Dr. Gary Puckrein, National Minority Quality Forum

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Mark Masselli: This is C onversations on Health Care I'm Mark Masselli

Margaret Flinter: A nd I am Margaret Flinter.

Mark Masselli: Well Margaret open enrolment has come to a close on the online insurance
market places created by the Affordable Care Act and in the few assured months millions of
Americans have gained insurance coverage, a rocky start but much more promise than people
expected.

Margaret Flinter: And business was brisk during the final days of open enrolment up 20% per
day in the final week here in our home state of Connecticut and I think that was the experience
all around the country though of course lagging in states like Texas that actively engage in
trying to block the promotion of the health ca re law.

Mark Masselli: The Department Of Health And Human Services did grant a small reprieve
st
Margaret as long as the person started the enrolment process by March 31 deadline they
would grant a grace period for a couple o f weeks to make sure they could iron it out all the
difficulties they might have encountered. They won’t be hit with the tax penalty for not having an
insurance by the end of March.

Margaret Flinter: Well we should know Mark that there are lots of opport unities for lessons
learnt here. I don’t know when we will get another big impact program like this but the
administration could have done the better job of messaging. A recent Kaiser Family Foundation
p oll show that 50% of Americans just had no idea whe n open enrolment was coming to a close.
Many of them thought enrolment had already ended.

Mark Masselli: There are simply so much complexity to health care law and all of the changes
to health care surrounding it . I think it’s going to take some time to process such a dramatic see
change and in fact the law envisions over the next few years of enrolling all of the people they
set out to do.

Margaret Flinter: And speaking of change another poll shows that by two to one marg in a
majority of Americans feels the health care law should be kept in place and fixed over time
rather than repealed or replaced . S o it seems like Americans are beginning to understand the
benefits of Obama C are or the Affordable Care Act in ensuring acc ess to health care for all
citizens.

Mark Masselli: Meanwhile legal challenges to the law continue a private company has sued
against the mandate requiring free contraception coverage through employee insurance plans.
The Supreme Court heard the case recently and there has been no decision yet but the analyst
are saying that with the courts conservative leaning on this issue the mandate could be in
jeopardy.

Margaret Flinter: Well the health care law definitely has an emphasis on prevention and an
emp hasis on women’s health and on parity and of course we would like to see that mandate
appalled for those reasons.

Mark Masselli: It’s about creating an opportunity for equal access to preventative health
services including birth control and it was importa nt minority populations tend to be impacted
higher numbers in this country and that’s something our guest today knows quite a bit about.

Margaret Flinter: Dr. Gary Puckrein is the Founder and CEO of the National Minority Quality
Forum and he sees the h ea l th care l aw as a game changer in terms of reducing health
disparities in this country.

Mark Masselli: Lor i Robertson will also be stopping by the managing editor of FactCheck.org as
always on the hunt for misstatements about health policy spoken in the pu blic domain.

Margaret Flinter: And no matter what the topic you can hear all of our shows by going to C H C
Radio.

Mark Masselli: And as always if you have com ments p lease email us at CHC R adio or find us
on Facebook or Twitter because we 'd love hearing fr om you.

Margaret Flinter: We will get to your interview with Dr. Gary Puckrein in just a moment.

Mark Masselli: But first here is our producer Marianne O’Hare with this week’s headline news.

Marianne O'Hare: I am Marianne O’Hare with these health care headlines. Uninsured and
staying that way and assessment of the millions of Americans who are still uninsured after open
enrollment on the insurance exchanges under the Affordable Care Act has drawn to a close. It
shows many are choosing to remain uninsu red even though they have options both on and off
the exchanges. A Kaiser Family Foundation Poll showed 50% of adults under age 65 who still
lack coverage plan to remain without insurance while 40% they do signup by the deadline at
st
month’s end and only fo ur out of ten of the uninsured knew that March 31 was the deadline to
sign up for coverage. A majority of the public 53% is tired of hearing fights over the health care
law, 42% believe the debate should continue.

Meanwhile of the 5 million folks who require insurance in the federal exchanges a vast majority
qualified for tax subsidies do off set the cost of the health plans. Without those subsidies many
families would find insurance unaffordable for the largely low and moderate income people
acquiring the insurance and appeals court challenge is posing a threat to those subsidies the
corner stone of the healthcare laws and insurance mandate. The case heard Tuesday began
with a lawsuit filed by the residents of West Virginia and several other states who object to be ing
required to buy insurance even with subsidies. Meanwhile the Supreme Court h eard arguments
last week regarding a privately owned fo u r profit company rejecting the health laws mandate
supplying free contraception to insured women. The hobby lobby case in which a company
owner cited religious beliefs for his rejection of the mandate was presented to be fore the
conservative leaning High Court, decision yet to be handed down .

