Daniel Dawes, Health Law Attorney and Author of 150 Years of Obamacare

Daniel Dawes

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, we a re back from a couple of days at the Democratic
convention this was quite exciting to see the first woman in US history become a major
party nominee for president .

Margaret Flinter: So many important issues addressed at the convention s but since we
are passionate about healthcare and we believe in healthcare for all , we were
particularly interested in issues related heath. Certainly the mayor of Flint, Michigan
talking about the lead poisoning crisis , the references to the creation of the children's
health insurance program that was the forerunner to the ACA and has provided care to
so many children , t he intensely powerful stor ies about the need to have a better handle
on gun - control all very powerful all tied to health. Our guest today attorney Daniel
Dawes participated in the creation of the Affordable Care Act and has written a historical
treatise on the pathway across a century and a half that led up to what he calls the most
comprehensive legislation to date address ing health disparities in this country , really
looking forward to hearing his unique perspective .

Mark Masselli: And Lori Robertson also stops by, she is the Managing Editor of
FactCheck.org, who looks at misstatements spoken about health policy in the public
domain.

Margaret Flinter: And no matter what the topic, you can hear all of our shows by going
to chcradio.com.

Mark Masselli: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you.

Margaret Flinter: We will get to our interview with Daniel Dawes in just a moment.

Mark Masselli: 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. The Centers
for Disease Control and Prevention has issued a warning urging pregnant women to
avoid the Miami - Dade County area of Florida for the time being as more than a dozen
people had become infected with the zika virus through locally acquired mosquito bites
in a small part of that region over the past week . And those numbers are expected to
rise, a particular concern the number of pregnant women already living in the region

Daniel Dawes

who could become infected as well as those travelers who might become infected then
pass the virus onto their partners .

The CDC is urging pregnant women in the affected areas to take precautions to avoid
mosquito bites and if they practice safe sex to prevent sexual transmission of the virus .
The CDC also suggests that those men and women who traveled to the area should
wait at least eight weeks before trying to conceive a child , and men who have had
symptoms of zika should wait at least six month. For now , the physical outbreak area
but is relatively small however public health officials are bracing for outbreaks in other
geographical areas as the mosquito population continues t o move into the continental
US .

And it calls to mind in urgency according to some lawmakers in Congress to set up
dedicated fund always available to appropriate funds to respond to public health crises
in disease such as zika or Ebola . Connecticut Congre ssman Rosa DeLauro is calling
for $5 billion permanent fund to be set up to respond to outbreaks when they occur.
There are several other proposals being considered from both sides of aisle that create
some smaller funds but have the same idea.

A positive outcome from an open source collaboration amongst scientists around world
Geneva based Medicines for Malaria Venture handed out a Malaria Box containing 400
diverse molecules to labs in 30 countries mak ing them accessible to academic
researchers who normally wouldn’t have access to such compounds . Scientists say the
effort has spun out more than a dozen drug development projects including a colon
cancer drug that the National Cancer Institute is now working . In part, those discoveries
are thank s to a simple solution to bridge the gap between industry and academia .

E - cigarette s have taken off being charted [PH] by some as less toxic alternative to
smoking actual cigarettes but a study out of the University of California Berkeley should
prove a c autionary tale , researchers tested t w o solvents commonly used in e - cigarette
liquid , heat ed them and check ed the vapor for signs of toxins. The solvents
transformed when heated creating emissions laced with dozens of harmful chemical
compound . The scientists said their findings could be an important tool for the F ood
and D rug A dministration which will start regulating e - cigarette s on August 08. I am
Marianne O'Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Daniel Dawes , health law attorney and
author of a “ 150 Years of Obama Care”, he is the Executive Director of Health Policy

Daniel Dawes

and External Affairs at Morehouse School of Medicine. He is cofounder of the Health
Equity Leadership & Exchange Network. Mr. Dawes server o n the newly established
Health Equity Leadership Commission providing guidance to Members of Congress , the
Obama Administration and for Department of Health and Human Services . He earned
numerous awards for his work including the Congre ssional Black Caucus Leadership in
Advocacy Award. He earned his law degree from the University of Nebraska College of
Law . Daniel welcome to Conversations on Healthcare.

