From ACA Repeal Attempts to Natural Disasters and Health Tech Breakthroughs, a Look Back at 2017

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , it feels like we've been through a tumultuous year in the
world of health policy and I suspect we'll see more of the same in the year to come
while the Affordable Care Act face several near - death experiences in 2017 , i t was
battered but still standing at the end of all it. There was no small achievement
considering the forces aligned in Washington committed to seeking its repeal .

Margaret Flinter: And do you Mark there was another I thought kind of notable event
and that was in spite of a significantly shortened open enrollment period for coverage in
2018 close to 9 million Americans managed to sign up for cover age in just six weeks .

Mark Masselli: But we ’ re still facing a lot of uncertainty , the tax reform bill that passed
just before Christmas has eliminated the individual mandate requiring all Americans to
carry health insurance and that is expected to impact coverage in the coming years .

Margaret Flinter: We could see 13 million Americans drop out of coverage over the next
decade because of that , that of course is what underlay the entire movement for the
universal mandate .

Mark Masselli: 2017 also saw an unprecedented number of natural disasters impact
America and its territories .

Margaret Flinter: And 2017 was also the year that the true scope of the opioid crisis
really came into focus in America opioid overdoses now the leading cause of accidental
death in this country and the numbers are continuing to get worse .

Mark Masselli: We've really been fortunate to have some pretty terrific guest s on the
show this past year to address all of these big challenges , so we thought we'd take a
l ook back revisit some of those conversations . There were great challenges but also
some exciting advances in things like gene editing , telehealth , technologies that are
certain to disrupt the status quo in years to come .

Margaret Flinter: We learned so much from all of our guests this past year looking
forward to tapping back into some of those moments .

Mark Masselli: We are always blessed to have Lori Robertson stop by , she is the
Managing Editor of FactCheck.org. You can hear all of our shows by going to
chcradio.com.

Margaret Flinter: And as always if you have comments, please email us at
[email protected] we love hearing from you.

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Mark Masselli: We will get to our look back at 2017 in just a moment.

Margaret Flinter: But first here is our producer Marianne O'Hare with this week's
headline news.

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Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. 2018 is
starting off with more questions than answers regarding health policy . Funding for
Children's Health Insurance Program or CHIP was added in a last - minute budget
resolution before the holiday whi ch essentially proved enough money to keep the
program going until the end of March . Funding for CHIP actually ran out at the end of
September , many states were concerned the lack of reauthorization of CHIP funding by
Congress would have led to millions of vulnerable American children losing health
coverage . CHIP covers healthcare for some 9 million children in a number of states
were bracing for necessary cuts to the program if Congress did not act . The Tr ump
Administration has stripped away another Obama era measures scaling back the use of
fines to nursing homes that harm residents , 4 in 10 nursing homes have been fine d for
violations since 2013 under the Obama measure . Under Trump Administration ’ s
guide lines nursing home regulators are being urged not to levy fines or actions even in
a case where a death has occurred at a nursing home facility .

On the heels of the Apple Heart Study genomics testing company 23and Me is looking to
launch a large - scale study on genetics and obesity . The weight loss intervention study
is launching at the start of peak weight loss season seeking 100,000 participants using
23and Me's personal genomics platform to help researchers analyze g enetic
components to obesity and how they might impact effectiveness of different weight loss
protocols . Last year 23and Me set the stage for this year's study launching the first
genomic weight report . This information shows how people ’s specific genetic s may
influence their own responses to not only exercise and make certain food choices but
also factors like sleep and stress . I am Marianne O'Hare with these healthcare
headlines.

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Mark Masselli: We're marking the end of 2017 a pivotal year in healthcare , a year that
began with the inauguration of Pres. Trump and ended without repeal of the Affordable
Care Act , w ith all of the uncertainty over health policy this past year we thought it would
be a good idea to revisit some of those guest s from 20 17 . So look back with us as we
remember some of the most notable events in health policy in the past year , efforts to

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repeal the Affordable Care Act, global health advocates who met the challenges of
recent natural disasters , state health commissioners wh o tackle d the big public health
issues on the front lines and the promise of new technologies such as gene editing ,
telemedicine , block chain , they are poised to disrupt the healthcare industry as we know
it.

Margaret Flinter: Well you know Mark when we launched this show , we want ed to offer
a forum where the best minds in the industry could help us understand the changes
underway in health policy , everything that was going on in the technology front with
innovations across the healthcare spectrum that we knew would influence the health
care of the future . And nine years later we ’ re still watching dramatic events unfold from
continued changes to health policy to the enormous opi oid crisis to the advent of
exciting new technologies that will and are transf orming care delivery . I think we would
say there’s been a lot of excitement and great promise as well .

