Bipartisan Policy Center Health Policy Director Katherine Hayes Discusses GOP Health Reform Implications

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

Mark Masselli: This is Conversation on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, I think we are going to see some of the Trump
administration health policy start to come into focus. Se ema Verma has
advanced toward her ultimate role as administrator of Center for Medicaid and
Medicaid Services and it signals a more conservative approach towards funding
of health programs governed by CMS, which impacts over a third of Americans.

Margaret Flinter: With the rhetoric that’s coming from the Trump administration
and from HHS Secretary, Tom Price, has been pretty clear. Secretary Price is
seeking significant reductions in the Medicaid program and they are supporting
the GOP leadership for cha nges that will impact Medicare down the line as well.
So, with that in mind, Seema Verma was selected for the post.

Mark Masselli: She has worked to advance policies that are aligned with more
austere approach. She helped vice president Mike Pence’s ho me State in
Indiana set up an alternative to the Medicaid Expansion Program. It covered
more uninsured poorhousers, but they had to pay for more of their care out of
their own pocket than those typically covered by Medicaid.

Margaret Flinter: And you kn ow, Mark, physicians in Indiana report they have
been quite favorable of the approach, because they at the same time received
more compensation in recent years under Indiana’s Medicaid expansion.

Mark Masselli: And it’s something our guest today is watch ing; Katherine Hayes
is Director of Health Policy at the Bipartisan Policy Center, a nonprofit,
nonpartisan, Washington think - tank, started by former members of Congress
from both sides of aisle, whose mission is to foster bipartisan efforts to advance
imp ortant social policies.

Margaret Flinter: And they have produced a very detailed report on how the
programs governed by CMS should continue to be supported in the new
administration so that important gains in population health are not negatively
impacted .

Mark Masselli: Lori Robertson also stops by, the Managing Editor of
FactCheck.org, but no matter what the topic, you can hear all of our shows by
going to www.chcradio.com .

Margaret Flinter : And if you have com ments, please email us at
[email protected] or find us on Facebook or Twitter , because we love to
hear from you. Now we will get to our interview with Katherine Hayes in just a
moment.

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

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 Healthcare Headlines. The
Republican plan to repeal and replace ObamaCare has seen the light of day.
The plan being promoted by house speaker, Paul Ryan would eliminate the
insurance marketplaces that have helped millions of poor and uninsured
Americans gain coverage. Instead, there would be a new set of subsidies based
on a person’s age, not their income. The plan would also ph ase out support for
States that has helped them pay for the Medicaid Expansion, which has also led
to millions more Americans gaining health coverage across the country. Right
wing conservatives and Congress don’t think it goes far enough to reduce
govern ment health spending and there is already pushback from a number of
consumer rights organizations; AARP, the largest advocacy group for the
nation’s seniors is decrying the GOP Health Plan saying it will have a negative
impact on a large swathe of the nati on’s ageing population. Syphilis is on the
rise, part of a growing trend in recent years of a spike across the spectrum of
sexually transmitted diseases, but Syphilis which was largely considered
eradicated by the CDC back in 2000 has boomed back into exi stence in certain
sectors of the country, Louisiana, Georgia, parts of California, areas grappling
with poverty and where women have little access to prenatal care, meaning they
are not being tested for the presence of STDs before they deliver their babies
leading to a spike in the birth of Syphilis infected babies. Public health officials
are warning State Health Departments to get a better handle on the problem.
The American Girls Doll Brand has been a hit with the generation of girls
designing dolls th at represent an interesting cross - section of races and historical
periods, giving kids an opportunity for positive messaging. Now, American Girls
is entering the medical realm, offering an addendum kit that helps girls connect
with the challenges of keepi ng up with type 1 diabetes. Children traditionally
have a tough time managing type 1 diabetes, which requires finger - pricks, insulin
checks, carb counting, and a whole host of other preventive measures. The
diabetes care kit comes with doll - sized accesso ries including blood sugar
monitors, insulin pumps and the like, which the girls can use to act out the very
scenarios they must deal with in their own lives. According to an article in the
New York Times on this new phenomenon, parents and children are l ike are
raving about the American Girls diabetes care kit. I am Marianne O’Hare with
these Healthcare Headlines.

