The Robert Wood Johnson Foundation and the Politics of Health Care Reform

Communications, Advocacy and Policy Development

A formidable challenge for any foundation trying to reform health care policy is translating the broad principle of assuring that all Americans have access to high-quality health care—which for all practical purposes means expanding health insurance coverage—without becoming embroiled in partisan politics.

For the most part, foundations have tended to avoid the issue by funding nonpartisan research and disseminating it to policy-makers—cerebral activities that run little risk of arousing political opposition. It is when foundations begin to take a more active role by funding advocacy organizations, conducting media campaigns, and supporting activists that they run the risk of being accused of violating lobbying laws or taking sides politically. As Beth Stevens and Lawrence Brown observed in the very first volume of the Robert Wood Johnson Foundation Anthology series, in 1997, “Foundations are condemned to falter in pursuit of health reform because their goals are high, the means available to them are limited, and health reform combines complicated policy problems with acute political conflicts.”

In this chapter of the Anthology, Brown University political science professor James Morone explores how the Robert Wood Johnson Foundation used the more activist tools at its disposal—particularly advocacy, policy development and communications—in an attempt to bring about health care reform. The Foundation found itself entangled in partisan politics when Republicans accused it, in 1993 and 1994, of promoting the Clinton health reform plan, and this criticism has affected the way the Foundation has approached health policy in the succeeding years. As Morone notes, since that time, the Foundation has adopted a more nuanced and cautious approach to encouraging health reform at the national level.