Putting Healthcare Above Politics: United States of Care Co-Founder Emily Barson on Medicaid Buy-in and State Based Health Policy Solutions

Emily Barson

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Female: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery and the great minds
who are shaping the health care of the future. This week Mark and
Margaret speak with Emily Barson Co - founder and Executive Director
of United States of Care, it’s a nonpartisan consortium of some of the
top health policy analyst, health industry stakeholders and patients
advocacy groups all co mmitted to improving access to health care for
all Americans.

Lori Robertson also checks in the Managing Editor of FactCheck.org,
she looked at misstatements spoken about health policy in the public
domain separating the fake from the facts. We end with a bright idea
that’s improving health and wellbeing in everyday lives. If you have
comments please email us at [email protected] or find us on
Facebook, Twitter, iTunes or wherever you listen to podcast . You can
also hear us by asking Alexa to play the program Conversations on
Health Care. Now, stay tuned for interview with Emily Barson,
Executive Director of United States of Care on Conversations on
Health Care.

Mark Masselli: We’re speaking today with Emily Barson, E xecutive Director of United
States of Care a nonprofit, nonpartisan organization dedicated to
advancing access to affordable health care for all Americans, seeking
to put health care over politics. Previously, she serve for eight years at
the Department of Health and Human Services under President
Barack Obama. Most recently as Director of the Intergovernmental
and External Affairs, prior to that Ms. Barson, she earned her degree
in political communications from George Washington University
School of Media and Public Affairs. Emily, welcome to Conversations
on Health Care.

Emily Barson: Thanks for having me.

Mark Masselli: Yeah, and congratulations, you and Andy Slavitt co - founded the
United States of Care and you’ve really put together a great coalition
of people from health policy, health industry from around the
country. You’ve got names that are familiar to many of our listeners
Atul Gawande, Mark Cuban, Tom Daschle, Governor S teven Beshear
and Dr. Don Berwick as well as Michael Levitt. I’m wondering if y ou
could just tell our listeners how old these came people together under
the banner of United States of Care and what’s the unifying mission?

Emily Barson: Well, we were founded around a simple but very ambitious mission to
ensure that every single Americ an have access to affordable health
care. We believe there’s more tha t unites Americans than divides us
in health care and that refocusing the discussion around everyday

Emily Barson

Americans and their experiences is the key step in any successful
discussion of reform s or expanding health care access. You mentioned
some of the more notable members of our founder’s council. We are
grateful certainly that they’ve all signed on and support of that
mission and lending their considerable expertise certainly. What I
would sa y is the founder’s council members that I think are the most
compelling and really important to our work are the ones you haven’t
heard of.

We have representatives from the patient advocacy community,
disability activist, we’ve got parents of medically com plex children,
and others who really help us in our mission to keep the patients
experience front and center in our work. Those are people like Elena
Hung, she co - founded an organization called Little Lobbyists. People
like Lane Senna [PH] who is one of th e patients and community
advocates at the center of the New Mexico coalition, we’ve partnered
with that have been advocating for Medicaid buy in, in that space.

Margaret Flinter: Well, Emily I think it’s safe to say that as a nation we’ve been through
quit e a dramatic rollercoaster of a ride maybe starting with the
crafting and the passage of the Affordable Care Act, its
implementation and then all the challenges that we’ve seen as the
years went on. It has triggered really pretty profound changes in the
Am erican health care system expanding coverage for tens of millions
of formally uninsured Americans, and of course we’ve seen that it
heightened some of the political divide in the country. But what’s
really fascinating about your work it seems is that you’r e creating a
framework for policy discussions that rises above politics and above
those political divides and really seeks to unite the country around
this critical issue of health care. Talk to us about how you’re seeking
to redirect this narrative around this critical issue of health care in
America?

Emily Barson: As you mentioned the last many years of national discussion around
health care have certainly been dominated by the ACA. We’re really
excited to create that framework and be able to move beyond the
current political fray and look to the next set of innovative policies
that can continue making progress towards our ultimate mission. The
politics have gotten in the way and most especially so at the federal
level. We don’t see there’s a lot of prospe ct for federal progress, at
least for the next couple of years and that’s why our approach is really
focused at the state level to build an evidence space of what can be
scalable and bring more relief to people in those states in the short
term while we ha ve this broader conversation about what the future
of health care in this country can look like.

We’ve certainly seen a lot more promising momentum for
bipartisanship at the state level and the ability to move beyond the

Emily Barson

politics than we currently see in W ashington. That’s really why we’re
trying to take politics out of being the center of the discussion and
focusing on the patients. We know that when you or someone in your
family needs health care it doesn’t matter if you’re a republican or a
democrat, you just want to be able to go see the doctor. We think
that should be the underlying goal at the center of any health care
reforms and keeping those experiences in front of mind.

