After nine months of the Trump presidency paired with unified Republican control of Congress, it is very clear that, at all levels, our assumptions about public policy and funding need to be reconsidered. It doesn’t matter whether you agree or disagree with the new administration’s direction; if you are responsible for governing an organization that partners with a state or federal program, you are facing a very changed landscape.
For example, as October began, funding authorization for several long-standing federal health insurance programs was allowed to lapse. Nonprofits depending on funding connected to the Children’s Health Insurance Program (CHIP), Community Health Centers, and the Health Service Corps were left in limbo. They await word on if Congress will act and reauthorize some or all of their funding and to see if the president will agree to sign. While this drama plays to its end, they face a crisis.
Amy Simmons, who directs communications for the National Association of Community Health Centers, told the Bakersfield Californian that “Facilities across the nation have begun instituting hiring freezes, limiting hours at health centers, reducing staff hours and tapping into their reserve funds. The health center funding cliff is affecting health centers right now. You can’t deliver healthcare effectively on a month-to-month basis. That’s a lot of uncertainty when it comes to patients’ lives being on the line.” Carole Maddux, the executive director of the Good Samaritan Health & Wellness Center in Jasper, Georgia told WABE that “it’s affected her ability to plan for the center, which has been expanding. For instance, I’ve got several openings on my staff right now that I’m trying to fill, and in the back of mind there’s always this uncertainty because the funding hasn’t been renewed yet.”
These are examples of nonprofit leadership stepping up in the midst of a funding crisis to make the necessary decisions in response to an immediate threat, limiting damage to their clients and their organizations. While they’re at it, they ought to advocate for political leaders to support their programs and to restore funding as well. This is hard and important work, and planning for these challenges should have begun perhaps months, or even years, earlier.
Nonprofit Quarterly, in covering the impending loss of funding for important health programs, recognized, that “the September 30th deadline was set up two years ago and so should not come as a surprise.” Was that when serious planning should have begun?
The 2018 federal budget just approved by the House targets much of the federal ‘safety net’ for drastic funding cuts. In almost every sphere of government activity, there are powerful forces pushing for rollbacks and reversals. Whether these changes make it through the Senate or not, that they’ve gotten this far should be enough to prompt serious planning to develop the strategic directions needed to respond to the “what if?” question.
So, why are we caught scrambling so often when possible scenarios become our realities? Are we afraid to place another burden on the agendas of organizations that are already stretched? Are we afraid to take on a difficult balancing act, one that requires meeting today’s pressing needs while we think through the next year and beyond? Is the discussion of unpleasant possibilities and difficult choices, like those now facing Community Health Centers, too upsetting and demoralizing to have before the checks stop arriving?
Good governance requires good planning, and good planning requires an assessment of many possible futures. It allows us to think through how we would respond to even unpleasant possibilities before we have no choice. It lets us consider new solutions. It does not guarantee a future free of pain or risk, but it gives an organization a better chance to take control of its future.—Martin Levine