Episode 71. Intersections of Policy and Philanthropy Interview with Cara V. James, PhD
Michelle Rathman: Hello one and all, and welcome back to a brand-new episode of The Rural Impact. I am Michelle Rathman, and for those of you joining us for the very first time, thank you. We are so glad that you're here. As a reminder, we are the podcast that works hard to connect the dots between policy and rural everything.
Well, today's episode is one. I know I say this a lot. It really is one that I have been looking so forward to all year, and when I tell you who our guest is, you will understand why. But before I reveal that information to you, let me first start off by extending an invitation because in case you missed the opportunity to join us here for our livestream event in the studio.
That was a recording that we did on November 20th which happens to be National Rural Health Day. Don't you worry, because the entire event is posted on our Rural Impact YouTube channel, and the links, of course, will be on our website, theruralimpact.com. But in this episode, I wanna tell you that I had the privilege of welcoming nine guests to the show, each of them participants in a most unique multi-year initiative in rural Massachusetts.
Now you can find the links again on our resource page, but for now, if you are listening on your favorite podcast channel and scrolling around during some holiday shopping, take a quick detour to this website. Okay, you ready? Here we go. It is theruraleffect.org. Again, that's theruraleffect.org, and I am encouraging you to visit this site because well, at the end of the day, you're gonna find the work of over a dozen nonprofit, small community organizations doing outstanding work to address the gaps that are all too familiar in rural life.
From food security to transportation, economic development and empowerment, to building healthy communities and finding the all-important common ground, these stories will not only inspire you, but I do believe that they can provide you with kind of a roadmap for how to make waves of change in your own rural community in the coming year. We have, witnessed a lot of chaos in 2025 for rural communities. And so just in terms of the resources, if you go back and listen to any of our episodes this year, you'll get caught up as to why.
But the good news is these organizations, as I said, can help teach us the way forward. Okay, now let's get into today's topic. All year, we've been wanting to do a series focused on the intersection, very important intersection between philanthropy and policy. And while the last episode does do some of that, because each of the nonprofits featured while they're able to do their work because of support through grants, today's guest takes the conversation to a whole new vitally important level.
Why? Well, in case you have not been following the news about what's happening to America's nonprofits, here are just a few things that will help get you up to speed. So, hang tight with me for a minute, okay? Because first is an article, just an excerpt that I'm gonna read to you from Forbes, which was published on July 24th, 2025. Doesn't that seem like a million years ago? The title is as follows, "A Quiet War is Targeting America's Nonprofits. Most Don't See It Coming."
One excerpt from this piece from Jason Wingard reads this, "President Trump's second term is triggering a systemic unraveling of nonprofit America. Federal grants have been frozen. Education, healthcare, public broadcasting, the arts and global diplomacy programs are all taking direct hits. Foundations can't keep up with the wave of emergency appeals, and many nonprofits are running out of lifelines. With government dollars now used as leverage, the institutions that have long held civil society together are being quietly dismantled."
It goes on to say how, "Trump's return is disrupting the nonprofit economy. Well, it didn't start with a budget cut. It started with a message; you no longer matter. And for nonprofits across America, that message is being delivered in silence, shortfalls and shutdowns."
Now, another piece that appeared in Politico in April of this year titled "Trump's War on Nonprofits," the authors, there are many of them, wrote this. And again, we'll put these links on our website. "The Trump administration is mounting a sweeping offensive on America's nonprofit sector, deploying a blend of funding cuts, the elimination of tax benefits, bureaucratic paralysis, and even installing a small DOGE team to target organizations that challenge the President's agenda.
The tactics include indirect measures like hollowing out the entire grant-making agencies like AmeriCorps and USAID and making federal personnel or contract cuts at other agencies so deep that groups can no longer access grants or loans. This part is shocking folks, but there is also more direct efforts like visits from DOGE or the USDA halting 500 million in deliveries to food banks.
DOGE staffers have attempted to install their own operatives inside major nonprofits like NeighborWorks and the Community Development Group and the Vera Institute, which simply advocates for lower incarceration rates.”
So, when I read that. It was so chilling to me to think about, just the implication of all of these things that were happening just a little, it makes less than six months ago, but perhaps the most compelling words that I have read on the matters of public policy and philanthropy come from my guest today in a post dated February 25th, 2025.
