Trump Transition Adviser Michael Leavitt Addresses Future of Affordable Care Act

Michael Leavitt - CEO of Leavitt Partners

Mark Masselli: This is Conversations on Healthcare, I am Mark Massellie.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, it’s really only a few weeks before we see a
transfer of power in Washington, the final days of the Oba ma administration are
winding down as the Trump transition team makes ready to move into place.
And already, there is much speculation on what will happen to the Affordable
Care Act.

Margaret Flinter: While Trump the candidate was very vocal about repea ling and
replacing the healthcare law President - elect Trump has actually been kind of
quite on how he plans to do that once in office.

Mark Masselli: Well the Trump transition team has been rather mum on some of
those details Margaret, the Republican lea dership has been quite clear. House
Speaker Paul Ryan and Senate Majority Leader Mitch Mcconnell have indicated
they are aiming for a swift repeal of the law even if there is not a fully formulated
replacement plan in place.

Margaret Flinter: But there are a number of health industry analysts who are
saying not so fast. The thinking is there will be more of a dismantling of certain
provisions of the law by undercutting funding for individual parts of it for instance,
economist from both sides of the ais le are warning that a complete and swift
repeal would bring about chaos in the health industry and many millions of
Americans would lose coverage and be part of the unfortunate chaos.

Mark Masselli: Our guest today is advising the Trump transition team a nd how
best to navigate the healthcare debate, the honorable Michael Leavitt is a highly
regarded health policy strategist in the country and he brings considerable
professional gravitas to the table. He is a former three term Governor of the
State of Uta h, Secretary of the Department of the Health and Human Services
Mr. Leavitt has sound policy advise for the incoming Trump administration and
how important it will be to build a coalition around any changes to health policy. I
am really looking forward to that interview Margaret.

Margaret Flinter: And Lori Robertson Managing Editor of FactCheck.org will be
stopping by, she is always on the hunt for misstatements spoken about health
policy in the public domain. But no matter what the topic, you can hear all of our
shows by going to www.chcradio.com
Mark Masselli: And as always if you have comments, please email us at [email protected]

or find us on Facebook or Twitt er we love hearing from
you.

Michael Leavitt - CEO of Leavitt Partners

Margaret Flinter: We will get to our interview with the honorable Michael Leavitt
in just a moment.

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

Marianne O’Hare: I am Marian ne O'Hare with the healthcare headlines.
Dramatically rising drug prices have been deemed one of the leading causes of the rise in healthcare cost. Now some states are attempting to crack down. A number of states have joined a civil lawsuit against seve ral pharmaceutical companies for allegedly price fixing and conspiring to diviup the market share. 20 states filed the lawsuit against Mylan, Teva Pharmaceuticals and four other generic drug makers alleging that they conspired over things like stake dinne rs and girls nights out on the pricing of two common generic drugs that according to one copy of the complaint. The drugs involved in the lawsuit include the delayed

release version of a common antibiotic doxycycline hyclate. Doxycycline hyclate for
exam ple, rose from $20 for 500 tablets to $1849 between October 2013 and May 2014.
Connecticut Attorney General George Jepsen, who lead the civil suit says their
investigation has revealed this is likely just the tip of the iceberg.

More cause for worry amon g those infected with the Zika virus especially pregnant
women. A new study shows far more extensive brain damage in babies born to Zika
infected mothers than previously thought. Even in the absence of a obviously
abnormality such as micro syphilis. A s tudy of a 125 Zika infected women in Rio d e
Janeiro , done by Brazilian and American scientists and released by the New England
Journal of Medicine noted almost half pregnancies had adverse outcomes ranging from
fetal death to serious brain damage. Out of the 117 infants born alive 42% had grossly
abnormal brain scans or physical symptoms.