Mark Masselli: Emily, I like a couple of things that you’ve said that there’s m ore that
unites us than divides us and clearly that politics has gotten in the
way. But we’re entering already the cycle of the 2020 presidential
race. We’ve got many democrats who have declared an interest in
promoting Medicare for all. I’m just wondering based on your own
experience, what health policy issues do you believe will resonate
most strongly with voters in this 2020 campaign cycle?

Emily Barson: Well, I will say, I’m not in the business of giving political advice, we’re
a policy focus nonprofit organization. I will say that what we find
promising is seeing a focus on the end goal of making sure everyone
in America can access the health care that they need. There are a lot
of proposals that will be debated both on the campaign trail as well as
pro posals that have been introduced in congress and that’s great. I
think having a real exchange of ideas and passing out what make
sense is going to be positive for getting to the end goal of reform.
From our perspective what’s most important is that the voi ces of
patients and families are heard, and we’ll be watching to see which
ideas among the discussions meet our underlying principles which is
first everyone should have an affordable regular source of care.

Second, that no one should face financial hardsh ip or have to make
choices between paying for their health care for themselves and their
family and other expenses in their life. Third, that reform should be
done in a way that’s politically and financially sustainable so that
people won’t feel nervous th at their health care is going to be at risk
depending on the results of this election cycle or who is controlling
congress or their governor’s manson. We think those are really the
principles that we are organized around. We’re not advocating behind
one pa rticular policy approach, we think there’s a lot of ways to get
there and that’s why we want to start building out those learnings on
the ground.

Margaret Flinter: Well, Emily I think one of the things that we’ve all learned a lot about
is how to improve a ccess to health coverage to people having health
insurance by expanding Medicaid that was certainly a key part of the
Affordable Care Act. I was really interested in your initiative at United
States of Care that seeks to expand on that example with a Medic aid
buy in initiative, which I understand is gaining interest in many states
as a possible way to provide even more affordable coverage options

Emily Barson

to people. Can you talk about this initiative and the Medicaid buy in
playbook that you’ve created?

Emily Barson : Sure, Medicaid is a health care program that’s run through the states
and it’s a state federal partnership, so both governments pick up part
of the cost of providing care. Populations that get Medicaid are
people like kids, pregnant women, children with disabilities . Under
the Affordable Care Act, Medicaid expanded to more populations in
state that decided to expand their program to cover low income
adults. Now, as you mentioned as many as a dozen states have been
considering a Medicaid buy in approach th at would build on the
framework of Medicaid in their states and allow more people to pay
to buy coverage. This is something that we find appealing because it’s
an approach they can look at now, building on the framework of a
program that is efficient and p opular at providing health care
coverage.

Medicaid buy in would allow states to tailor a program to what their
particular population needs, and that could be around specific
populations like world communities or small businesses or it could be
providing a more widely available options. Part of our approach at
United States of Care is caring learning, gathering what the best things
that people are doing in states and making sure that other states
aren’t starting from scratch. What we’ve done is created a set of
resources on Medicaid buy in to do just that. They can all be found at
Medicaidbuyin.com which has a map tracking activity in this area,
across the country. There’s a video explaining what Medicaid buy in
means. As you said there’s what we’re calling a Medicaid buy in
playbook which is an actionable roadmap that advocates or law
makers who might be thinking about this as a solution for their state
can use, figure out what problems they’re trying to solve and pull
together policy and coalition based info rmation about how to make it
happen.

Mark Masselli: We’re speaking today with Emily Barson, Executive Director of United
States of Care, a nonprofit, nonpartisan organization dedicated to
advancing access to affordable health care for all Americans. She
se rved at the Department of Health and Human Services, most
recently is Director of Intergovernmental and External Affairs. You
know, I think we’ve always had the view that states our engines of
innovation and also I think it’s probably a place more likely t o have a
conversation with real people. We’ve seen some states like
Massachusetts and Maryland have created some great examples of
improving access to care. What are you seeing out in the states in
terms of innovations and solutions that others might emula te?

Emily Barson: We couldn’t agree more, we believe also that states are the
laboratories of democracy and innovation and allow for policy

Emily Barson

innovation that meets their needs and that other states can learn
from as well as informing policy at a national lev el. You know you
mentioned Maryland, last week they advance a bill around easy in
moment. This was passed by an overwhelming margin with bipartisan
support, and this was legislation that would established a simpler
system for people who need to find health coverage. In fact it would
let uninsured Marylanders start the enrollment process just by
checking a box on their state income tax return. From there they can
signed on if they’re eligible for financial assistance and be enrolled
into coverage.