A nd the stethoscope as smoking gun something to consider. A recent study conducted in
Switzerland showed one out of twenty patients leave a doctor’s office with an illness causing
germ after contact with their physici an while hand washing protocols are strictly followed in
many cases now. There is still a contact culprit , the stethoscope and the study conducted by
the director of infection control at the University of Geneva hospital show the bacteria on the
diaphragm of the stethoscope was much higher than on the palm o r the back of the clinicians
hand. Common sense dictating that reusable equipment should be wiped down after each use.
I am Marianne O’Hare with these health care headlines.

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Mark Masselli: We are speaking today with Gary Puckrein PhD, President CEO of the National
Minority Quality Forum an independent nonprofit research and education organization dedicated
to improving health care for all populations. Dr. Puckrein writes extensively on health disparities
and health re form for the Huffington Post and has published two successful magazines
American Visions and Minority Health Today. He was awarded his doctorate from Brown
University graduating Phi B eta Kappa. Dr. Puckrein welcome to conversations on healthcare.

Dr. Gary Puckrein: Well thank you very much.

Mark Masselli: And as our listeners may know that April is National Minority Health month.
Your organization the National Minority Quality Forum is a offshoot of an earlier organization
you found at the National Minority Health Month Foundation which sought to eliminate the
disproportion number a burden of premature death and preventable illness in special
populations. Health disparities really remain just an enormous problem for our country and
while the Affordable Care Act is attempting to close the access gap we still have a long way to
go before we see improved out comes and I really I would ask you to illuminate for our listeners
how wide that gap of access and care and health outcomes really is?

Dr. Gary Puckrein: It’s a great question you know if you think about it, if you go into a health
care facility be it a hospital , a doctor’s office or pharmacy the first thing you are asked to present
before you have access to any services is your insurance card . And that in surance card tell s a
lot about what you can receive by way of products and services so what’s happening in a lot of
underserved communities we have somewhere around 52 million Americans who have not had
an insurance card . S o the result of that is they eit her get emergency care in hospitals or they
get subsidized support from the federal government in which all of our taxes go for. Typically
when they are provi ding that emergency care it’s more expensive because it’s a rescue care
typically in the emergenc y room or because the patient has now progressed further in the
disease then they ought to have given our ability to a risk of the development of that disease .
It’s hidden. We don’t see them immediately come out of our pockets but when we go into a
healthcare facility the cost of that rescue care or that charit y care is built into a price it’s worth
and that’s part of what ACA is doing. It's saying, we ll first of all i t says we're already pa ying for it
l et's realizing but let’s do it so that we are doing it in a way in which those people can have
continuous healthcare so they are not getting rescue care anymore which is very ex pensive
then not showing up in the emergency room which is very expensive. And we're making them

better able to be part of a work force because they now can go to work and so that’s really what
ACA is doing.

Margaret Flinter: Well Dr. Puckrein a sort of difference slant that i know you have been very
concerned about is the dispropo rtionate representation of minorities in clinical trials and you
have a campaign the I’ m I n C ampaign that looks to rectify that iniquity t ell us about that. What
are you hoping to accomplish and what’s been the cost of that historic underre presentation in
clinical trials ?

Dr. Gary Puckrein: One of the things that needs to be understood about clinical trials is that
they are not only used to develop the new therapies but they are also used to help us
understand what is actually the best therapy to provide an individual when they have a disease
or disorder . A nd what we come to learn is that everyone’s diff erent. We are moving into the
world of personalized health care in which we are trying to provide the right care to right
moment, to the right individual . And in order to accomplish that we have to get to b iodiversity ,
we have to have more d iverse population s in clinical trials so that we can best understand what
works and it’s actually kind of a numbers game and what you want to try to do is get a good
sample of the population that is most likely to be affected by disease and to get them into trial to
see what appropriate therapy will work for them. The problem has been is that minority
populations have not b een represented in clinical trials in the past and so what we have done is
it’s really in the clinical setting after the drug or device is approved it’s in use and practice where
we come to find out how well it works in a particular patient population . S o the idea is to b ring a
little bit more rigo r to all of th is by encouraging greater diversity in clinical trials and so that’s
what the I’m In C ampaign is trying to do. You 'll get to the issues of trust as well as to help
everyone understand the value of participating in a clinical trial.

Mark Masselli: Dr. Puckrein you use the word rigorous and it seems that sort of captures the
diligence that your organization bring to the task in hand which is really about collecting health
data from around the country and charting disparities and really looking at both ethnicity and
drilling down the zip codes really to help shape a mosaic so that the health care population, the
policy makers and their like understand the sort of scope and size of this health disparity . S o
talk to our listeners a little more about the most important and unexpected discoveries that you
have mimed from this data.