As the Obama administration readies to handover reigns to the incoming Trump
administration many healthcare consumers are concerned for what may happen to their
coverage if GOP leadership make good on their promise to repeal and replace the
Affordable Care Act. One of the aspects of the law provided protection for Americans
under 65 with preexisting conditions so they couldn’t be denied coverage. 55 million
Americans ha ve some diagnosable pre - existing condition that puts them at risk, that fact
has lead to a spark in social media activism the Twitter handle #the27% has provided a
platform for Americans with pre - existing conditions to weigh in on their fears of losing
cov erage. President - elect Trump has acknowledged protections for Americans with pre -
existing conditions has been a popular aspect of the law. Health Equity advocate Dr.
Atul Gawande launched the Twitter page to allow patients to lend their voices and their
concerns. I am Marianne O’Hare with these healthcare headlines.
Mark Masselli: We are speaking today with the honorable Michael Leavitt, advisor to President - elect Donald Trump’s healthcare transition team and
founder and chairman of Leavitt Partners, a consulting company focused in on
healthcare policy. Governor Leavitt also served as both administrator of the Environmental Protection Agency and Secretary of the Department of Health and Human Services under President George W. Bush. A former three ter m
Governor of the State of Utah, Governor Leavitt has served as chairman of both

Michael Leavitt - CEO of Leavitt Partners

the National Governors Association and the Republican Governors Association.
Governor Leavitt was the lead advisor on Mitt Romney ’s presidential transition
team. He earned h is business degree from Southern Utah University, Governor
Leavitt welcome back to Conversations on Healthcare.

Michael Leavitt: Well thank you for including me.

Mark Masselli: Governor Leavitt, you bring quite a reputation as one of the most
highly re garded republican strategist in the healthcare arena and you also bring a
vast amount of expertise from both state governance as well as running several
federal agencies within the Bush administration. And now here we are watching
the President - elect Trum p’s transition team lay the ground work for the incoming
administration. Team you are now lending your advise to and what are some of
the more important decisions that the Trump team needs to make in establishing
a successful new vision for health policy in America.

Michael Leavitt: This is the most important transition of power that occurs literary
in the world because of the role United States plays. There are three basic jobs
the first is to put a team on the field, the President - elect has nominated in the
health area Congressman Tom Price. The second is then to begin to ready an
agenda for the first 100 or 200 days it’s important to answer the mandate and it’s
clear that the people of this country gave the new administration and the new
Congress. T he third, is to begin coordinating closely with Congress if that
agenda can be successful and then there is a lot of other details that have to be
taken care of in terms of how you manage the attention of the world, President -
elect will be meeting by phone dozens of foreign leaders and each of them have
an agenda and we have seen that play out in the news.

Margaret Flinter: Well Governor Leavitt, when you were last on with us a few
years ago, you spoke then of the need to recalibrate some aspect of the
Af fordable Care Act that you thought would make it work more effectively. So
now we have been through a number of years of open enrollments, more than 20
million Americans have gained coverage. The industry and the delivery system
really has seemed to reca librate itself to multiple regulations and directives in the
ACA how do you feel the incoming administration should proceed on this track
and how do you think repeal works without causing great disruption to the
healthcare industry?

Michael Leavitt: The one certainty in the next several months about healthcare is
that there will be a Bill that will pass Congress that would be titled repeal and
replace. What is uncertain is what they will define repeal to mean and what they
will define replace to mean. P retending that the law never happened is not an
option, but the Republicans have for 3 elections in a row campaigned that they
would repeal and replace the law and I think they have no alternative but to fulfill
that, given the mandate for change that occu rred in the last election.

Michael Leavitt - CEO of Leavitt Partners

So I believe there will be a Bill that will pass and there will be parts of the
Affordable Care Act that in fact can be changed. And I think one area that will
look quickly to see will be obviously the individual mandate I thin k that’s likely to
disappear. Now the problem that all of this brings is they do have to replace this
because there are 20 million people who now have coverage and many other
Americans whose healthcare will be affected by this. So at least there appears
right now is that they will repeal the portions that they believe can be replaced
and they will give themselves some time in which to actually formulate the
replacement.

One of the commitments that Republicans have made is that they don’t intent to
do thi s in a way that does not involve a bipartisan support. And I think that’s
important, one of the primary mistakes that was made in the past Affordable Care
Act is that it was done entirely on a partisan basis and they seem committed not
to make that mistak e again.

