Dr. Jeffery Levi, Trust for America’s Health

Mark Masselli: This is a Conversation s on Health Care I’m Mark Masselli.

Margaret Flinter: A nd I’m Margaret Flinter.

Mark Masselli: Oh Margaret we saw a deadline come and go last week States had to
th
decide by February 15 whether they would set up the ir own health insurance
exchanges or l et their s tates to be covered entirely by the Federal Exchange.

Margaret Flinter: Well those online insurance exchanges are supposed to be in place
st
and ready for consumers by October 1 of this year I think a lot of States felt it was just
too much of a burden or simply refused to participate for their own political reasons.

Mark Masselli: It looks like half the States in the Nation will not be setting up exchanges
those states le d largely by Republican Governors a nd in states with very high demand
like Florida, Ohio, Pennsylvania and Texas have opted out.

Margaret Flinter: Governor Chris Christie of New Jersey said that differing to the federal
insurance exchange was the responsible choice for his state . Now all stakeholders on
the payroll and provider s ide would agree with that there were lobbying for the state
exchanges to be set up so they have more local control but either way we’re getting to
the same enter point.

Mark Masselli: That we are and on the othe r side of the coin 17 states in the district of
Columbia ha d been given conditional approval by Health and Human Services to set up
their own state based insurance market p laces which will offer one stop shop in for
Insurance and Medica id Coverage.

Margare t Flinter: An estimated 12 million customers were expected to buy their
Insurance online by next year and that n umber expected to hit close to 30 million by
2020.

Mark Masselli: A few more Republican Governors were switching their tune about
Medica id ex pansion . Governor Brewer of Arizona and the Governor of Ohio was well
now leaning towards agreeing to expand eligibility requirements for Med ica id coverage .

Margaret Flinter: Well Mark we predicted this would happen because the economic s
are just too ha rd to ignore . T he federal government is picking up the tab for the first
three years of that expansion and I have to imagine that their provider communities
were lobbying str ong on behalf of that.

Mark Masselli: I guess today is focusing on healthcare n eeds of the nation especially in
the are a s of prevention.

Margaret Flinter: Dr. Jeffery Levi is the E xecutive Director of the Trust for America's
Health a nonprofit policy organization that works to make disease prevention a national
priority.

Mark Mass elli: We ’ ll hear about other viral claims regarding the healthcare law from
Lori Robertson Managing Editor to FactCheck.org .

Margaret Flinter: And no matter what the topic you can hear all of our shows by Google
in CHC R adio.

Mark Masselli: And as alw ays if you have comment s e - mail us at c hcradio.com or come
find us on Facebook or T witter we ’d love to hear from you.

Margaret Flinter: We’ll get to our interview with Jeffery Levi in just a moment.

Mark Masselli: But first here is our producer Mariann e O'Hare with this week ’s head line
news.

(Music)

Mariano Hare: I’m Marianne O'Hare with these healthcare headlines . The deadline ha s
passed the States have spoken, it appears we are a nation divided 26 s tates opting out
of setting up their own insuranc e exchanges online insurance marketplaces called for
under the affordable care act that would allow folks to purchase insurance online like
they would vacations on travel websites or purchases on Amazon.com . Twenty six
mostly G OP governors opted out of se tting them up meaning the federal government
will have to offer insurance marketplaces for folks living in those s tates . Seventeen
other States are going ahead with setting up exchanges and another handful of s tates
are utilizing a third option setting up a partnership with the federal government .
Meanwhile beginning in 2014 seniors will b e paying less out of pocket for drugs about
5% less and those enrolled in the medicare part y the standard deduction will be
reduced to 310 dollars next year those cuts a ttributed to provisions and the affordable
care act . The Obama administration has announced this we think plan this week to
achieve a full mapping of the human brain , the multibillion dollar plan will call less
research from experts around the globe to ch art the millions of neurons and brain
functions still yet to be mapped the measure like a quest the map that human genial will
likely yield a host to do treatments and cur es for everything from all timers and
Parkinson’s to better treatment for a depressio n and autism . I’m Marian ne O’ Hare with
th e se healthcare headlines.

