March 13, 2014
By Kenneth D. Miller
Assistant Managing Editor
Robert K. Ross, M.D., is president and chief executive officer for The California Endowment, a health foundation established in 1996 to address the health needs of Californians. During his tenure at CE, the foundation has focused on the health needs of underserved Californians by championing the cause of health coverage for all children, strengthening the capacity of community health centers, improving health services for farm worker and ex‐offender populations. Recently, the Los Angeles Sentinel caught up with Dr. Ross, who talked about why he loves his role at CE, the Affordable Care Act, as it relates to underserved communities and what healthcare improvements he hopes to see in communities of color.
About Dr. Robert Ross from the California Endowment:
My roots are in New York City. I grew up in the South Bronx.
I am a pediatrician by trade. I practiced in New Jersey and then Philadelphia for a number of years before turning to a career in public health and community health. I came to this leadership position in late 2000. This is my 14th year at the foundation.
LAWT: Wow, talk about a transition – the Bronx to here. Who was it who had their antennas out and came to you and said, ‘[we want you] at the California Endowment?’
RR: It’s hard to say. I’m not sure how they found me.
The California Endowment went through a series of two or three CEOs, none of whom were deemed appropriate to be the permanent CEO. It was right around that time I got recruited to join the board.
Someone said, ‘Bob, you should resign from the board so you could apply for the position.’ And, the first time I was asked I couldn’t do it. I just had too much going on in San Diego.
Another year went by and they were still on the search. The board vice chair at the time said, ‘you bring a lot of experience and skill that we’re looking for. Why don’t you resign from the board so you can interview and apply.’ So, that happened in the middle of 2000.
And so, that’s how they found me. This job’s been a gift, a privilege. It’s the best job in the world.
LAWT: ‘It’s the best job in the world.’ Why do you say that?
RR: It’s really a blessing to work for a corporation that shares your core values. That’s a gift. Most people don’t have that luxury.
With this board, they’ve been clear that underserved, marginalized communities are a priority for us.
LAWT: Does the foundation do anything beyond the fourteen communities that they give grants to?
RR: We focus on fourteen underserved communities across the state. We’re working with leaders of those fourteen communities to assure healthy futures for young people in those neighborhoods.
We know there’s good and bad with that. The good is that you can stay with the community and see what impact your investments have over time. The downside is that you constrain the ability of the communities outside of those fourteen to get at your resources.
And so, it’s not an easy decision but we felt that there are two ways to look at philanthropic dollars. One way is charity. The other one’s change. And, it was my view in the early years of the foundation, we were funding too much charity and not enough change.
Charity is a lot easier to fund. It’s easier to give 5 million dollars to a children’s hospital to get your name on the wing. (For example) the California Endowment Emergency Room … the ribbon cutting is nice, the photo op is nice. Funding is not as glorious.
LAWT: How do you go about determining who gets what (among those underserved communities)? We live in a community with a lot of other ethnicities but the core African American community usually feels slighted, like we’re always left out.
RR: Fact number one is that we’re a $3 billion foundation in assets. We’re California’s largest health foundation and maybe California’s fourth largest foundation. And, we’re about number sixteen or seventeen in the country.
So, we’re a big foundation. That said, it is fiscally impossible for us to address the needs of every underserved community in the state of California. The money just doesn’t go that far.
To put it another way, we do about $150 million a year in grants in charitable activity. That’s about one half of one percent of the state Medicaid budget. $3 billion sounds like a lot of money and it is and $150 million a year sounds like a lot of money and it is but by definition someone is going to be left out.
[Fact] number two, everybody thinks their community gets the short end of the stick. From the Latinos, we hear that African Americans get far more than their fair share of resources and they don’t get enough. From the gay and lesbian community [we hear], ‘we get shorted…’ Women’s groups complain that we have more of a focus on young men of color.
We try not to get paralyzed by those discussions. We look at our mission.
We look at our strategic plan and what we have prioritized. We are trying to get some things done with these dollars. So, the best way to approach a foundation, California Endowment or not, make sure you understand what that foundation is about.
That said, African American communities are at the short end of the stick on a lot of these health inequities, so they should get more. We have just begun to routinely collect data on who we’re funding on an ethnicity basis. [Underserved communities] have been looking up for so long from where they are, that it appears that no one considers them a priority. We understand that.
LAWT: What is your role in Covered California?
RR: As it relates to communities of color in general and particularly African American communities, we think we’re at a pretty magical moment. We have the right kind of leadership in the right kind of places [like] the school district and the state legislature. We [also] have Obamacare.
Obamacare is a once in a fifty year opportunity. We haven’t seen anything this big since Medicaid in 1964. We felt the three year window that we’re in right now (2013-2016) the beginning of Obamacare, is extremely critical to underserved communities, not only to get them enrolled but to also make sure the delivery system is reforming in a way that’s more accessible to their needs.
And, Obamacare does that in a number of ways, like looking at mental health and providing more dollars for prevention services. One issue for me is that we see African American and Latino enrollment lagging. [One reason is] we’re not message communities, we’re messenger communities.
In our communities the messenger has just as much weight [sometimes] even more weight than the message. These are communities where what the minister says, what the beauty salon owner says, what the barbershop owner says holds more weight than the millions that could be thrown at an ad campaign.
(Dr. Ross thinks the solution is just getting the right message out with the right messenger).
There are two ways to get coverage if you don’t have coverage through Obamacare. One way is through the health exchange. That’s where you can get subsidies for your coverage. The other thing Obamacare did was expand Medicaid.
There is a cutoff enrollment date for Covered California (the health exchange), which is March 31. There is no cutoff date for Medicaid. The exchange enrollment will start again in October.