served by current Foundation grantees. The first Listening Session held in April 2012 in partnership with Helping and Lending Outreach Support (HALOS) in Charleston provided an opportunity to listen to the stories of kinship caregivers who live each day as the Unsung Heroes in the lives of children they care for. The second Listening Session in collaboration with the Puentes Project/PASOS in Columbia gave us the opportunity to hear from the Puentes Community Ambassadors who are compassionately leading as Bridges of Light in their communities. The third Listening Session held jointly with GRACE Ministries in Georgetown brought us face-to-face with home-bound and chronically ill senior citizens whose lives are Touched by Grace by the volunteers that serve them.

We listened deeply and empathetically to these statewide issues at a local level through the perspectives of individuals served, applying Grantmakers for Effective Organization’s (GEO) Widespread Empathy definition of empathy to our work. GEO defines empathy as “the ability to reach outside ourselves and connect in a deeper way with other people – to understand their experiences, to get where they are coming from, to feel what they feel” (p. 4). What we heard surprised us; and at times even moved us to tears as we listened to their struggles, hopes, and fears. We walked away reminded that everyone has a story. When we stop to listen empathetically to the experiences of those we serve, their stories can illuminate and inform the ways grantmakers and nonprofit organizations strategically respond to the remaining unmet need.

Read the 2012 Listening Session Summary, Everyone Has a Story.

Written By: Stephanie Cooper-Lewter, Ph.D., Senior Research Director