This is just after I happened to see this person while I was in Washington, DC. The blog that she wrote is entitled, "What Do We Stand For?" And she wrote, "philanthropy has a long history of supporting social change. Foundations provided critical support to the Civil Rights Movement through the voter education project, legal defense, and more.
Philanthropy helped design the Head Start program and continues to support its implementation. Funders also supported analysis to advance the Mental Health Parity and Addiction Equity Act of 2008, outreach and enrollment for the Affordable Care Act and numerous advocacy efforts at the state and local level.
In contrast Philanthropy also helped fund the effort to overturn Roe v. Wade and students for fair admissions, the organization that sued Harvard and the University of North Carolina over their admission practices.”
This guest goes on to say, in this blog, "change is possible, but it takes time, effort, and sustained support."
These are the words of Cara V. James, President and CEO at Grantmakers in Health. And I am honored, and I mean that to have had the opportunity to sit down with Cara just before the Grantmakers in Health convened their in November 18th through 21, Health Policy Exchange. which focused squarely on the nationwide movement, hundreds of nonprofits across the us, which is protecting the freedom to give.
Now a few more things about Cara that I think are important to share for you to know is that prior to joining GIH in 2020, she served as the Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services, of course at CMS and in the US Department of Health and Human Services, where she provided leadership, vision and direction to advance health equity.
Under her guidance, CMS developed its first CMS equity plan to improve quality in Medicare. Its first rural health strategy created an ongoing initiative to help individuals understand their coverage and connect to care, increase the collection and reporting of demographic data, and develop numerous tools and resources to once again advance health equity.
I'm gonna tell you, you will be hard pressed to find another person more dedicated to health equity and more qualified to discuss the critical importance of building strong partnerships between government entities and nonprofit organizations serving rural populations, which is by my count, almost 65 million people.
So, with that said, it is my distinct pleasure to welcome Cara V. James to the show. I am ready for this conversation. I know you are too. You know the drill. Let's go.
Michelle Rathman: Cara James, President and CEO of Grantmakers in Health, welcome to The Rural Impact. I'm so thrilled that you are here. I've been wanting to have this conversation with you for a very long time. Thank you for joining us.
Cara V. James, PhD: Thank you so much, Michelle, for having me. I really appreciate the invitation to be here.
Michelle Rathman: Oh my gosh, you, the work that you're doing, could not be, I mean, it's always important, but to me, in my mind, it could not be more important than where we are today. We are recording this, just entering into our second week of February, or excuse me, of November, February was the last time I saw you in person.
And of course, by the time this episode drops, you will have just sunset the Grantmakers in Health, Health Policy Exchange, and I suspect this year was like no other gathering. We'll kind of think ahead because it's been quite a challenging year for nonprofits, and I've been following your work and so many other nonprofits out there fighting the good fight.
But before we dive into all of that, for our listeners who are not familiar with the outstanding work that your organization does, the organization you lead, what should we all know about Grantmakers in Health?
Cara V. James, PhD: Well, again, thank you so much for having me. Grantmakers in Health, we are what's called a philanthropy infrastructure or philanthropy serving organization, and that means we work with health foundations across the country. We've been in existence for more than 40 years, helping foundations and others learn, connect, and grow. So, we provide educational programming such as our conference that you've mentioned, which is our health policy one.
We also have another conference that we do in June, which is covering a breadth of topics in health beyond the policy focus. We provide strategic guidance to, health funders to help them in different ways. We provide surveys and research around what the field is doing. So, we're like that connective tissue of health philanthropy. Despite our name of Grantmakers in Health, what we are not is a foundation ourselves. So, a lot of people think that we do grants and we do not.
We primarily, as I said, work with the foundations to help them do their work in service of better health for all through better philanthropy.
Michelle Rathman: I love that you have such a big, big picture of what all this means. So, Cara, back in, as I said, last time I saw you was in DC. We were at a policy conference together, and I think it was maybe just after you wrote this piece, you wrote, blog if you will. And it's entitled, "What Do we Stand For?"
And if you'll indulge me for just a moment, I wanna just read one piece of this because it just, again, it just rips at my tugs, at my heartstrings. And I've read it a few times, so it goes like this. "Health philanthropy is at a critical juncture. We cannot do what we've always done or even what we did during the pandemic.