Dr. Gary Puckrein: We have been collecting since about 1998 and we have a database now of
well over 900 million patient recor ds. We're on any random events when you look at
populations do wn at the zip code level you can predict how many people in that population are
going to the hospital because they have had a heart attack. How many of them will go on
dialysis . How many new cases of diabetes you are likely to see in the year and I think that is
perhaps the most important understanding that I walked away with. These are highly predictive
events and so when you t alk health disparities what you are really talking about is a pat tern of
essen tially bad outcomes of that are occurring and reoccurring in certain communities . A nd any
good scientist knows that when you see patterns those patterns are caused by set of variables
out there and so the work is to try to understand those patterns and then how can we break

them and improve them and eliminate disparities when we see them and I think that sort of the
lesson that I have learned over the years.

Margaret Flinter: Well Dr. Puckrein that of course would lead me to the next logical question
about what do we do as people who have certainly hoped the access to a high performance
health system would rise or both . S o what are creative interventions, what’s the kind of work
that’s going on this ex citing new.

Dr. Gary Puckrein: So what do we want out of our health care system. There is a body of flown
out there that suggests that people should only get the health care that they can afford and
there is another body of flown out there that says that health care ought to be right . Wh at I
th
understand is this unlike the early part of the 20 century we now have choices. On the early
th
part of the 20 century , you know, health care really couldn’t intervene to save li ves. A nd now
we are developing the technology that can really control if not eradicate a disease . A nd so the
question is do we want to apply that generally across the population ? Now obviously I fall down
on the side that health care ought to be covered but that’s the work in the conversa tion that we
need to have at the national level.

Mark Masselli: We are speaking to day with Gary Puckrein PhD, President CEO of the National
Minority Quality Forum independent nonprofit research in education organization dedicating to
improving health care for all populations. Dr. Puckrein you have been supportive of the
Affordable Care Act with one sort of caveat and that’s the creati on of the 15 Member
Independent Payment Advisory Board or IPAB which was established to find ways to contain
the cost i n Medicare and your concern is that the panel yields too much power so tell us what
you think the negative impact on the health of minority seniors and what your organization has
done to try to change it .

Dr. Gary Puckrein: Consumer demand for health care is going to grow. We have an aging
population. By 2030 a third of the US population will be on Medicare. You have minority
population who have actually underused health care historically who are now going to be
insistent that they have access to qualit y care. I think you build a very nice economy aroun d
providing health care services. I think a lot of the confusion around the value of health care is
that we tend to only have a conversation about it of a cost proposition and I think there's a value
proposition to health care both in terms of it’s a largest sector in our economy and I am just not
persuaded that in a market economy you want government price control to be extent at the iPad
w ould seems to suggest . A nd so I just think that there are som e real thought than needs to go
into that.

Margaret Flinter: Well Dr. Puckrein we talked mostly about health care so far so I want to pivot
a little bit and health but you know when we talk about the social determinants of health and
poor health we talk a bout things like diet and living conditions but of course just being poor is a
huge contributor to health disparities. Maybe you could share with us what is your data showing
you about areas where the health of minority communities has been improved by targeted
interventions and I would also perhaps ask you an opinion question as the push for increasing
the minimum wage and trying to raise more people out of poverty takes hold in a country . W hat

is the impact from your viewpoint of increasing minimum wa ge and just raising people out of
poverty on eliminating health disparities?

Dr. Gary Puckrein: So I think about it -- there's sort of an equilibrium as it were where human
life survives better . A nd the question is if we're really about providing and insuring of that
population has a great quality of life have opportunities for jobs, have a health care system that
is responsive to their needs you kind of get to the social determinants of health which is that you
can actually plot by geography where life expectancy in this country is greater and where it’s
less I mean people are doing that right now . A nd it’s a function of the quality of air, the diet, the
opportunities for exercise, the access to health care . A nd so as Ameri ca becomes more diverse
what we want to make sure is that our society is creating the best possible opportunity for
everyone to have great quality of life . And so some of the environmental changer I think ACA is
certainly an important part of t hose enviro nmental changes. We are having conversations
literally about the social determinants of health and lots of organizations are beginning to step in
to look at issues about diet and here we 're going to find a very complex story when we start to
think about diet in diverse populations . And we also see this part of education and certainly we
j ust are an important part of it. It is really not appropriate for people to work a full day at a job
and not have a living wage. I don’t understand a so ciety in which the business model is that my
business can 't survive unless I provide someone wages that doesn’t allow them to raise your
family . There is something upside down about th at model and I think that’s what the
conversation is about.