Mark Masselli: Oh I think you're absolutely right Margaret , and you know we kicked off
2017 with a great conversation with the Hon. Michael Leavitt fo rmer HHS secretary
under the elder President George Bush he now runs one of the most influential
conservative consultancies on health policy in this country . Gov. Leavitt served in an
advisory capacity to the Trump Transition Team and speculated time of our interview on
what the administration would do well to focus in on its approach to health reform .

Gov. Leavitt: The one certainty in the next several months about healthcare is that
there will be a bill that will pass Congress that will be titled Repeal and Replace what is
certain is what they will define repeal to mean and what they will de fine replace to
mean. Pretending that the law never happened is not an option but the Republicans
have for three elections in a row campaigned t hat they would repeal and replace the law
and I think they have no alternative but to fulfill that. And I think one area that we will
look quickly to see will be obviously the individual mandate I think that's likely to
disappear , s o at least the appearan ce r ight now is that 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 intend to do this in a way that does not involve
a bipartisan support . One of th e primary mistake s that was made in the passage of the
Affordable Care Act is that it was done entirely on a partisan bas is. The most important
change that has occurred in healthcare potentially over the last 60 years is that
transition from fee - for - servi ce payment to some type of payment where providers are
paid on the basis of value . Will this transition from fee - for - service to value payment
continue under the new administration ? And I think the answer to that is , yes, it's being
driven by an economic imperative that if we want to continue to have great healthcare

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we have to change the way it's paid for because there's no way we can continue to
spend an increasing share of the American economy on one thing , healthcare .

Margaret Flinter: On th at Mark we welcome conservative policy analyst Lanhee Chen
Director of Domestic Policy Studies at Stanford University and Research Fellow at the
conservative Hoover Institution . He gave us an analysis of why he thought the House
GOP Health Reform Bill the American Healthcare Act had failed .

Lanhee Chen : Sure . Well you know I have described the failure of the American
Healthcare Act as a self - inflicted wound as well and Republicans ha d an opportunity
here to advance legislation that would have taken step s in the right direction I think in
terms of thinking about healthcare systems. It’s certainly was an opportunity to advance
some important goals for example reform of Medicaid , and really this was one of the
situations where Republicans knew th at Democrats were going to oppose the bill and
do so with relative unanimity . For Republicans though they were the ones who ended
up holding this bill up. And whether you blame some of the moderate Republican ’s
action or some of the more conservative hardl ine freedom caucus , either way
Republicans really were the ones who prevented this legislation from advancing . And
so what's disappointing about this was the inability of Republicans to get together and
agree th at bill got pulled. And we're in a situatio n now where any progress on repeal
and replace ment of the Affordable Care Act has become that much more difficult .

Mark Masselli: We have see n a rise in the poll around the popularity of the Affordable
Care Act , and I'm wondering what you think the next steps are going to be for
Congress ?

Lanhee Chen : I think they have to really seriously consider whether in fact they’re
committed to repeal and for replace ment of the law of Obamacare and if they are I think
they have to ask themselves, what are the measure s and steps they can take to do
that ? I think first of all there are things about Obamacare that suggests that in some
markets there is some serious issues , for example the stability of insurance markets in
many states . One of the thi ngs that’s interesting about the Affordable Care Act is even
if it's never repealed there is a provision in it that allows states to create innovative
health reforms on their own. In the absence of a federal consensus around how to
move forward on Obamaca re are there way s that various states can pursue their own
reform s even if it's different from the architecture set up by Obamacare.

Mark Masselli: And speaking of reform , and Margaret I think we always talk about
states in incubators for change , we had some interesting innovations at the state level
Dr. Jennifer Wal th all , Secretary of the Indian a Families and Social Service

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Administration , she joined us on the show this past year and helped us understand this
innovative approach to Medicaid expansion .

Dr. Jennifer Wal th all : The Healthy Indiana Plan actually p redated Medicaid expansion
this model is built on the theory that we can be partners with people to navigate their
way into the commercial health access market through engagement and support, but
t hat takes a lot of effort s together as partners . And in order to achieve that goal we
have to support and build infra structure for a healthy workforce. HIP is described as a
consumer directed approach to health coverage that actually replaces traditional
Medicaid in Indiana for all nondisabled who are ages 19 to 64 . And it's referred to as
consumer directed because the basic and routine cost of healthcare are paid by the
patient managed account versus the insurance company . And that is to promote
consum er behavior by giving patients greater control over their own health budget s and
the healthcare that they receive . HIP is structured so that it pays doctors more to care
for members HIP 2.0 pays Medicare rate s which are significantly higher and this has
helped recruit over 6000 new healthcare providers into the Medicaid network which has
increased access to care for our members .

Margaret Flinter: Well, also curious about the roles that other organizations like
community health centers may h ave played in helping to fill that primary care gap with
so many newly uninsured residents . And as you know the longer people were out of
care the more likely they had pet up demand .