If the circumstances are different during the pandemic, numerous funders increased their giving to support the needs of their community, but those increases were time-limited, and they were done in concert with additional federal and state resources, not as a replacement for them. We are already working to protect the communities we care about from potentially devastating budget and programmatic cuts and from legislation that would limit our ability as a field to do the work we need to do to improve health and reduce disparities.
But we know funders do not have the same resources as the government and philanthropy cannot fill the gap. Should Congress pass trillions of dollars and cuts? We also know that it's the government's responsibility to address social issues such as health and education on a large scale. While philanthropy tends to focus on unmet needs and things the government cannot do, if philanthropy steps into what is fundamentally a governmental role, it absolves the government of its responsibility and we remove the incentive for government to fulfill its role, leaving philanthropy to try and fill the gap for an undefined amount of time."
Fast forward. We are in November of 2025. Talk to us a little bit about that message. The unprecedented challenges facing philanthropic organizations serving the unmet needs of rural Americans from February through this day.
Cara V. James, PhD: Yeah. So, hearing you read that. It just kind of strikes me about how much of that unfortunately we have seen and are continuing to see. So, since February and even before, foundations have received like undetermined number of requests to fill in for so many of the places where cuts have happened or been threatened. And we've seen in some cases, you know, one foundation I spoke with has seen a sevenfold increase in their declines because of how many requests they're getting.
Another, foundation that I spoke with put out a request for proposals. They're a small foundation and they plan to award six awards in this program. They did this two years ago and they received 60 applications. They did it this spring and received 690 applications. It is taking a toll in terms of just the amount of time and volume of requests, but also, as I said in that piece, philanthropy cannot step in and fill the role of government. It does not have the dollars to do that, first of all.
The other thing that we're seeing, we did some recent polling ourselves and 60% of engaged voters think it is responsibility of philanthropy to step in and replace government. And so again, math doesn't work on that. There are not enough dollars.
And as we said in terms of what is that role of government? Government's role is to provide and represent for its citizens and provide essential services such as education, infrastructure, health and safety. And we're seeing this government move away from that, which is leaving real holes in a lot of communities, particularly underserved communities like rural and other tribal areas and other spaces. And it has the risk of really increasing disparities that we have already seen before we started this, and worsening the impacts of that. And so, it is also one where philanthropy really does work best when we're complimentary to government not replacing and supplanting, and again, can't do it even if we wanted to.
But really trying to fill in those places where we can. And there have been places philanthropy has stepped in. But again, there's so many places where the need continues to exist and we have not got the resources to fill all of those needs.
Michelle Rathman: Yeah, especially now, because if we are looking down the road, I mean obviously we're, we've been sitting on this issue with SNAP and the on again, off again. So, 42 million people. We've done a lot of conversation on this podcast about what that does for rural Americans. And I find it really interesting, the irony here, maybe, the contradiction, I suppose the protecting the freedom to give.
I mean, that is this year's theme for your health policy exchange, protecting the freedom to give. In April of this year, the Council on Foundations released a public statement from philanthropy inviting all charitable organizations to join together to protect their collective freedom, to express themselves, to give and to invest in their communities.
So, I find it really just amazing 750 plus organizations signing onto this public statement, including your organization. Let's talk about that for a few moments, because if philanthropy is supposed to step in, you know, where the government is walking away from its responsibilities, and yet the government is attacking nonprofits and philanthropies for giving.
Let's have a conversation about that.
Cara V. James, PhD: Yes it is the irony at a time when the need is growing and yet there are attacks on the ability to do that. And you know, when you think about what the First Amendment says in terms of making sure that Congress does not pass any laws that are abridging people's freedom of religion or, freedom of speech, or freedom of assembly, or the right even to petition the government, for redress and grievances.
And yet at this time, starting even in January with some of the first executive orders, philanthropy was listed as a target potentially for some of those related to diversity, equity, and inclusion. More recently with some of the efforts attacks on political violence, and the executive memorandum on Antifa.
Again, you're now seeing attacks on philanthropy and philanthropy and what people choose to give their money to charity for is a fundamental expression of that freedom of speech. We cannot even if we don't like where people are using to send choosing to send their money, that is their First Amendment right to give to the causes and the organizations that are supporting their values and aligning there, and they, we don't always see eye to eye on that.