Mark Masselli: Well said. We have been speaking today with Dr. Gary Puckrein, President and
CEO of the National Minority Quality Forum. You could learn more about his work by going to
nmqf.org. Dr. Puckrein thank you so much for joining us on conversat ions today .

Dr. Gary Puckrein: Well thank you for your time.

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Mark Masselli: At C onversations on H ealth C are we want our audience to be truly in the know
when it comes to the facts abo ut health care reform and policy. Lori Robertson is an award
w inning journalist and managing editor of FactCheck.org a non - p arti san , nonprofit consumer
advocate for voters that aim to reduce the level of deception in US politics. Lori what have you
got for us this week?

Lori Robertson: Well we recently heard Presid ent Obama jumbling his fax when asked ab out
employer sponsored premiums. During a live online Q&A the interviewer relate a comment from
Dan from Nevada. Dan works for a large corporation and said his insurance cost had " sky
rocketed since the Affordable Care Act was passed " was the law to blame ? Obama said no and
he is correct that generally the law isn’t to blame for sky rocketing work based premiums but
then the President answered it a little fussy. He said the average premium was going up 15% a
year before the ACA but that figure doesn’t pertain to employers sponsor plans instead Obama
was talking about the individual market which saw an average 15% premium increase the year
before the law was passed . Employer plans the topic of the question haven’t seen an annual
increase close to that since 2002. Family premiums in the employer market increased about

4.8% per year on average in the 5 years prior to the law. In the 3 years since the average
growth has bee n 5.9%.

We talked to experts back in 2011 when employer plans jumped up b y 9% and the y said the
law ' s new requirements were responsible for about 1% to 3% increase. New requirements
included allowing adult children’s to stay on parents plan until a ge 26 covering preve ntive care
without cost sharing, increas ing annual coverage limits and covering children regardless of pre -
existing conditions. The rest of that years increase as is normally the case was due to rising
medical cost and that’s why Obama also went a bit too far when he said on Web MD that the
only impact on employer plans was a requirement to offer a minimum set of benefits. Large
employer plans also have to spend 85% of premiums on medical cost and have an external
appeal process f or policy holders. Small group plans at companies with up to 50 workers are
the ones that have to cover the law ' s essential health benefits . And that's my f act c heck for this
week I am Lori Robertson, Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s major
political players and is a project of the Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you would like to check ed email us at chc radio.com we
will have factcheck.org Lori Robertson check it out for you here on C onversations on H ealth
C are.

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Margaret Flinter: Each week conversations highlights a bright idea about how to make wellness
a part of our communities and to everyday life’ s. F ood labeling could be going one step further
than simple calorie coun t s in the future. Public health researchers at the University of North
Carolina has some pep in their step for another approach to getting consumers attention when
pondering th ose food and beverage choices. There is a growing interest and a new approach to
displaying calorie counts next menu items instead show the amount of exercise that would be
required to burn off those calories consumed from drinking say 20 ounce cola. They de velop ed
an icon symbolizing a person walking and how far that person would have to walk to erase the
calories they are just about to consume. They conducted a randomize study to determine what
if any effect the measure would have on consumer choices.

Dr. Anthony Viera: And we showed them basically a full menu with all items and so one group
was randomized to no information except the food items. Another one was a menu of pretty
much every item exact same way and it had the calories . And then a third option had calories
plus minutes to walk with our little figure and it had , you know, for example 91 minutes and then
finally a forced menu that showed the same exact thing with the same exact figure with miles to
walk so I might say 5.1 miles .

Margaret Flinter: Dr. Anthony Viera , Professor at the University of North Carolina Chapel Hill
School of Public Health . He said the study showed quite clearly that when consumer saw th e
consuming the food or a drink item would require them to walk five miles to burn those calories
off as opposed to just seeing the calories it had a direct impact on the choice.

Dr. Anthony Viera: So if you looked at total calories ordered when you are shown no label the
average calories ordered w ill be 1020. When you are shown calories only which is a, you know,
sort of the policy, the current policy the average order was 927 calories and we are show ing
calories plus miles the average total was 826 calories . S o as you can see there was a definite
de crease in calories when you are shown calories plus miles.

Margaret Flinter: The results of the initial study w ere so conclusive. They are now scaling up
their research to test in restaura nts. Restaurant food labeling showing a consumer how much
exercis e will be required to burn off the calories consu med, helping them comprehend the actual
calorie value of the foods they choose and maybe that’s positively impacting their intention to
consume fewer calories more wisely. Now that’s a bright idea.

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Margaret Flinter: This is C onversations on H ealth C are , I'm M argaret Flinter .

Mark Masselli: A nd I am Mark Masselli . P eace and H ealth.

Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
University. Streaming live at www.wesufm.org and brought to you by the Community
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