Dr. Jennifer Wal th all : We have seen an incredible surge of partnerships around the
primary care space both from community health centers and also from bringing in a
primary care workforce . And one of the things that I've been very excited to be part of is
on the governor ’s health workforce com mission really filling th ose primary care deserts
for the state s so that we improve access to healthcare in general . About 87% of our
HIP Plus members use preventive health services during their first year of enrollment so
that's a pretty big deal in my mind.

Margaret Flinter: And staying with our theme of the states we welcomed Louisiana's
health Sec. Dr. Rebe kah G ee. She not ed the significant increase in health coverage in
her state when newly elected Gov. John B e l Edwards expanded Med icaid , her office of
course was instrumental on helping the region prepare for hurricanes Harvey and Irma
sharing the lessons they had learned the hard way from Hurricane Katrina and she
talked about how Louisiana prepared differently for these storms as a direct result s of
what they went through and most importantly what they learned and prepare d for .

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Dr. Rebekah Gee: There were many mistakes made, some of them were just because
new city of that sided had endured a hurricane disaster of that pro portion y ou know
25,000 individual s had to be evacuated post storm almost 2000 people lost their lives .
In Katrina there was a lot of communication going in different directions but we didn't
have a disaster response network, we now do, we have a central command, I have
operation center where we coordinate all of the healthcare activities for the state . Prior
to Katrina folks had n’t experienced that level of devastation now we really insist that
everyone leave . So in the wake of Katrina we develop ed new and robust primary care
facilities in the New Orleans area , but I think more importantly was the decision that
Gov. Edwards made to expand Medicaid . Here in Louisiana we have a large number of
working poor folks who 1 in of 4 were uninsured you know i f they went to a charity
facility or an emergency room now nearly 440,000 adults many for the first time in their
lives have access to primary care . And we know that over 100,000 of them have
received preventive health services tens of thousands have gott en a colonoscopy ,
19,000 women have gotten diagnostic breast imaging . And so having a whole system
of care for them where they have insurance can go to a federally qualified health center
that has been a real sea change for Louisiana .

Mark Masselli: Wit h so much turmoil happening around the world and the ongoing
refugee crisis we welcomed Save t he Children's CEO Carolyn Miles there are 2017
report on the End of Childhood was a sobering wake - up call on the plate of so many of
the world’s children.

Carolyn Miles: So we looked at eight what we call childhood enders things like child
mortality , mal nutrition which stump s children not just physically but it stumps their
growth mentally , being out of school so having an end to their education , child labo r ,
child marriage which we know for girls particularly is a huge ender of childhood . A nd
then forced displacement by conflict , s o being a refugee or being displaced inside your
country , those of the things that really we believe ends the childhood . And g irls who are
married as children most of them will drop out of school , they will then usually have a
child within a very short time of being married the age of 13 or 14 , a nd then those
children don't get an opportunity to go to school . So you know one of the best things to
protect children is to really move that age of marriage up for girls .

Margaret Flinter: Yeap. And Michael Nyenhuis, CEO of Americares talked about the
devastation brought by the back - to - back hurricanes struck in 2017

Michael Nyenhuis : We’re really focused on supporting local health infrastructure before
disaster and afterwards and recovery, and then sort of ongoing in a longer term way.
We focus ed on local health centers, building their capacity to serve the health needs in

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their community. And one critical way that we do that is making sure they have access
to medicines and medical supplies , s o we do have a large logistical operation that
distributes medicines and supplies . And then our work goes beyond that to build the
c apacity of these local health centers .

Mark Masselli: Margaret , it was a breakout year for gene editing with some of the first
notable treatments in human setting the stage for what could truly be an era of
personalized medicine . We had Dr. Samir Damani on with us recently , a founder of
MintHealth one of the handfuls of entities looking to utilize blockchain in healthcare .

Dr. Samir Damani: And so what blockchain enables is enables a Self - sovereign patient
control led health record that ’s tied to a global unique identifier. It allows for the
seamless and secure transfer of clinical and behavioral data between patient authorized
stakeholders . And so blockchains are essentially the centralized ledger of all
transactions across the peer - to - peer network and using this technology any participant
can confirm the transaction without the need for any kind of central certifying authority.
This requests a transaction that you broadcast to peer - to - peer network of computers
known as nodes , t hese nod es then validate the transactions and the user status through
a lgorithm s . And that’s what this peer - to - peer global network open source is actually
doing at least in healthcare what can happen now is blockchain essentially eliminates
the middleman and allows for seamless and secure d transfer of data and information
and that gives patients control.

Margaret Flinter: Earl ier this year we welcomed Dr. Peter Yellowlees on the show, he is
the President of the American Telemedic ine Association, he talked about the coming
wave of digital natives in the healthcare landscape who will begin to drive the demand
for telemedicine protocols across the healthcare industry .