But again, it is our fundamental freedom of speech and expression of how we use our own dollars. And those foundations that are supporting these communities with root, helping with SNAP, helping to make sure community health centers have their needs helping to make sure kids are able to continue to learn and have environments that are healthy and thriving, as we're seeing cuts in fundamental programs in those spaces of education, of housing changes that we're seeing that philanthropy steps in to fill many of those voids in their communities and has always been there. But again, can't do everything. And there's some things that philanthropy has supported that we may not like because they disagree with where we are principally.
But again, it is the fundamental freedom of speech for people to choose the causes and the organizations that they want to support. And it is a founding principle of our democracy that is under attack at this moment, and where foundations are having to spend dollars and resources defending that, those dollars could be better spent in the communities that they're trying to help and support.
Michelle Rathman: Isn't that the truth? I've been thinking about that so much. Kind of like defending the indefensible and all the money that's going into the, the legal, the legal funds for all of this fight. But you have to do it. I wonder, since I won't be there at a conference, what are you hoping that comes out of this?
I mean, you, you have great conversations and what might be that call to action from the Protecting the Freedom to Give, theme of your conference. What can we all take away from that before we move on to the next subject?
Cara V. James, PhD: So one of the things is, if you'll miss this meeting, but there's the opportunity in June where we will continue these conversations. And the theme of our Annual Conference in June will be Life, Liberty, and the Pursuit of Health. And as we think about what we will be discussing in next week at the conference, it is the policy impacts of a lot of the policies that we have seen in these first few months.
So topics related to, Medicaid. We will be talking about SNAP. We will also be talking about the immigration and health linkages because as we're seeing what's happening with ICE, the mental health toll, but also the fear of people going to receive services that are needed to help them stay healthy, we will also talk about impacts on health equity.
I have been at Grantmakers in Health for over five years and before that, as you know, I worked at the Centers for Medicare and Medicaid Services, directing the Office of Minority Health, and that's an office that doesn't exist anymore.
Michelle Rathman: I know it.
Cara V. James, PhD: And when we think about the people whose roles and responsibility, it was in government across a number of these agencies to look out for many underserved communities, people with disabilities, rural communities, communities of color, those who are LGBTQ, many of those offices are no longer in existence.
And so, it begs the question, “who is looking out for these communities?” And as we know, in rural spaces in particular, one size doesn't fit all with policies and that having that ability to make sure that the policies coming out are meeting the needs of the communities. Ideally, you know, sort of informed by communities in terms of what that looks like.
So those will be some of the things that we'll be talking about as well as how, when it comes to that call to action, how we can engage more funders in reducing those systemic barriers that are contributing to poor health outcomes. And that's part of the policy.
For the first time, we will be doing a Hill day. And that's part of taking funders up to get to meet and introduce policymakers, to educate them about the important work that foundations do in their communities to help fill these needs. Also to be able to educate them on some of the impacts that the policies are having real time. And it's a way to help them learn about what funders do from a group they don't frequently hear from.
And that's something we learned as we were working with one of our partner organizations, Grantmakers in Aging on reauthorization of the Older Americans Act. We learn from the policy makers that they don't hear frequently from philanthropy. And so this is that opportunity to go educate them about the work and about what we do.
And our call is to get more funders engaged in policy and to think about how they can use that to reduce those systemic barriers that are hindering their goals of better health for all.
Michelle Rathman: Yeah, my goodness. I mean, you're speaking my language because if we are not recognizing, this podcast is all about connecting the dots between policy and quality of life. And so, it cannot be ignored. My gosh. Alright, so let's talk about this for a moment, the future of rural health and wellbeing, because in October of this year, you've had quite the busy year, GIH, along with National Rural Health Association.
I, which I'm a member. And with the support from the Georgia Health Policy Center, joined voices to lead an initiative, called Reimagined Rural Health and wellbeing by aligning systems and resources to achieve optimal health for all individuals living in rural America.
So, what were some of the takeaways from listening sessions? 'Cause you had several listening sessions and of course, given where we are today, one trillion with a T and cuts to Medicaid. There's no turning back. There's no toothpaste going back on the tube on this one over the next 10 years. We estimate, obviously 11.8 million people losing their health insurance by 2034.