Mark Masselli: I wonder if we could take a moment to look at the person
President - elect has choose to run the Department of Health and Human
Services, representative Tom Price is a orthopedic surgeon from Georgia, a
Conservative Republican Congr essman he has been leading proponent of
repealing the health law. And I am wondering you know you are one of 22
secretaries of HHS so you have a catbird seat of what it takes to run that office.
What general advise do you have for incoming secretary Pric e.

Michael Leavitt: The Department of Health and Human Services is a large
department, it includes 27 different units. The Centers for Disease Control,
Medicare, Medicaid, all of the welfare programs, a big part portion of the
Homeland Security portfoli o, the Food and Drug Administration. There are
80,000 employees and a trillion dollar budget. So this is not just about the
Affordable Care Act, there is a very substantial portfolio of other responsibilities.
And one of the things I would offer him in terms of advise is there will be many
other components of the job other than just repealing and replacing the
Affordable Care Act.

Tom Price is a physician he understands policy and he understands the
granularity of the law from a very intimate standpoint that of a practicing
physician. There are lots of perspectives and part of the duty and the
responsibility of the secretary is not just to drive your own views but to
understand the broad consensus of people when possible, sometimes you have
to go slower in order to go fast and because there is so much potential
disagreement. And we have seen that actually play out in the Affordable Care
Act here we are 6 years later essentially starting over again. And it’s because
they insisted on going fast, if they had gone a little slower and obtained bipartisan
support it’s unlikely in my judgment that we would still be debating this.

Michael Leavitt - CEO of Leavitt Partners

Margaret Flinter: Well Governor Leavitt we are very focused right now on the
coverage issue but I am always mindful of just how mu ch delivery system
transformation was called for as well under the Affordable Care Act and some of
those forces has been in play, I know you had been engaged in a great view of
the transformations that are happening in the healthcare around the country.
A nd they are really about meeting the increased demand for primary care, care
that delivers better outcomes more safely. We saw a growing number of
accountable care organizations and certainly a big expansion in federally
qualified health centers and of co urse hospitals as well. And all these forces in
many communities joined together to improve care coordination and patient
outcomes. What do you think these organizations should be thinking about as
they prepare for changes under the Trump administration?

Michael Leavitt: The most important change that has occurred in healthcare
potentially over the last 60 years is that transition from fee for service payment to
some type of payment where providers are paid on the basis of value. The
question is will t his transition from fee for services to value payment continue
under the new administration. And I think the answer to that is yes, it will
because the change is not being driven simply by political ideology. It’s being
driven by an economic imperative t hat if we want to continue to have great
healthcare we have to change the way it’s paid for because there is no way we
can continue to spend an increasing share of the American economy on one
thing, healthcare. So the only thing to do and the smart thing to do is to change
the way we pay for it. And I believe that the Trump administration will not only
agree with that but they may in fact hasten it.

Mark Masselli: We are speaking today with the honorable Michael Leavitt
founder and chairman of Leavitt P artners a consulting company focused in on
healthcare policy one of the health industry advisors to the Trump transition
team. Former three term Governor of the State of Utah, Governor Leavitt also
served as both administrator of the Environmental Protect ion Agency and
Secretary of the Department of Health and Human Services under President
George W. Bush. We have had this incredible divide in our country and you
wrote a book Finding Allies, Building Alliances, how in this highly charged
partisan world we are going to make sure that we have a bipartisan solution
moving forward.

Michael Leavitt: We have to acknowledge that government has moved overtime
into a much more partisan process, that’s driven by the fundamental belief that
the other party won’t do the right thing. And another thing we can count on is
that people who gained power typically over reach and that’s one of the things
that leads to another shift in power. So I think the key here is to recognize the
big danger is over reach that is to sa y we have got this appetite now because we
haven’t had power to do everything exactly the way we want it done. I believe
the Republican party has a very impressive and historic opportunity to put in
place a governing structure that will last for a long ti me, if they have the discipline

Michael Leavitt - CEO of Leavitt Partners

not to overreach. You have to have enough risk then everyone is willing to sit
down and to talk and to give up some things that they would like to have but they
just can’t and have it sustainable.