Dr. Peter Yellowlees : I mean the difference i s now just you can do more on your fund
when you couldn’t on early systems that I spent an enormous amount of money on .
There’s been also huge change in attitudes particularly with the younger generation
people under 30 you know we typically think of as b eing digital native s and who have
different expectations of being able to get information immediately . And then people
always used to think of – so telemedicine or using the se technologists is being an
either/or choice situation. And the reality of life is that increasing numbers of patients
are being seen in a hybrid manner you know they sometimes see the doctor in person,
they sometimes see them online and essentially the doctor - patient relationship
nowadays has become a much more fluid and quite honest ly better relationship . To
many years in psychiatry we have – we have done what we called curbside consultation
so that a primary care doc will ring a psychiatric. We will have maybe a 2 to 4 minutes

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conversation with that person, the psychiatrist will g ive them an opinion , all we are doing
with the asynchronous telepsychiatry is saying , why don’t we actually record the patient
and I can actually send you a recording of a patient, you can get to see what they look
like , you can get to see how they answer and then you can give me an opinion . We
have done a number of studies showing that you could be just as accurate
diagnostically , we have been doing a study recently looking at several hundred patients
who have chronic medical and psychiatric illnesses and we are doing these
asynchronous consultations every six months to basically help the primary care do c with
the overall management of that patient.

Mark Masselli: The recently announced Apple Heart Study is now allowing millions of
Apple Watch users to download a free app that identifies irregular heartbeats and if
AFib is detected . They are swiftly linked to a telehealth physician through American
Well, a company founded by our recent guest s , Roy and Ido Schoenberg .

Roy Schoenberg: If you realize what corner telemedicine has gone by when the Apple
Heart Study was announced, you know if you think about the way that medicine has
always been, either we showed up when we were very sick or in some ways healthcare
developed ways in which occa sionally if we were willing to do so, it would take a
snapshot s of where we are and try to identify earlier certain diseases . But with a heart
study we try to cross a certain line because for the first time we are saying , healthcare is
not going to wait until you show up with a certain healthcare condition but rather we are
actually going to go to where you are . We are going to kind of live with you and try to
do our best to understand whether certain things that are happ ening with you and your
body may indicate that some kind of treatment or some kind of intervention is needed .
That’s a radical departure in th e philosophy of how we do medicine and I think this is
really the corner that the Apple Heart Study signifies.
Id o Schoenberg: We see something pretty amazing that the first time that the tool that
is used by consumers which inheritance [PH] is not a medical device can be so
instrumental to help us understand something that could have a potential far - reaching
clinic al impact. Once we hold the study we will be able to show to find people that could
warrant medical attention far sooner than any other medical intervention , and s o we
have this tool that we use every day that listens to our body . And then we are able to
close the loop with board certified providers that show up much quicker than any other
alternative to help navigate and understand a finding .

Margaret Flinter: You know Mark, I am reminded every single week on the show that
while health polic y continues to morph and change in the shifting political landscape , we
are on the frontline watching a transformative healthcare revolution underway . In the
meantime for our listeners if you want to tap into our more than 400 shows, please go to

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our webs ite chc radio.com . And thank you so much for listening we have got more great
guests in the queue for 2018 here on Conversations on Healthcare .

Mark Masselli: On ward, peace and health .

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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 award - winning journalist and managing editor of FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce t he level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: At the end of the year we chronicled the worst political falsehoods or
what we call the whoppers of the year. At a campaign style rally in Kentucky in March
President Donald Trump falsely said that “Many of our best and brightest are leaving the
medical profession entirely because of Obamacare.” The number of active physicians
increased 8 % from 2010, when the Affordable Care Act became law to 2015, the most
r ecent data available . Earliest this year Trump also wrongly claimed “Obamacare
covers very few people,” but the number of Americans without health insurance had
fallen by 20 million since the ACA was enacted.

And without evidence Trump said that by all owing insurers to sell plans across state
lines premiums would go down 60 % and 70 %. Experts told us they knew of no study to
back up the claim and they disputed the idea that average premiums would drop
significantly.

We chronicled several claim s about t he Republican effort to repeal and replace the
Affordable Care Act for instan ce House Speaker Paul Ryan Ryan and Independent Sen.
Bernie Sanders both distorted the C ongressional B udget O ffices’ analysis of the
Republican bill. Sanders claimed it would “ throw 22 million Americans off of health
insurance,” while Ryan said no one would be thrown off insurance. “It’s that people will
choose not to buy something they don’t like or want.” CBO said the bill would reduce
the number of people with health insura nce by 22 million s ome would voluntarily choose
not to buy insurance, but others would no longer be eligible for Medicaid or would not be
able to afford coverage. And that’s my fact check 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, emai l us at

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www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.
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M argaret Flinter: This 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 www.wesufm.org an d brought to you by the Community
Health Center.