And that might accelerate, quite frankly. I think that's maybe a generous, total right there. I think we're gonna see more than that and a catastrophic cuts to SNAP, of course. Even taking into consideration this $50 billion one-time Rural Health Transformation grant. Folks know by now, I am unapologetic, I'mnot on board because I know that the gap is gonna be so wide that 50 billion is gonna be gone like that, wherever it might go. So, talk to us about the, those listening sessions and maybe some action items. 'Cause if we're gonna reimagine, oh my gosh. It's, I can't even formulate what that's gonna look like in a year from now.
Cara V. James, PhD: Yes, I think so. One, we wanna thank the Commonwealth Fund who gave us the grant to do this work. And as we were thinking about the conversations, it's interesting because we started this project before the election last year. And so, I think for a number of projects that we've had in the, in the rural space where we have a community of practice of health funders, in the, with Brookings around rural engagement and investment in infrastructure and economic well and health and wellbeing.
We have this, and we have, um, also, as you know, the rural, public, private, partnership that we do in philanthropy with the Federal Office of Rural Health Policy, and that meeting in October, unfortunately, was missing the Federal Office and the CDC Office of Rural Health because of the shutdown. But what we heard in those listening sessions were, real emphasis on the need to build civic engagement and civic capacity in rural communities that we, frequently see policies that are, impacting rural communities that are not being developed by people who are from rural communities or that have been informed by the people that these policies are supposed to impact.
That we also need to invest in infrastructure in rural communities and that there is, one of the things that we often, I think, skip over, there, is great work happening in rural communities. And we need to listen to the communities, empower the communities to do the things that they know need to be done in their communities and to reduce some of those barriers that are making it harder for that work to happen.
Investing in communities, investing in infrastructure, investing in breaking down those systemic barriers, making sure that the policies are, policies that are flexible and informed by rural communities and will work in rural communities. And then the last thing that I would say, which was something we talked a lot about at the rural health public private philanthropy meeting is getting out and walking the land.
That when you get into communities and see how things work in reality, that it makes for much better learning and also helping us to connect with the people that we are trying to help and to learn more that can be brought back. And so really encouraging people to get out and walk the land. Um, and so we do this through our Rural Health Road trips. Also, we have our community of practice that meets in, in different spaces. We were just in Red Cloud Nebraska, at the beginning of October and that was a really interesting, and great community where you're seeing a lot of transformation happen, but also, you know, some things that we could do to help them out a little bit more.
Michelle Rathman: Yeah, it is remarkable. To be able to go and, and be embedded and to see firsthand, have conversations with people firsthand and understand the challenges and my gosh, the strength, and the tenacity. It's just remarkable. I'm so glad that you said that.
I do wanna talk a little bit about, you know, these are some words that this past year, you know, we've had to, if you wanna play, you've got to say or not say certain things. So we, we talk about things like advancing health equity and social justice. And I'd love to hear your thoughts about, you know, how we keep that front and center and not shy away from saying the truth that needs to be said.
We have a health equity problem and social justice problem in this country. Rural is not, does not escape these challenges. So how do you see us moving forward through a rural lens that we continue to advance health equity and address social injustices? And how, what's philanthropy's role in making sure that we stay on track?
Cara V. James, PhD: Yeah, so I'm so glad you asked that question. I think that one of the things that this challenge speaks to related to health equity is a co-opting of a narrative. The words have become so polarized when we say diversity, equity, and inclusion, or when we say health equity, but really what those concepts are about and what the work is about is making sure that we are reducing the systemic barriers that make it harder for people to achieve their highest level of health.
It is not about, you know handouts or anything like that. It's about meeting people where they are and making sure that they have those needs. So, as we just talked about in terms of what we've heard from those listening sessions, what rural communities want, they want people who are representing them and making those policies for them.
That's diversity. That is, you know, right there is diversity. Making sure that we have equitable policies that don't favor urban areas or that don't favor other groups is part of that equity, and inclusion of sort of all of us in that. I think that what we have seen that, if you don't use those words, there is a lot of support for the ideas of making sure that everyone has a fair and just opportunity to achieve their highest level of health.
