The passage of the Affordable Care Act (ACA) in 2010 brought with it countless opportunities, both to expand access to uninsured populations systematically excluded from the healthcare delivery system, as well as to strengthen and innovate beyond the existing system's status quo. The California Endowment became an early champion, providing over $350 million to support ACA implementation with a range of grantmaking strategies focused on outreach and enrollment, health workforce development, and systems change innovations. As part of its effort to understand the impacts of its ACA and prevention-related grantmaking, The Endowment contracted Engage R+D to develop a series of learning products between 2017-2020.
With a focus on The Endowment's ACA grants, this learning brief explores the intersection between power building, racial equity, and systems transformation. It is based on the synthesis of various evaluation efforts over the last decade and more recent interviews with key stakeholders. We share important lessons from this body of work that can help inform efforts to transform mindsets, policies, practices, and systems in the years to come.
Recognizing that deeply entrenched inequities exist and, in some cases, have been exacerbated by the very policies meant to reduce them, population-level health improvements will require a more explicit focus on racial equity along with substantial financial investment, time, political will, and cross-sector collaboration.