One of the risks that is being weighed right now is how do you get that, do you do
it by not passing anything or do you do it by passing a repeal and then working
on a bipartisan basis to overcome a common thing. I thing it is a good case it
could be made that that might happen, I don’t think there will be any
bipartisanship on the repeal. But I think there maybe a substantial amount of
bipartisanship on the replace.

Margaret Flinter: I wonder if I might ask about one area obviously that’s of great
interest to us and that is th e community health centers in the United States that
serves about 24 million people. And over this last years the drive to
transformation in the health centers has really accelerated certainly the
advancement of interdisciplinary care, team based care, ou tcome focused care,
training of our clinical workforce with the advent of the teaching health centers
and training primary care physicians and the programs to train primary care
nurse practitioners. So as we move into this new administration do you think that
that’s one of those areas where there maybe bipartisan agreement, any
observations on that for our listeners?

Michael Leavitt: I served as Secretary of Health during a Republican
administration and President Bush made very clear that one of the top priorities
he had in health was to expand and improve the community health center
system. And each year we received additional resources and I was under very
direct orders to not only expand the number but to improve the funding. And we
have actually eit her dramatically increased funding to nearly 4000 of them but we
added 14000. I think what we are saying here is that there is bipartisan support
for community health centers. And they play a very important part of not just the
safety net but in the new system of primary care, they become a part of the
foundation of primary care. So I think there is reasonably quite optimistic about
the future of community health centers in this new payment system. Now it’s
going to require that community health centers themselves learn to adapt and to
be a part of a larger network not just a safety net that means new skills, it means
new ways of doing things and reaching out and becoming a part of the broader
community.

Mark Masselli: Well you also served three terms as the Governor of the State of
Utah and you know we always think about states as incubators for changes. And
you have seen what happens when a state population gains access, now we
have representative Ryan contemplating perhaps a new way to sort of envis ion
how Medicare works. What do you see the positives and negatives surrounding
both the proposals around expansion of Medicaid the privatization of Medicare,
how should governors and state legislators be thinking about their work in health
planning and p olicy with all this transition going on?

Michael Leavitt - CEO of Leavitt Partners

Michael Leavitt: Well we find the country in peculiar situation now because we
have 33 states that have expanded Medicaid and you have 18 that have not.
Which means that you have federal funding going to 33 and 1 8 that aren’t and
that’s not a circumstance that’s really consistent with the long term objective of
Medicaid. I think what we will see is, see some changes, mostly giving states
more flexibility and we may actually see less funding in certain of the opti onal
populations provided it means that in certain populations there maybe some
flexibility on what the benefits are. I don’t know we will have to wait and see how
that unfolds, but I don’t think there is any lack of commitment to taking good care
and hel ping those who are in hardship.

Margaret Flinter: Well Governor Leavitt one thing I think we can be pretty sure of
st
regardless of what happens with the healthcare law is that 21 century
healthcare is undergoing dramatic transformation with new technolog ies and
biomedical advances. We recently had Dr. Victor J. Dzau, President of the
National Academy of Medicine and he was talking about the advisory panel that
you and other experts participated in creating some scientific and biomedical
recommendations f or the incoming President. So what are the trends that you
think are going to dominate healthcare transformation?

Michael Leavitt: Well I think we will clearly see a change in the way people get
paid, away from fee for service towards more of value paym ent. I think we will
see more emphasis on primary care. I think we will also begin to see a
pronounced reshaping of the way healthcare providers organize themselves
rather than everyone being general contractor if you will I think we will begin to
see ne tworks of care. And we will begin to see the insurance system move
toward that where we have more narrowed networks where people can
exchange for price concessions, people will agree that they will draw their care
from a prescribed network that will have to be done voluntarily but I think it will
happen. I think we will begin to see more of the risk for healthcare shifted toward
consumers at the same time I think we will see consumers have a more
deliberate choices. I think those are perhaps some of the more significant tellers
of change.