But the words have become so politicized and so divisive that we can't use those. And so, I think that when we think about how we are talking about things, how we can use bridging language to come together, that we are stronger together. That we have more in common than we think. And I find so often, you know, when I go into rural communities or if I'm in sort of an urban underserved areas, the challenges are very similar.
And part of the effort is actually intentional of keeping us divided because when we come together, we actually can make powerful change that is helpful to all of us rather than maybe some who have fewer interests of all of us in mind. But I think that that is one of, everyone I think can get behind that notion that we shouldn't have barriers and systemic challenges that make it harder for people to be healthy.
Michelle Rathman: Absolutely. Let's talk a little bit about expanding healthcare access, and improving quality of care. I mean, this is something that anyone who listens to this podcast knows and knows my 30 plus year career in, in health, urban and rural. I'm very concerned and that's an understatement about what we're gonna be looking at in terms of expanding healthcare access.
Can't do that without providers, can't do that without clinics, hospitals, and so forth. We can all agree that we need to make some changes. That we, we have some, really archaic ways of looking at health. It's after the fact, versus the preventative care and so forth, but what does that look like from your mind, Cara, moving forward in terms of expanding healthcare access and improving quality of care?
Where do, where does that, what path are we on to make that happen? What? What needs to shift?
Cara V. James, PhD: So it's a great question and I think this is one of the opportunities of what is happening, that it is a moment for us to radically reimagine our future because what we want our future of health to look like, as you said, we have challenges that existed before January of this year, and people were struggling with access.
We had rural providers and hospital closures, people who were really, and as this is being kind of unfortunately expedited in some of the challenges and policies that are causing people to lose coverage, that are going to make it harder for providers in community health centers or rural hospitals or nursing homes to stay afloat.
It is an opportunity for us to think about what is that future we want to have where everyone has access to health coverage, preventive services. I think that unfortunately what we are going to see in the next few years is increasing loss of coverage. The Medicaid changes that we've talked about, those are on the horizons, but there are others we've already seen you know, with the, people in the marketplace that the premiums are going up through the roof there. And as we have kind of this unfortunate perfect storm of food costs going up, housing costs going up, healthcare costs going up, jobs not so much going up, people are going to have to make some real tough choices.
And we're going to unfortunately, see the impacts of those choices. But what we can do coming out of this is really put together that plan for the future. We have a system that is built on inequity, unfortunately, that you know your access to the health system determined by your coverage or lack thereof, and provider payments determined by how you're entering that system.
And a system that is really a treatment system. It's not a health system, it's a treatment system. And so, what if we had an actual health system that we put together coming out of this that is our, plan for the future where we are supporting people's ability to be healthy and to thrive, and not just to get treatment when they get sick.
Michelle Rathman: Right, and that goes on to another priority really, I should say. These are policy priorities of Grantmakers and Health, and it's improving population health. I mean, that. We, we, I think about the Make America Healthy Again, I'm not sure of the time before that we're talking about, but to make America healthy, all of America, rural America included, you know, this is where our food comes from, right. As well, improving population health.
So, let's talk a bit aboutthe work that you're doing in that area and how you're helping lift up other organizations to achieve that. Almost it feels like unattainable goal at this point, but it shouldn't be.
Cara V. James, PhD: It shouldn't be. And it's not. And I think it is. It is attainable. It is also hard. And that's one of the things philanthropy has a little bit of the luxury of being able to support long-term investments in ways that others may not be able to, and to do some of that future work. And so, when we think about population health in the space, as you mentioned, some of the rural work that we've been doing.
So, lessons learned from those foundations who really have been, deep, long-term investors in rural communities. What have we learned, but also how can we work more together in, moving forward in that space? Interestingly, in those conversations, civic capacity has also come up in rural communities as an important driver of that and making sure that people have kind of the leadership and the skills needed to, implement the changes that their communities need.
We also, as I said, have had this long-term partnership with the federal office and, NRHA with the rural public, public-private philanthropy meeting that's been going on for more than 13 years. We're also with this work that we've done with Commonwealth and kind of linking up with others through, the Georgia Health Policy Center and NRHA, thinking about that future, what does that look like?
And it builds on some of the work that NRHA has been doing with some of the other, researchers in that space. How do we come together? Because what this moment is calling for, is for us to all work differently than we have been. And I talk about in philanthropy, we typically give people a menu of options.