Another ex ample is in North Carolina which passed and got approval
for a first of its kind Medicaid waiver that’s funding what they called a
healthy opportunities program. What this does is it’s an attempt to
directly address nonmedical drivers of health. And what m akes this
program so groundbreaking, it’s the first time that CMS is allowing a
state to use Medicaid funds to directly provide services like nutritious
food, or housing services, some of those nonmedical items that we
know impact people’s actual health ca re and the underlying cost in
the system. We’re really excited to learn what the results of that
demonstration will be. Even here in United States of Care we are
working to bring stakeholders together to collaborate also on looking
at some of the health eq uity and nonmedical drivers of health that
impact people’s actual health care as well as the cost. There’s a lot of
exciting momentum happening throughout the country.

Margaret Flinter: Well, Emily wrapped around all of this is this ever present concern
ab out cost, and while we’ve seen some slower growth in cost in some
areas we still see premiums that go up, the share that people have to
pay out of pocket being unsustainable for some people. Of course, the
cost of pharmaceuticals remains just a very big is sue. Tell me what the
United States of Care is doing around making recommendations or
innovations around this larger issue of the cost of care?

Emily Barson: Certainly, in addition to looking at some of those programs that
address the social determinants w hich we do think ultimately we’ll
require systematic change to bring down those costs. I think drug cost
and the underlying pain that people feel every month when they go to
fill their prescriptions is real. We have put out some tip for states
about lavers that state law makers can take around controlling those
cost . I t’s also been one of the areas that has been heartening to see
bipartisan interest at both the state and the federal level in
addressing when a quarter of people are leaving the pharmacy
witho ut selling their prescription because of cost. We know this is a
real issue that needs to be prioritized.

There are also other cost that consumers are really feeling the pain,
you know you should up at the hospital to get care and weeks or

Emily Barson

months later get hit with a surprised bills for an out of network
provider. This is also been an area that we’ve seen bipartisan action.
As an example, in Texas there’s been bipartisan legislation to address
this issue and in fact taking the patient out of having to be th e middle
man between providers and insurance companies. We know that
health care cost both to consumers and throughout the system are
escalating, and we need to find ways to really bring down that cost
curve and reduce the overall cost of providing that ca re.

Mark Masselli: Health care is a large section of our GDP I don’t know what it is, 18,
19%, it continues to rise. But, it employs lots of people, right? There’s
a whole group of folks who are working to try to bank it more
efficient. But where do you co me down in terms of what the impact
will be, do you think we can have an efficient economical reduction in
our health care cost and not hav e a disruption in the workforce and
somehow lower this total amount of GDP substantially. As you sort of
model this u p what happens to that workforce if there’s no
opportunities for growth in the health care world?

Emily Barson: Yeah, we certainly have reason to be optimistic. I think there is a
renewed interest addressing that cost curve, you’ve acknowledge that
there’s a lot of people employed in the health care system and
whether that’s people at hospitals or providers. We want to make
sure that it’s organized in a way that’s most efficient in providing care
to the most people. Many approaches have focused on the unins ured
population and certainly have made progress towards addressing
those needs. But, we know that half of Americans are covered by
insurance through their jobs, and millions of people are covered by
Medicare and Medicaid. It’s exciting to see employers at the table,
they’re going to need to be part of the solution and I think we know
there isn’t a single silver bullet or a single approach that we think is
the solution to everything. But we know that we need all the
stakeholders to be there and that include s people who are providing
that care, people who are working in the health care industry, that’s
also why we’ve made sure that leaders from nonprofit care providers
and doctors and nurses are all part of the conversation in our work on
the founder’s counci l.

Margaret Flinter: We’ve been speaking today with Emily Barson, Executive Director of
United States of Care, a nonprofit, nonpartisan organization that’s
dedicated to advancing access to affordable health care for all
Americans putting health care over p olitics. You can learn more about
their work by going to United States of Care.org or follow them on
Twitter @US of Care. Emily, we want to thank you for your many
years of dedicated public service in the health policy arena for the
work that you’re doing to advance health care for all Americans and
for joining us on Conversations on Health Care today.

Emily Barson

Emily Barson: Thanks for having me.

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Mark Masselli: At Conversations of Health Care we want our audience to be truly in
the know when it comes to the facts about health care 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 the level of deception in US politics. Lori
what have you got for us this week?

