This report has two aims. First, it seeks to examine the role of philanthropy in the passage of the Patient Protection and Affordable Care Act (ACA) in March 2010; in this regard, it resembles a traditional case study of philanthropic impact. But it also uses that examination to address some of the epistemic and methodological challenges involved in evaluating policy advocacy more generally; in this way, it also seeks to present a metastudy of the narratives of impact that have emerged regarding philanthropy and health care reform and the evidentiary support on which they are grounded.The challenges in evaluating philanthropy's hand in shaping policy have been well documented; this report has certainly run up against many of them. Yet at least one of these challenges is addressed directly through the retrospective, historical approach that this report takes. If foundations have often found it difficult to evaluate grants aimed at affecting policy change because of the broad time horizon such transformation often requires, looking backwards from the vantage point of such a significant change—the passage of the ACA—provides an outstanding perspective on the question of philanthropic impact. Analysis is staked, in this case, to a particular legislative outcome. For this reason, this report does not engage the role of philanthropy in the implementation of the Affordable Care Act. However, it is important to note that many of the funders discussed below have taken a leading role in supporting that process and appreciate that passage of the legislation represented only an initial step in a lengthier campaign to ensure that all Americans have access to affordable, quality health care