Here's what you know, you can do that pick and choose what works for you. And in this moment, we all kind of need to agree since Thanksgiving's on the horizon, that we're baking a cake and that this is the recipe we're gonna follow. And Michelle, you're bringing the eggs. I'm gonna bring the butter. Somebody else is gonna bring the flour. And we're gonna bake a cake because if we just do the menu of options, we might have too much flour, no eggs, and not enough butter, and we won't have a cake. And so that's what this moment is requiring of all of us.
And so, through the population health space, looking at rural health, we've also been engaged, as I mentioned, on aging and looking at how we can improve outcomes. That's another space where as we are seeing particularly impacts in rural communities as we have an older population there and we don't have a support system in older adults, regardless of where they live geographically.
And that these cuts that we have also seen are impacting programs at the Administration on Community Living, which provides a lot of the services for our older adults. We'll see what happens with Medicare. But that is also on the horizons. We've heard not as much news in terms of, the Low-income Health, Heating and Oil Program, LIHEAP. Access to that, that we, and as our population is getting older, caregiving, for those, you know, who are trying to provide those services. And as my colleague at Grantmakers in Aging, Lindsay likes to say there is no Medicare fairy out there. And a lot of people find out about that when their loved one needs long-term care services and they learn that's not a Medicare benefit in the way that they need, and it's only through Medicaid that that becomes eligible.
So rural health, our aging adults. And, we haven't really even had time to talk about the implications of maternal, health in this moment. And what this is going to look like where we are already, again, a population that was having challenges and not where we should be given our investments in this country for our maternal health outcomes.
And we're making it harder for people to get care and to get the services they need.
Michelle Rathman: Yes. Oh, all of it. Yeah. I tell you folks, as someone who has worked with rural hospitals all over this country, when you think about the fact that very long-term care, every community of I have ever worked in this has been the biggest challenge, one of the biggest challenges, if not the biggest challenge that they had to face.
And it really is about reimbursement. You know, it is not about making sure that we can age in place with dignity, and to the best of our ability in good health. But it is about, it's a numbers game and that, it's frightening and maddening at the same time. And to your point, maternal health and childcare, I mean, these are all things.
So, the last topic before we kind of go into our closure here is that promote community engagement and empowerment. I love that you said that. I love, I know you know someone named, Becky Payne and the Ripple Foundation and she talks about building civic muscle and talk a little bit about that because I think what can happen is people can pull out and they can say, I don't, I don't wanna have any part of this.
It's, it's like a lightning rod being a part of any kind of government system. But community engagement is so vitally important now, I think again, more than ever, how do we, or, and how does philanthropy help to move that dial to get more people in the community engaged for problem solving, versus, you know, sitting back and waiting for problems to be solved.
Cara V. James, PhD: Great. Yeah, it’s a great question, and I think one that many foundations are asking themselves at this moment. And we saw actually a trend with health funders in the pandemic trying to move closer to community to make sure they were getting the resources out there. And I think that, you know, you had said earlier that there's such a spirit of tenacity in rural communities, and so there is a lot there.
The question, how do you connect those dots and sort of get that in there? One of the ways in which that happens is through the local and regional foundations that are there because they are more proximate to community than maybe some of the larger national foundations and know about some of the great work that nonprofits are doing or who that community leader is in that space who could be, invested in.
And so, one of those things of building that civic muscle is supporting the nonprofits who are in those communities through their ideas, through leadership training. There's a great program that one of the foundations is doing in Arkansas with some of the mayors to help them build capacity. The local mayors that are down there, because people step into these spaces and not many of us have been trained in any way to do that, but how do we help them strengthen their leadership and their capacity?
So, there's also a rural leadership development program out of Kansas that is, building capacity and supporting leaders. So, investing in the leaders, investing in the resources, and helping to foster those networks where they can learn from one another, to the extent possible. Helping them walk the land and connect with others at the state level or the federal level to see and learn how policy can work.
For those nonprofits, you're seeing foundations who are investing in nonprofits to shore up their infrastructure. Because one of the other things that we have recognized, I think more so now than before, programmatic grants pay the nonprofits to do the program.
