In November 1996, the Kaiser Family Foundation initiated a project to examine different strategies for expanding health insurance coverage to America’s growing uninsured population. The Foundation asked two leading health policy experts with experience in Democratic and Republican leadership roles, Judith Feder and Sheila Burke, to direct the project’s work in considering and evaluating the potential for, and likely impact of, alternative incremental reform options. This continuing effort has made important contributions to the public and policy dialogue about covering the uninsured. With new proposals emerging across political parties as we head into the 2000 election, the project’s analysis of tax-based reform options along with direct subsidy or government expansion options is directly relevant and useful to the debate. produced a series of expert proposals and issue papers .

Southern Africa Grantmakers’ Affinity Group: The Role of U.S. Grantmakers in a Changing Region

November 10-12, 1999 Westfields Marriott, Chantilly, Virginia Introduction

Southern Africa has had its share of turmoil and dramatic change. Although South Africa has over the past five years established itself as a shining example of democracy and Mozambique has transformed its economy and government shattered by nearly a decade of civil war, the situation is not as favorable throughout the region.

Peace efforts in Angola have disintegrated; political and human rights are under threat in Zimbabwe; regional armies stepped in to stabilize Lesotho; trade unions and activist groups press for greater democratic rights in Swaziland. Besides the continuing political challenges, the historical social and economic development needs are compounded by an accelerating HIV/AIDS epidemic which threatens to decimate the region.

Proposal

Private U.S. funders have played a long running and important role in the transformation of the region. The question in the present context, however, is how effective can grantmakers and donors be in this changing environment? Is the political environment conducive to sustainable progress on social and economic needs? What are the prospects for civil society in the region? Will all our efforts be swamped by the AIDS catastrophe? How do we work effectively with regional governments, non-governmental organizations and the private sector? How can private funders better leverage their resources and impact?

As part of an on-going series of meetings designed to foster U.S.-Southern Africa independent sectors linkages, the Affinity Group plans to hold a 2-day workshop to examine these pertinent questions and to exchange practical ideas about increasing the collective effectiveness of private U.S. funders in southern Africa. The emphasis will be on real examples of effective grantmaking, program interventions and case studies of private-public collaboration and partnerships, as well as prospects for increasing U.S-southern African linkages.

The workshop will include an opportunity to engage in discussion with resource persons from southern Africa, as well as high level representatives of U.N. agencies, the World Bank, and U.S. government.

Proposed Discussion Topics

• Southern Africa in the post-Mandela era: Political, Economic and Social Challenges
• What Lessons Have Private Funders Learned in Southern Africa?
• Case Studies of Effective Grantmaking
• Collaborating with Bi-Lateral and International Donor Organizations
• Investment Driven Grantmaking
• The Prospects for Civil Society: Examining The Enabling Environment
• Examining Practical Examples of Public-Private Partnerships
• Developing Partnerships between funders, government and non-government organizations
• The Sustainability Conundrum: Indigenous Philanthropy, Endowments
• The HIV/AIDS Epidemic: Implications and Responses
• Making the Affinity Group a more Effective Resource

Outcome

It is anticipated that participants will come up with a viable plan of action for the way forward to effective grantmaking. This will include drawing up a practical outline/timetable for implementing the recommendations reached at the end of the workshop.

Results from the 1999 Survey of Experiences with Medicare HMOs

This report examines the effects of Medicare HMO withdrawals on elderly and disabled beneficiaries who were involuntarily disenrolled from their HMO at the end of 1998. Based on a nationally-representative survey, the report describes new insurance arrangements made by beneficiaries after their HMO withdrew and considers the effects of this insurance transition on benefits, costs, and continuity of care. The study finds that most beneficiaries fared relatively well after their Medicare HMO withdrew, but more than a third of all disenrollees experienced a decline in supplemental benefits, nearly 40 percent incurred higher premiums, and over 20 percent had to find a new personal doctor. Beneficiaries who experienced the greatest problems after their HMO terminated coverage tended to be the under-age-65 disabled, racial and ethnic minority beneficiaries, the poor and near-poor, and those reporting fair or poor health. A paper based on the findings in this report appears in the November/December 1999 issue of Health Affairs, Volume 18, Number 6.

• Report

This study of Native Americans health care funding and expenditures includes the following: An analysis of all sources of financing and the level of total health expenditures by and on behalf of Native Americans, a detailed analysis of the same data for each of the 12 Indian Health Service areas across the country, an estimate of per-capita spending for health services to Native Americans overall, an illustration of the tribal discrepancies in per capita spending and a projection of the increased cost if Native Americans were provided with a typical employment-based insurance benefits package.

• Report

An analysis of issues affecting reauthorization of the Indian Health Care Improvement Act. The study examines the historical impact and effectiveness of the current law, its relevance in the context of the contemporary health environment and the issues pertinent to discussions about reauthorization of the Act.