Mark Masselli: We are speaking today with Katherine Hayes , Director of Health
Policy at the Bipartisan Policy Center, the only Washington D. C. think - tank
dedicated to promoting bipartisan solutions to the nation’s biggest challenge.
Before that, Ms. Hayes served as the Associate Professor in the Department of
Health Policy at George Washington’s School of Public Health. Prior to that she
ser ved as Vice President of Jennings Policy Strategies and also worked in both
Houses of Congress as a health policy advisor to both political parties and also
served as Program Consultant to the Missouri Medicaid Agency. She earned her

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

law degree at the Ame rican University, Washington College of Law. Katherine,
welcome to Conversations on Healthcare Today.

Katherine Hayes : Thank you for asking.

Mark Masselli: We‘ve been a fan of the Bipartisan Policy Center for a while now,
launched 10 years ago by a nu mber of Congressional Veterans from both sides
of the aisle, who saw the need to create a nonpartisan think - tank to tackle some
of the nation’s toughest social challenges including healthcare and sadly, it
seems partisan brinksmanship has ascended to new h eights. Now, I think it is
fair to say it’s bipartisan and we are seeing this manifest again. I am wondering if
you could share with our listeners, the current reform climate and where you may
see the seam of opportunity, particularly as it affects the n ation’s vulnerable
populations.

Katherine Hayes : Well, first of all I would to make a point that you know
healthcare is very personal. Families are asked to pay premiums, you know, for
an insurance policy that, you know, if they are healthy, they may no t need, they
incur more cost in the form of deductibles and co - insurance, when they are most
vulnerable. Generally, Democrats and Republicans think of healthcare from
opposite ends of the political divide. Republicans tend to value personal
responsibilit y and allowing the States to have threshold, while Democrats tend to
value providing Federal assistance to low - income population, so that they have
coverage and having some minimum Federal standards as a backstop in case
States don’t, in their view, protec t consumers. In 2009, Democrats and
Republicans weren’t able to find a common ground between these two opposite
poles and so Democrats ultimately decided to go it alone. There was no
Republican buy - in and the GOP has spent the last six years trying to un dermine
and repeal a law that they believe is wrong for the American people. Now, they
are risking doing exactly the same thing. Repealing the law and putting in place
a reformed structure based on their values. So we know that at least for the next
few months, we are going to have to go through this wrangling process, but at
the end of the day, the only way to end this battle and to have a healthcare
system that is a blend of the two ideologies is to compromise and this is
especially important for low i ncome populations, who have trouble affording their
deductibles and co - pays or have trouble even finding providers to begin with.

Margaret Flinter: Well, Katherine , I do think there is this one area, where there
seems to be agreement and that is that we always need to protect healthcare for
the nation’s most vulnerable and that is the children, but at the moment we are
not even sure what will happen with that and this new iteration of health reform,
you’ve noted that the Bipartisan Policy Center has just released a detailed report
urging Congress to continue current funding level for the nation’s safety net
health programs, such as CHIP, The Children’s Health Insurance Program and
the nation’s community health centers until at least 2020 - 2021. Could you t alk

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

about what’s its stake here and what your research suggests would be the best
stop moving forward?