It doesn't pay to make sure that HR is functioning or that, you know, the building is sort of able to function and have not, you know, a leaky roof or whatever. And so those are some of the things that we also have to invest holistically. And so, foundations moving from programmatic grants to more general operating grants that allow the nonprofits to support all of their needs and to develop those communities.
And then I think the last thing that I would say is we also have to get, a little more comfortable with failure because not everything is going to work out. That's okay. This is part of, you know, sort of the testing model. We're investing in testing and seeing what does work and supporting that, but we can't always pick the perfect one that's gonna go because we need to have a little bit of an experimental laboratory.
And philanthropy can do that because we have that latitude and flexibility. And so, becoming a little more comfortable with. I won't call it failure, but things that didn't quite go according to plan.
Michelle Rathman: Like when my, when I bake, you know, I cook. No problem, but I think I love that analogy. Alright, before we close out, I always ask, what is one advocacy tool or idea that our listeners can take away today, to put into action tomorrow or the next day that will make an impact where policy and protecting the freedom to give is concerned?
What, what can you, your nugget of wisdom.
Cara V. James, PhD: Well, my nugget wisdom, I think would be for the health funders that are out there who may not have a policy and advocacy agenda at this moment to really consider investing in one, because if you are not addressing the barriers that are contributing to the poor health outcomes you're seeing in the communities that you're caring about.
You're just tinkering at the edges and there are ways in which you can educate yourself on what is permissible, under those IRS rules, and there is a lot that is permissible. I would also say invest in the community leaders. In that power to support them, and share power, kind of co-create with them what those opportunities and solutions are.
And that's something that more foundations are doing. But we need even more doing that because community really does have a lot of the answers for what we're trying to figure out.
Michelle Rathman: Yeah, absolutely wonderful advice. And I say get offline. You know, get, get offline and go. Go inside.
Cara V. James, PhD: Walk the land.
Michelle Rathman: Walk the land. I love it. I love it. I love it. Oh my gosh. Cara James. It was, I don't even know. I'm going to tear up a little bit. It's just been wonderful to have this conversation with you. Please follow the work of Grantmakers in Health and while we have to say goodbye to Cara, stay right with us because we're gonna be back with some closing thoughts.
Michelle Rathman: My sincere thanks to Cara James for joining us today. And before we sign off, I want to share some of Cara's closing remarks from the GIH Health Policy Exchange that I had mentioned to you, at the beginning of the show. And I share this with you with Cara's blessing. So, here's a portion of what she said.
"We heard recommendations about the myriad ways philanthropy could help, including providing technical assistance, funding workforce capacity, using our power to convene, to create spaces for strategic thinking and offering the stability needed to plan beyond crisis.
But our work must go beyond plugging holes. We must protect the communities being most directly targeted with the resources needed to survive. We must resist takeover and occupation, and we must defend democracy. We also need to maintain our commitment to health equity, secure in the knowledge that the work is still legal. And remember that just because someone says something does not mean the law has changed and we cannot fall into the trap of anticipatory compliance that creates a chilling effect before policy changes have been implemented or laws enacted."
I think those words are filled with wisdom and I thank Cara again for allowing me to share her words with you. To all of you listening, I thank you for your time. I am willing you peace filled end of the year.
But I also wanna let you know that we will be back with one last episode before 2026 takes hold. In the meantime, we would greatly appreciate it if you would subscribe to this podcast. You could do that both on our website and when you do that, just takes a few seconds to give us your name and email address so that we can make sure that you receive our email updates and recaps on any channel that you listen to.
We also appreciate it when you subscribe and we love it when you rate us and leave us a note. On social, you of course can find us on BlueSky, Facebook, LinkedIn is a place that I'm quite active and if you are so inclined, we also really do appreciate your donations. For those of you who have made donations this year, thank you so much because you are helping us to maintain The Rural Impact and bring you conversations that are, we know it, not light subjects, but our goal is always to help enlighten.
My thanks to Brea Corsaro and Sarah Garvin, formerly Sarah Staub. Congratulations long overdue on your nuptials for all your work behind the scenes. My friends, until we are together again, I invite you, encourage you, implore you to take really good care of yourself and to the best of your ability, those around you.
Again, I'm Michelle Rathman and we will see you again on a brand-new episode of The Rural Impact.