(Music)

Mark Masselli: We’re speaking today with Dr. Jeffery Levi , Executive Dir ector of the
Trust for America ’ s Health a non p r o fit organization dedicated to making disease
prevention a national priority . Dr. Levi is the lead author on a report just released A
Healthier America 2013 strategies to move from sick care to health care in the next four
years . Dr. Levi has authored numerous reports and testified before congress on
disaster p reparedness environmental health , chroni c diseases and obesity academic.
He’s also an associate professor at George Washington University’s Department of

Health Policy. He served as an Associate Editor of journal for public health and was
deputy director of a White House office of national aids policy . Dr. Levi welcome to
Conversations on Health Care .

Dr. Jeffery Levi: Thank you I’m glad to be here.

Mark Masselli: Yeah , Jeffery your organization Trust for America ’ s Health has been
working for ten yea rs now focusing on ways to improve public health and healthcare in
America and you recently released a report A Healthier America 2013 which takes a
look at strategies for moving the American health system from secure to true healthcare
in the coming year . S o what areas of healthcare are you most concerned about and
where have you focused the bulk of your effort ?

Dr. Jeffery Levi: You know so much of our healthcare delivery system is focused on
dealing with problems after they have cause us to be sick ra ther than preventing them in
the first place and so we a re very oriented to a primary care system and so focus really
is on how do we create a society where the healthy choice becomes the easy choice
where people are more active and eat better get their im munization s , do the things that
will keep us health y in a first place , keep us productive in a first place and therefore
make us not need the sick care system as often . S o we’re really focused on those
kinds of interventions , you know, policies and practi ces so that you know kids get
healthier food in school and our neighborhoods are work able and save to also making
sure that you know we get the screenings we need early -- get early diagnosis of
condition so they can be dealt at earliest stages where there are best treated but also
getting the immunizations and the other clinical preventive services that keep us health.

Margaret Flinter: Well , Jeffery that’s a very broad agenda and I know that inherent
within that is a deep concern with the toll of chroni c diseases in this country and you
suggest and report that that’s a leading cost of health cost and death in this country and
note that one and two Americans is living with some kind of chronic disease like type 2
diabetes and of course rates will increase we can expect due to ageing population but
also due to the nation ’s obesity problem you have noted that there’s two possible
features we face in this scenario . S o for other scenarios what are they and what are the
solutions that you’re proposing that wou ld lead to a better healthier outcome for the
country.

Dr. Jeffery Levi: The concern that we have is that you know in today’s world about 75%
of our healthcare cause are associated with chronic diseases . Most of those chronic
diseases are preventable or very well managed if we do things outside the clinical
setting like being more physically active and eating healthier and controlling our weight
and we continue to have a growing obesity epidemic right now over 30% of Americans
are obese. We did some wor k with some modelers that show ed that you know 20 years
from now we could end up with over half population being obese and that has huge
health consequences . So the choice we say it’s right now is moving forward with a
growing chronic diseases burden , gro wing healthcare cost or we could do the very basic
things that need to be done not just to manage these diseases as well but also to

prevent them in the first place and reverse them in some cases so that we all end up
being healthier and our healthcare cos t are lower and our quality of life is better and
we’re more economically competitive . You know some of the solutions are pretty
straight forward and the other major leading cost of that preventable desk is tobacco . So
if we focus on th ose three things we could prevent a lot of these chronic disease , we
can r everse some of those chronic disease . There are some wonderful community
based programs that have actually successfully reverse the trajectory of people who
have pre diabetes and those are the kinds o f programs that we need in place , those are
kind s of policies we need in place so that our health care system doesn’t become so
burden with healthcare cost but more importantly that we as American lead healthier
life.

Mark Masselli: Let’s talk a little a bout that because you say that the real in health
reform happen when there was a coordinated and modernized approach to the public
health system to really improve the collective health of the nation we have to move
beyond the healthcare system and to commu nities wher e people live and work . Tell us
about your vision for a modernized unified approach to public health across the country
and what would it look like?