Lori Robertson: Democratic law makers claim the president proposed 2020 budget
would ransack or slash Medicare and Medicaid, likening it to an
assault on Medicare and the health care of seniors and families across
America. Experts ag ree the proposed cuts to Medicaid are significant,
but many of the Medicare proposals echo those of Barack Obama and
wouldn’t directly affect beneficiaries. It’s important to note that a
president budget proposal is more a symbolic statement of priorities
than something congress would actually vote on. President Donald
Trump’s proposed 2020 budget includes a net $777 billion reduction
in Medicaid spending and funding for the Affordable Care Act
marketplace subsidies over 10 years.

Those cuts would come from repealing the ACA including the
Medicaid expansion and turning Medicaid into a block grant
programs. As for Medicare a program politicians of both parties oft en
highlight in lines of attack, those proposed spending reduction total a
net $515 billion to $5 75 billion over 10 years depending on how
they’re measured. Notably, several of the Medicare proposals in
Trump’s budget are similar to cost cutting measures Obama had
proposed when he was president. For instance, proposals to reduce
post - acute care paymen ts and to cut payments for bad debt are
similar to Obama policies.

The budget watch dog group said, in fact Obama’s fiscal 2017 budget
proposal included reduced post - acute care payments. The Trump
budget proposals to pay the same for outpatient services wh ether in a
doctor’ s office or other facilities and changed graduate medical
education payment are expansions of Obama proposal. At least one of
the Trump Administration’s proposal a change in out - of - pocket cost
for Medicare Part D prescription drug coverag e would directly affect
beneficiaries causing some to pay less and others to pay more.

Paul N. Van de Water a senior fellow at the Center on Budget and
Policy Priorities told us that besides the prescription drug benefit
change and perhaps a medical liabil ity reform the proposals in
Trump’s budget, quote, would not directly affect beneficiaries. That’s
my fact check for this week, I’m Lori Robertson, Managing Editor of
FactCheck.org.

Emily Barson

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’d
like checked email us at chcradio.com. We’ll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

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Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Anxiety
disorders are on the rise among the nation’s youth. An experts in the
field of child psychology feel the condition starts much earlier in
childhood with an estimated one in five children been affected. But
too often these so called internalizing disorders go undiagnosed.
Unlike children with more expressive condition su ch as ADHD or
autism spectrum disorder, young kids struggling with anxiety or
depression often internalize their symptoms and may just seem like
an introvert to the casual observer. University of Vermont Child
Psychologist Ellen McGinnis says the process o f diagnosis for younger
children is often painstaking and can take months to confirm.

Ellen McGinnis : I was actually doing my dissertation and the whole point of it was to
find an objective, a second battery for children with internalizing
disorders becaus e they have similar things versus some of
externalizing disorders and for autism but not anxiety depression
which I think are the most overlooked sort of in that age group.

Mark Masselli: Dr. McGinnis says the traditional method of diagnosis involves
creat ing scenarios that induce anxiety, followed by behavioral
observation by clinicians and the results can be inexact. She teamed
up with her husband and fellow researcher biomedical engineer Ryan
McGinnis to create a wearable sensor that can pick up on physi cal
cues that suggest the presence of anxiety using accelerometers and
simple algorithms to compare normal stress responses.

Ellen McGinnis: The device is called inertial measurement unit, and so we strapped
that belt on each child and have accelerometer i n it. And so we’re
able to pick up angular velocity speed, how much the child is bending
forward and backward, things like that. It actually picks up 100
samples per second, so much more than the eye can see. We are able
to see if kids with anxiety and dep ression move differently in response
to a potential threatening information, and they do. Kids with a
disorder turn further away from the potential threat than kids without
a disorder.

Mark Masselli: Dr. McGinnis says one of the most promising aspect of th is device is
that it can pick up anxiety and depression disorder symptoms in a
matter of minutes instead of months. Their research paper published
in the publication plus one shows the device was nearly 85% accurate

Emily Barson

in making a correct diagnosis, and she s ays early diagnosis is the key
to avoiding more damaging manifestations of anxiety disorder later
on.

Ellen McGinnis: What’s really great about it is that we increase the sensitivity
compared to subjective parent reports, questionnaires that they fill
out. We’re picking up more kids who might have got previously
undetected.

Mark Masselli: A simple wearable tool that can assist parents and clinicians in
determining if a child is suffering from anxiety disorder leading to less
guess work and more rapid diagno sis and treatment, now that’s a
bright idea.

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Mark Masselli: You’ve been listening Conversations on Health Care, I’m Mark
Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Peace and health.

Female: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at chcradio.com, iTunes or wherever you
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