Katherine Hayes : This whole issue, these expiring programs, they don’t expire
until September, they’ve sort of been lost in this battle over health ref orm and
what, I think, people tend to forget is, you mentioned, is that these are historically
bipartisan programs. The Children’s Health Insurance Program was enacted
almost 20 years ago and the fathers and mothers of that program were Ted
Kennedy, a Dem ocrat from Massachusetts, former first lady Hilary Clinton, J.
Rockefeller from West Virginia, the Republicans were Orrin Hatch from Utah,
John Chafee from Rhode Island, and more recently Senator Chuck Grassley
from Iowa has been very engaged. The communi ty health centers have been
around for about 50 years and it has long enjoyed bipartisan support; so one of
the big concerns is that these programs, as I said, are just being lost in the
shuffle here and States are really at a loss of what to do. Their fi scal years
st
begin, most of them, on July 1 of this year and so they are sort of operating in
the dark here. They are having to put their budgets together not knowing, you
know, they are assuming, I guess it’s going to continue, but they don’t what the
MA T rates will be, they don’t how much it will be, so we really need to get this
uncertainty out of the way right away and then continue with the discussions on
health reforms.

Mark Masselli: Your reports have outlined some pretty specific guidelines for
w hat you think is essential if the level of coverage for the nation’s vulnerable
population is to be made, so what are you calling for Congress to do specifically
in your report?

Katherine Hayes : Well, we are asking them to extend the program for another
four years. First, we know its probably going to take a couple of years to sort out
whatever is going to happen on health reform and we are asking them to
continue the same level of funding that they have had for the last two years and
we have to remember that this program covers, you know, almost eight and half
million children and if that doesn’t move forward, it’s almost a perfect storm, you
know, these expiring programs and the uncertainty in the health insurance
markets, particularly in the individual market that is generated by the Affordable
Care Act today. So, we are asking States to continue covering the Medicaid
populations that they have been covering and continuing to provide the increased
MAT rate, that means the Federal Government pays a grea ter percentage of the
funding until 2019 and then we begin to phase it down.

Margaret Flinter: Well, Katherine , we talked about the Affordable Care Act and
we’ve seen more than 20 million Americans get health coverage, some through
the online insurance e xchanges and 85% of those who purchased insurance and
exchange received some kind of subsidy and then we had the Medicaid
Expansion being covered through the Federal Matching Program and all this
looks like it could be in jeopardy, one of the ones that cer tainly concerns people

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

is the whole issue of block grants for Medicaid, which would mean less financial
support for the States. What are your recommendations for continued Federal
Matching and other financial support for the States?

Katherine Hayes : I w orked on The Hill back in 1995 and 1996, when we had the
last Block Grant Debate. In 95 and 96, there was an attempt to block grant, the
Medicaid Program and welfare and at the end of the day, they were not able to
get agreement on the Medicaid Block Gran t. It actually passed Congress and
President Bill Clinton detoured it and that was because of the significant cuts in
the Medicaid Program and if you look at the TANF Program. That program which
was block granted really has not grown at all since 1996. So, I think there’s a
concern if you move forward with a block grant, particularly among the governors
that they are going to see the same sorts of things. One out of every four
Medicaid dollars are spent on long - term services and support; for the elderly and
disabled under age 65 and with 10,000 baby boomers turning 65 everyday and
enrolling in the Medicare Program, we are going to see in 20 years a huge rush
of individuals as they hit their 80s, who are going to be in need of long - term care
and we don’t have a Federal program for that, all we have is Medicaid, so people
spend down all of their resources and end up qualifying for Medicaid, ending up
in either a nursing home or in some cases they can get services in their home,
but there is this very large population that is very hard to control and it’s only
going to get worse, so I can’t blame governors for being concerned about this.

Mark Masselli: We are speaking today with Katherine Hayes , Director of Health
Policy at the Bipartisan Policy Center, the only Washington D.C. think - tank
dedicated to promoting bipartisan solutions to the nation’s policy challenges.
You know, you’ve talked earlier about the values that Republicans have and the
values that Democrats have and it seems like they are both from Venus and
Mars , but we are down here on Earth having to resolve these issues and
Margaret, we remember we had David Gergen on the show.

Margaret Flinter: Absolutely.

Mark Masselli: Who, talked about this issue of, it wasn’t a settled matter when it
wa s done in a partisan way; tell what the bipartisan center is doing on trying to
bring people together that find that seam of opportunity and collaboration so that
we can move in that direction?