Dr. Jeffery Levi: Actually the affordable care act created a mechanism for us to think
much m ore broadly about how we create health in this country . The forum care act
created a national prevention council which is comprised of 17 of the agencies and
offices across the federal government who have an impact on health . S o it’s not just
Department o f Health a nd Human Services or this veterans affairs department that run
big health systems . It’s also housing and urban development and transportation and
labor department and education because we know you know what happens in the
schools matter for hea lth people being better educated results and better health
outcomes we know that people who have stable housing are more likely to be health
and so every agency of federal government and every sector in our society has a role to
play in helping to create h ealth in. So the Prevention Council and National Prevention
Strategy that really provide a gu ide post for all the federal agencies but also business
community , for the education community , for a community based organizations , for
phase based community and for the healthcare system about how we can keep people
healthier in the first place . S o that’s I think the very large vision t h at’s incorporated in
that national prevention strategy and the document that we just published we folks little
bit more on the interaction between the healthcare system and the public health system
and recognizing that as our healthcare delivery system changes with the affordable care
act as more and more people have insurance we have to make sure that we continue to
emphasize the role of prevention of keeping people healthy in the first place.

Margaret Flinter: Well , Jeffery we ’ve been noting that there’s been a tremendous
resurgence in the last year to a focus on something that was talked a lot about in the
70s and 80s and not so much in 90s and the first part of century that was the social
determinants of health as you ’ve just described education, housing, employment what’s
the role of technology in influencing community health?

Dr. Jeffery Levi: Oh I think there are probably three things that we can point to that will
make a difference in community . A nd so one of the investments in the affordable care
act is in creating a new program called Community Transformation Grants which is
really providing resources from the federal government s to communities acros s the
country more than a third of a population is covered by this programs . A nd it’s really to
support the creation of coalitions within a community that represent health at the health
care delivery system , education , publ ic safety , parks and recreation zoning to ever
maybe relevant to making that community healthier for them to come together and say
okay what will it take for people to be more physically a ct fast people make -- have the
opportunity to make healthier choice s of food . W hat can we do to reduce tobacco use
to expand access to clinical preventive services and they have been charged with
making a real difference in their communities and adapting it to the needs in their
communities . A nd so I think the second pa rt is that so much of the messaging that we
need to be doing around public health doesn’t necessarily happen with a s physician re
but really the notion of expanding the community health work alert workforce is
incredibly important . Thirty, forty years ago we had public health nurses and I think the
notion of a c community health work is a very similar sort of thing . S omeone in the
community from the community who can reach people where they’ ar e . In some cases
that will mean obviously using the social me dia and very different types of technology
th a n we did in the p ast but we shouldn’t underestimate the value of that one to one
connection as well.

Mark Masselli: We’re speaking today with Dr. Jeffery Levi , Executive Director of the
Trust for America’s He alth a nonprofit organization dedicated to making disease
prevention a national priori ty . Dr. Levi is the lead author on a report just released A
Healthier America 2013 . S o Jeffery you were talking a moment ago about the challenge
that American faces in the issue of obesity and it’s clearly one of the biggest threats that
t h is country faces and yeah there are a lot of great minds have been working on this
and it’s still then seen to be making a lot of progress.

Dr. Jeffery Levi: Oh th is is a very large problem and it’s not going to be solve overnight
we really need to be talking about reversing this problem with kids and I think we’re
beginning to see a lot of helpful signs . W e see some communities where obesity rates
among kids are going down a n d it’s primarily around working in the schools and
educating kids that’s the only choices and changing the choices that are unavailable in
the schools you know and the kids take so much le ss to change the trajectory and you
know one study where kids were given a diet so that they instead of sugar - sweetened
soda and that reversed their trajectory toward obesity . S o it’s -- with kids in particular
small changes connect a very big difference , with adults I think it’s obviously more of a
challenge because we know how difficult weight loss is but what we also know around
obesity is that you don’t have t o become thin in order to become healthier (14:06
Inaudible ) has shown is that a 10% loss in average weight can actually reverse some
of the ph ysical problems associated with obesity including diabetes and I think if we a re
clear about specially with adult that that’s the goal I think we can actually empower
people more and see some very positive health outcome.

Margaret Flinter: Jeff , I want to take a look at somewhat different area that I know has
been central to the focus of the Trust for America’s Health and that’s really the public
health sciences and public health infrastructure as related to our ability as a country to
respond to epidemiologic threats and factitio us diseases threats to bio terrorism have
only to read how much panic that’s been about the resur gence of a really bad influences
and or the norovirus that i s --

Dr. Jeffery Levi: Right.