Mark Masselli: We have been speaking today with the honorable Michael Leavitt
founder and chairman of Leavitt Partners a consulting company focused in on
healthcare policy and one of the health industry advisors to the Trump transition
team. You could learn more about his work by going to www.leavittpartners.com
or follow them on Twitter at LeavittPartners that’s L - E - A - V - I - T - T. Governor
Leavitt thank you so much for joini ng us on Conversations on Healthcare today.

Michael Leavitt: Well thank you for including me. At Conversations on
Healthcare we want our audience to be truly in the know when it comes to the
facts about healthcare reform and policy Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org a non - partisan, non - profit

Michael Leavitt - CEO of Leavitt Partners

consumer advocate for voters that aim to reduce the level of deception in U.S.
politics. Lori what have you got for us this week?

Lori Robertson: Recently House Spe aker Paul Ryan mentioned the independent
payment advisory board created by the Affordable Care Act saying it was “about
to kick in with price controls on Medicare.” We haven’t heard much about this
board since the first year or two after the law was passe d. So what has
happened within the independent payment advisory board, well this 15 member
independent board which would be appointed by the President and confirmed by
the senate is tasked with making recommendations on Medicare can cut cost. It
would ma ke binding recommendations if Medicare spending exceeded certain
levels, but no one has yet been appointed to this board and it’s actions haven’t
been triggered due to slow growth in per enrollee healthcare spending. The
IPAB hasn’t been formed because it hasn’t been needed yet. As the non -
partisan Kaiser Family Foundations explains in a July 2016 report the IPAB
process is said to be triggered for the first time next year, based on the Medicare
actuaries most recent spending projection. Without a board in place the
Secretary of Health and Human Services would be tasked with making the
recommendations for spending growth reductions to start in 2019. The board is
limited in what it can do, it can’t raise taxes, premiums or cost sharing, restrict
benefits or otherwise ration care. And recommended reductions would come
from “Medicare advantage” the part D prescription drug program, skilled nursing
facility, home health dialysis, ambulance and ambulatory surgical center services
and durable medical equipment .

With the new administration coming into office in January however, it’s unclear
what would happen to these provisions of the Affordable Care Act. And that’s my
Fact Check for this week I am Lori Robertson managing editor of FactCheck.org.

Margaret Fli nter: 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
checked email us at www.chcradio.com we will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Healthcare.

Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. Sub Saharan
Africa leads the world in maternal and infant deaths, according to an annual
report from Save the Children, an estimated 3970 babies died at birth in that
region in 2013. And some 550 mothers die per day as well. Most of the causes
have to do with lack of access to medical care in these low resource regions and
often the local midwives lack formal medical training to prepare them to conduct
interventions in the event of a life threatening event like a hemor rhage or an
infection.

Michael Leavitt - CEO of Leavitt Partners

Anna Frellsen : We know that 90% of all the deaths that we see today could be
prevented if the mother had had you know access to this you know really basic
skilled care during the child birth.

Margaret Flinter: Anna Frellsen is th e CEO of the Maternity Foundation their
organization has created intervention for midwives living in low resource areas if
they just have access to a smartphone. It’s called the Safe Delivery App and it
provides comprehensive training for midwives that te ach them and guide them on
what to do in the event of a birthing crisis.

Anna Frellsen : And empower them to be able to better handle the emergencies
that may occur during a child birth such as you know the woman starts bleeding
or the new born is not bre athing and so forth. So the first and foremost it’s a
matter of finding a way that we can reach the health workers and build their skills.

Margaret Flinter: Frellsen says the real promise of the Safe Delivery application
lies in it’s ability to provide ongoing obstetric and neo - natal training. The Safe
Delivery app has received the United Nations approval for wider deployment.
The Maternity Foundation plans to have the Safe Delivery app in hands of 10000
healthcare workers across the region by next yea r. A lot cost culturally sensitive
mobile app that offers immediate guidance and assistance to midwives and
health workers, empowering them with ongoing support and knowledge that can
improve birth outcomes, now that’s a bright idea. This is Conversatio ns with
Healthcare I am Margaret Flinter.

Mark Masselli: And I am Mark Masseli, peace and health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
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