Katherine Hayes : Well, the Bipartisan Policy Center has a lo ng history of
working on health reform. In fact, the first report that came from the Bipartisan
Policy Center was the leader’s report that was put forth by four Senate majority
leaders, two Republicans and two Democrats, it’s Tom Daschle and George
Mitche ll, Bob Dole and Howard Baker, the four of them really sat down and
worked to try to get a compromise and many of those components were included
in the Affordable Care Act, those bipartisan underpinnings. Since that time, BPC
has been working in a number of areas, mostly trying to help bring down the cost

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

of healthcare in the form of delivery system reform. Looking at patients with
multiple chronic conditions and trying to figure out the best way to pay for those
patients to help better coordinate that ca re, improve quality, and hopefully over
time lower costs. We’ve also been working on coverage issues such as the
Children’s Health Program and these other safety net programs and we’ve also
began an educational series. Right now, it’s very hard for either side to sit down
and talk about bipartisanship. I think we are going to have to watch this game
play out over the coming months. For something to be sustainable, they are
going to have to have bipartisan support. So, what we are doing is serving as a
r esource right now and we are holding educational events on some of the more
compelling issues to try to get people on a level playing field in terms of their
understanding. We will be putting out a couple of issue briefs on some of the
bigger issues.

Mar garet Flinter: You know, Katherine, it occurs to me that over the years since
the Affordable Care Act was passed, we just haven’t heard so much about the
numerous programs that were created under the Affordable Care Act that have
had an impact on populati on health and I think they’ve gotten lost a little bit in the
heated rhetoric of the past year as well. One example of that is the Maternal
Infant and Early Childhood Home Visiting program, other programs focus on
helping with Addiction and Mental Health needs in the community and your report
analyses the impact of programs like these and how they make a big difference
on long - term health outcomes and population health. Perhaps you could share
with our listeners some examples of the programs that you’ve a nalyzed and why
losing support for these programs would board ill for population health?

Katherine Hayes : You know, in addition to the 20 million people that have gained
insurance coverage, there are lot of people who don’t have insurance coverage.
Thos e who have not chosen to purchase health insurance or for whom it is still
not affordable. There are also a lot of underinsured individuals. You know, a lot
of the plans that are offered through the marketplace have really high deductibles
and to know th at you have to pay five or six thousand dollars when you are going
into get health services, you know, a lot of families just don’t have that kind of
money lying around. So, there are a number of programs that help fill the gap
there. One has been around for over 50 years, which is the Community Health
Center Program. Community Health Centers are located by definition in
medically underserved areas, both urban and rural; they require to accept any
patient regardless of their ability to pay and they are r equired to provide
comprehensive primary health care services, you know, services that aren’t
covered under traditional health insurance policies such as transportation,
translation, and sometimes case management. In fact now, we have recently
issued a fe w reports in our delivery system reform area that give additional
flexibility to some of the managed care plans under Medicare and Medicaid to
really take a look at some of the additional social services and support that really
might help people including for example you have a diabetic, who, they don’t
have a refrigerator, if it’s working, and t hey can’t store their insulin, so some

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

plans might be able to purchase a small refrigerator to store their insulin.
Another issue is meals, home delivered meals, a lot of senior citizens, particularly
those with physical limitations and cognitive impairment really need help. In
addition, home modification. There are plans and healthcare providers that can
go into the home and take a look at where the hazards are. They can put up
grab bars when they are needed and those sorts of things. Another program as
you mentioned is the Maternal and Infant Early Childhood Home Visiting
Program, really helps individuals, helps parents improve, both maternal and new
born healt h. It helps prevent childhood injury and malnutrition, helps to reduce
emergency room visits, and helps with school readiness, so all of these things
can be done through these programs and finally at the National Health Service
Corps, which too has been a round for a long time. There are more than 9,000
health professionals that are part of the National Health Service Corps and they
are deployed all over the country in medically underserved areas, where they
can’t attract physicians. In fact, one of my fo rmer colleagues in the Senate was a
National Health Service Corps volunteer and she ended up doing a fellowship in
our office, but she was stationed in a community in Alaska that was only
accessible by plane, so these are just such important places that we need to
make sure we fund.