Margaret Flinter: -- sickening people across the country to reme mber that threats come
in many kinds and for all of our concern and prevention in chronic disease we still live in
an age where that poses a real threat to the American public as well . How much
progress have we made in the last decade to strengthen in rea lly rebuilding what many
thought was kind of a crumbling public health infrastructure?

Dr. Jeffery Levi: That’s a great question , Margaret and I you know I think it’s important
never to forget those uncontrollable threats there are out there whether they ’re in the
form of bio terrorist threat or some new ( 15:26 Inaudible ) . W e do an annual report that
actually assess es the capacity to respond to essentially and effects disease or bio
terrorist threat or any kind of natural you know with natural disaster f orm hurricanes or
earthquakes to the snow storms . A nd you know we are very concerned about how well
we a re going to be able to respond you know we spent -- since 9/11 we have invested
billions of dollars and rebuilding some of that core capacity to respon d but what’s
happen over the last two or three years is a combination of the recession and state
budget cuts and cut back s in the federal level preparedness on the -- we’re probably not
as prepared today as we were two or three years ago and one of the thi ng s that we call
for in this report is that you know where you live shouldn’t determine the capa city of
your local health department just because there m ay be different resources we as a
nation have a need for every health department to have certain founda t ional capabilities
because without them especially when you think about infectious diseases you know
they don’t recognize county borders and so if we are as strong as the weakest health
department that’s the one thing s we call for in this report i s for th e federal government
say we a re going to assure that every community has those foundational capabilities.

Mark Masselli: Jeffery your website has an interactive map of the nation where people
can easily find access to data on health stats about their s ta te and look across the
country it’s a nice way to get a snapshot of the nation’s health . T ell us a little more
about other tools on your site healthamericans.org and where are you headed in terms
of the world of social media in terms of trying to get this information distribute out across
the country.

Dr. Jeffery Levi: The website has a whole range of information but i f you click on your
s tate you can see how you rank in terms of a whole series of issues it’s also linked to
the county ’s health rankings p roject that the Robert Wood Johnson Foundation support s
that you can also see how well your county is doing within your s tate then it’s not just
about health factors but also education and employment and other issues that can

effect h ealth . S o you can see how your S t ate is doing compare d to the nation you can
also see what kinds of policies your s tate may have we a re particularly focused on
obesity and preparedness but there ’s a whole range of issues that you can see . S o you
can then see how does my commu nity stack up in t erms of addressing healthy food
option in the schools for example and that can be the basis for taking some action . W e
have actually a day we update on what’s happening around prevention and the
affordable care act and other prevention r elated issues that can also keep you in touch
with what’s happening nationally.

Margaret Flinter: That sounds wonderful . A nd Jeffery we like to ask all of our guest this
final question when you look around the country and around the world what do you se e
in terms of innovation that our listeners at conversation should be keeping an eye at ?

Dr. Jeffery Levi: To me, the exciting thing is when I see communities coming together in
as diverse places as Akron , Ohio and Seattle , Washington you know in the cas e of
Akron , Ohio they came together around health in part because they knew in order to
revive their community economically they needed to be a healthier community that what
attract people to invest in their community and that’s what brought everyone toget her
from the health systems to the chamber of commerce , to the labor unions so the parks
and recreation folks to come together and say how do we make this community
healthier by you know focusing on having a better healthcare delivery system but also
makin g the community healthier by making parks more accessible by making sure that
schools are offering healthier options . S o each community doing their own thing and
Seattle they came together around equity issues why do we have these disparities
based on rac e and ethnicity in terms of health outcomes and how can we address that
and that require bringing it was actually led from the county executive’s office because it
was a recognition that everyone had to come together to address these problems . S o
we’re se eing a whole lot of creativity at the local level that I think it was just very exciting
to see.

Mark Masselli: We’ ve been speaking today with Dr. Jeffery Levi , Executive Director of
the Trust for America ’ s Health which just unv e iled its comprehensive re port A Healthier
America 2013 strategies to move from sick care to health care in the next four years .
Jeffery , thank you so much for joining us today.

Dr. Jeffery Levi: Thank you.

