The Great Depression caused unprecedented suffering and greater demands for the community’s human services agencies. In response, the Federation advocated for a welfare levy, which was placed on the ballot and approved by voters in 1932. This became one of two general-purpose human services levies that continue to support health and human services today.

The Federation lent funds to form the Cleveland Hospital Service Association (later becoming Blue Cross and eventually Medical Mutual) to provide pre-paid hospital insurance – the first across the board health care coverage provided in the country.