Mark Masselli: We are proud to have been speaking today with Katherine
Hayes, Director of Health Policy at the Bipartisan Policy Center, asking Congress
to continue to support for the nation’s safety net providers, community h ealth
center, and children’s health insurance program. You can learn more about their
work by going to bipartisapolicy.org or you can follow their work on Twitter at
bpc_bipartisan or at jetthayes. Katherine, thank you so much for joining us on
Conversat ions on Healthcare Today.

Katherine Hayes : Oh, thank you both very much.

Mark Masselli: 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 awar d - winning journalist and Managing Editor of FactCheck.org,
a non - partisan, nonprofit 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: In his first address to a joint session of Congress, President
Donald Trump said “ObamaCare premiums nationwide have increased by double
and triple digits” and he went onto give the average 116% increase in Arizona as
an example, but that State was the only one to have a tripl e digit average
increase in premiums on the Affordable Care Act exchanges, where individuals
who buy their own insurance get health coverage. The average nationwide
exchange was 25% increase from 2016 to 2017 in premiums among the 38
states that used heal thcare.gov for their exchanges. Ten of those States had
single digit increases or a decrease. The numbers for the second lowest cost
Silver Plans for a 27 - year - old and it is worth noting that 84% of the 10.4 million

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center

Americans with marketplace coverage in the first half of 2016, received tax
credits and there was wide variation in the average increase by State. Trump
has repeatedly cited the high end of that range, Arizona’s average 116%
premium increase, but Indiana, at the other end of the spectrum had an average
3% decrease. As we said, such a widespread in the numbers makes the report
right for cherry picking and that’s my FactCheck 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
checked, email us at www.ch cradio.com , we will have FactCheck.org, Lori
Robertson, check it out for you, here on Conversations on Healthcare.

Margaret Flinter: Ea ch week conversations highlights a bright idea about how to
make wellness a part of our communities into everyday live s. Each year more
than one million babies die at birth and another three million die within the first
few weeks of life, often from preventable causes. Newborns and particularly
primis have a considerable amount of difficulty regulating their own body
te mperature and without access to incubators, babies in the third world often
succumb to hypothermia. That got former Stanford MBA student Jane Chen
thinking how do we develop a low - cost solution to the problem.

Jane Chen : My team and I realized what was needed was a local solution.
Something that could work without electricity, that was simple enough for a
mother or midwife to use. We needed something was portable, something that
could be sterilized and reused across multiple babies and something ultra low
cost compared to the 20 thousand dollars that an incubator in the U.S. costs.

Margaret Flinter: Speaking at a recent TED talk, Chen said that they developed
a cocoon like device called simply Embrace, a thermal body wrap that encases
the baby and hel ps regulate body temperature for up to six hours.

Jane Chen : What you see here looks like a small sleeping bag for a baby.
There’s no seams inside, so you can sterilize it very easily, but the magic is in
this pouch of wax. This is a phase change mater ial, it is a wax like substance
with a melting point of human body temperature and then when it melts, it is able
to maintain one constant temperature for four to six hours at a time, after which
you simply reheat the pouch and it creates a warm microenvir onment for the
baby.

Margaret Flinter: And Chen and her developers have managed to keep the cost
of the Embrace Baby Warmer at around $25 per unit. Since launching the
product in 2010, they estimate that over 150 thousand babies’ lives may have
been sav ed with the device. A low cost high - tech portable temperature regulator

Katherine Hayes – Health Policy Director at the Bipartisan Policy Center
designed to regulate primi’s body temperatures to ensure that they not only
survive premature birth, but ultimately thrive as well. Now, that’s a bright idea.
Margaret Flinter: Thi s is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University , streaming live at wesufm.org and brought to you by th e community
health center.