(Music)

Mark Masselli: At Conversation s on Health Care we want our au dience to be truly to
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 ,
nonprofit consumer advocate for voters t h at aim to reduce the leve l of deception in U .S.
politics. Lori , what have you got for us this week?

Lori Robertson: Well , Mark and Margaret we found a few healthcare claims in President
Obama’s State of the Union and to the Republican response from Senator Marco Rubio .
Obama s aid that the affordable care act “ is helping to slow the growth of healthcare
cost ” it may be helping but the slower growth for healthcare spending began in 2009
before the law was enacted and it’s piece partly due to the down economy . I t’s true that
depe nding for 2009 to 2011 has been at it ’ s slowest to growth rate in 50 plus years
3.9% each year and experts say the healthcare law deserves some credit by
encouraging doctors and hospitals to reduce re - hospitalization s and wait for treatment s
but it’s uncle ar how much effect the law has had . On the Republican side Rubio said
that the law was “ supposed to help middle class Americans afford health insurance ” but
now some people are losing t h e health insurance they were happy with . But people
aren’t now losin g their health insurance in fact employers sponsored insurance is
expected to go up by one million people this year that’s according to estimates from the
congressional budget office . Rubio is referring to what is expected to happen in the
future employer s sponsored insurance is expected to go down by seven million people
as the law i s implemented some won’t have an offer from employers others will get
insurance from other sources like Medicaid or exchange it. But his comm e n t grosses
over the fact that 27 million fewer people are expected to be uninsured because of the
law because there’s one thing the law is expected to do it’s decrease the number of an
uninsured significantly and that’s my fact check for this week . I’m Lori Robertson
managing editor of factcheck.org.

Margaret Flinter: F actcheck.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 liked checke d e - mail us at
c hcradio.com we’ll have factcheck.org ’s Lori Robertson check it out for you here on
Conversations on Health Care .

(Music)

Margaret Flinter: Each week conversations highlights a bright idea about how to make
wellness a part of our communit ies and everyday life’s . W ell it’s mid winter and by now
it’s a good bet that a majority of health related New Year’s resolutions ha d fallen by the
way side and international aid organization has device a noble id ea for improving health
outcomes for the k ids they served in third world countries well improving the health and
fitness of folks here at home . CURE International provides orthopedic and
reconstruct ive surgeries from impoverished children in 27 countries around the globe.

Mark Masselli: And we ’ re there to provide the highest quality assertable care to them
and then the follow up care afterwards to help them deal with things like clogged foot or
twisted spines we treat a lot of burn contractures and cleft with the palate and then also
treats some neurological conditions like hydrocephalus in places like Zambia and
Uganda.

Margaret Flinter: Joel Worrall , Vice President of cure.org says that the surgeries to
repair Clough v an d other physical deformities average around a thousand dollars per

child . S o donations or a large source of funding and they thought what if they could tap
into the American desire to attain fitness goals here and tie that goal to raising funds
that needed to help children in need around the world and they launched the champi on
campaign . T he campaign seeks folks to sign up on their website and become part of
champion teams who all make a commitment to lose weight to increase their fitness
whatever that fitness goal might be.

Joe Worrall : We started the care champion as a wa y to both help our supporters
achieve those goals and through the help of some really, really generous celebrity
coaches we ’ve now got the opportunity or you’re n o t just sort of out there on your own
we’re actually partne r ing you with an entire team of peo ple who are all hoping to it
achieve a similar goals.

Margaret Flinter: Team members that they are to support one another’s goals and each
team members so this is sponsors to support them in their own diverse and when the
fitness goals attained the funds raised go to help a specific child in need.

Joe Worrall : So rt of connect you with the coaches and with the te a m of other people
that are all trying to achieve this together and we’ re giving you an opportunity to actually
see the results of what your har d work and what your fund raising is doing in the life of
specific children.

Margaret Flinter: Care.org ’s champion campaign a unique platform to help folks
seeking to improve their own health while providing funds to help the health of other
now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care , I’m Margaret Flinter.

Mark Masselli: And I’m Mark Masselli peace in health.

Conversations on Health Care broadcast from the campus of WESU at Wesley
University streaming li ve at wesufm.org and brought to you by the community health
center.