• Report

“Capping” a Family’s Benefits

Policy makers have long grappled with the complex questions of how to reduce poverty and promote economic self-sufficiency among the poor. Recent efforts have focused on how to influence key behaviors such as the decision to have children outside of marriage. One common legislative proposal has been to eliminate the traditional incremental increase in monthly benefits families typically receive after another child is born. This policy has been dubbed a “family cap” or “child exclusion.” This issue brief reviews federal and state laws related to the family cap and summarizes existing research findings about the impact of these policies on birth rates, abortion, and contraceptive use. It also examines public opinion on the subject.

• Issue Update

Southern Africa Grantmakers’ Affinity Group

As part of an on-going series of meetings designed to promote and strengthen U.S. – Southern Africa independent sectors linkages, the Southern Africa Grantmakers Affinity Group is planning a 2-day meeting focused on defining and examining the role of grantmakers in the region in the light of remarkably changing circumstances. The meeting, entitled “”, is planned for Washington DC on November 10 – 12, 1999, and will be attended by 25-30 participants. Participants will mainly include a small core group of U.S. private funders, as well as Africans from the independent sector and regional governments, representatives from the World Bank and the United Nations, and the U.S. administration.

The Southern Africa Grantmakers’ Affinity Group is an informal association of 55 private U.S. foundations and corporate giving programs with interest in southern Africa established in 1988 with the objective of facilitating communication and collaboration among the funders, as well as nurturing increased private American grantmaking in the southern Africa region.

• Agenda
• Program

The Role of U.S. Grantmakers in a Changing Region

The Southern Africa Grantmakers Affinity Group

November 10 12, 1999

The Westfields Marriott Hotel

Chantilly, Virginia

AGENDA

November 10

3:30pm on-goingCHECK-IN

6:00pm 8:00pmDINNER RECEPTION: Welcome & Opening Discussion

Jeffersonian VI RoomTopic:“Southern Africa: Challenges and Prospects”

• Amb. James Joseph, U.S. Ambassador to South Africa

November 11 (casual attire)

6:30am 8:30amBREAKFAST

Fairfax Dining Room 1

9:00am 9:15amINTRODUCTORY REMARKS

Grand Dominion VI Room

9:15am 9:40amKEYNOTE ADDRESS “The Role of Private Funders in Southern Africa: Pushing the Envelope or Swimming with the Tide”

• Yolanda Richardson, Senior Vice President, Africare

former Program Officer, Carnegie Corporation of New York

9:40am 11:00amPANEL DISCUSSION: Response from the Region

• Panelists:

• Hope Chigudu, Co-Founder, Zimbabwe Women’s Resource Centre and Network, Zimbabwe
• Sibongile (Bongi) Mkabela, Senior Programmes Manager, Nelson Mandela Children’s Fund, South Africa
• Edgar Pieterse, Executive Director, Isandla Institute, South Africa
• Carlos Fumo, Executive Director, Foundation for Community Development, Mozambique

11:00am 11:15amBREAK

11:15am 12:30pmROUNDTABLE DISCUSSION:

Grand Dominion VI Room “Prospects for Civil Society and the Enabling Environment in Southern Africa”

12:30pm 2:00pmLUNCH

Fairfax Dining Room 1

2:00pm 3:00pmBREAKOUT INTO WORKGROUPS

Workgroup 1:Developing guidelines for effective grantmaking (investment driven grantmaking; indigenous philanthropy, endowments). Adams Room

Workgroup 2: Examining practical recommendations for developing and sustaining partnerships between bi-lateral and international donor organizations, funders, NGOs and government. Grand Dominion VI Room

Workgroup 3:Making the Affinity Group a more Effective Resource. Hamilton Room

3:30pm 5:00pmWORKING GROUPS REPORT BACK AND DISCUSSION

Grand Dominion VI Room

7:00pmDINNER

Grand Dominion VI RoomTopic:“The HIV/AIDS Epidemic: Implications and Responses”

• Dr. Olive Shisana, Executive Director, Family & Community Health, World Health Organization, Geneva

November 12 (casual attire)

7:00am 8:30amBREAKFAST

Fairfax Dining Room 1

8:30am 10:30amROUNDTABLE DISCUSSION:

Grand Dominion VI Room “Practical Ideas, Strategic Realities, and Perceived Priorities”

11:00amCHECK-OUT

This report reviews how states have responded to the $500 million federal fund that was created by the federal welfare reform legislation in 1996 to help states maintain Medicaid coverage for individuals affected by welfare reform. State Medicaid officials were asked whether they have drawn down federal funds from the $500 million fund; to describe the factors that influenced their decision; and what activities they are supporting with the additional federal monies. The paper describes the current status of the $500 million fund and highlights how states are using this new funding.

The Difference Different Approaches Make: Comparing Proposals to Expand Health Insurance

This paper estimates and compares the impacts of alternative mechanisms for expanding health insurance coverage. A variety of approaches-expansions of existing public programs, direct subsidies, and tax credits-and target populations-including children, poor adults, parents of Medicaid- or CHIP-covered children, and early retirees-are considered. The impacts of the proposals on coverage, costs and other program outcomes are compared. This paper is part of the Kaiser Incremental Health Reform Project.

• Report