Daniel Dawes: It's great to be on today.

Mark Masselli: You wrote the book “1 50 Years of Obama C are ” a s a tutorial for students
of health policy and health equity activist s to understand the ACA role within the larger
context of health reform . You are looking back as far as reconstruction after the Civil
War and how the Affordable Care Act fits into that historical context .

Daniel Dawes: I know many of you have heard the President Obama and VP Joe Biden
saying that we have been trying to accomplish health reform for a century . But the
Affordable Care Act is much more comprehensiv e in the context of previous reform
effort s s o it include s robust provisions addressing inequities in mental health and
minority health . And that's really what we are try ing to do is to get people to understand
that we brought the independent reform movem ent together under one umbrella that
has taken us a 1 50 years . Because when you look at what Mental Health Reform has
did in the 1850s one campaign led by Dorothea Dix and others you know it took
decades of their lives to go around the country to highligh t the abuses that people with
mental illness were experiencing they were jailed or imprisoned .

And so this mental health reform champion s finally got Congress to pass a bill called the
Bill for the Benefit of the Indigent Insane only to have the president at the time veto it.
And that Pres ident should've been the most sensitive President when you talk about
mental health issues because he and his wife travelling on the day of his inauguration ,
they were traveling with their only son . The train crashed tragically and the only person
to die that day was his son, the wife experience d it, she saw and witnessed it, he also
saw it . And she fell into depression , clinical depression , terrible anxiety and instead of
signing the bill he w ill he wrote one of the longest veto message s where he made the
case for the federal government not getting involved in human welfare .

So it took 100 years before you saw piecemeal legislation coming up , but never
anything comprehensive like this first at tempt u ntil Pres. Carter comes into office and he
and his wife Rosalynn Carter attempted to get comprehensive mental health reform
passed . And it took them all four years of his administration to make that happen and

Daniel Dawes

they finally did two months before the 1980 election . And what happened with his
administration they actually prevented further implementation of those reform s and they
repe a led the rest of that in the next several months . And it wasn't until we started
negotiating the Affordable Care Act when we saw another opportunity to include the se
mental health reform s mandating mental health coverage ensuring that we continue to
build upon the Mental Health Parity Act and providing ability to revere those health
covers . So we have got all of those p rovisions, those principles and provisions from
those two effort s into the Affordable Care Act.

And then when you look at the minority health provision s, what's interesting about this
group of health reform s, the minority health champions actually got the ir bill passed and
signed into law it was the Freedmen's Bureau Act and it actually created incredible
access for freedman , the former slaves or free d people , poor whites. But because there
was no appetite at parallel the racial tensions were seen today again so what you saw
happen ed then was there was a comprehensive health reform b u t it only lasted seven
years , it was very short - lived . And so what we did was to take many of the strategies
and tactics that were used to pass that bill we used to pa ss the Affordable Care Act 1 50
years later and include provision from that bill into the ACA .

Margaret Flinter: You actually kind of have a sit at the table in the room as Hamilton
would say as the ACA was actually being drafted and it has always seemed to me that
the framers of the ACA [Inaudible 00:09:21 ] it in legislation but not in stone that this
legislation would have to adapt and evolve over time . How did the framers make a
legislation that could adapt and evolve over time ?

Daniel Dawes: So I wa nted to write a book that drew back the curtain s put readers in
the front seat so to speak so they could get a clear view of the incredible turning point s
in this sausage making . And as I spoke with individuals who had been around for
decades Congressman Louis Stokes , Sen. Ted Kennedy , Congressman John Lewis
you know it really dawned on me that this was the most inclusive bill ever crafted by the
US Congress . When we brought together this incredible group of 300 national
organizations representing diverse stakeholders you had women's groups , children's
groups , racial and ethnic groups , LGBT group s, disability groups , and then you have the
payers and the providers all coming together sa ying, you know what we agree that that
was the time to get health reform pass a nd to advance this health equity notion . You
had so many moving parts with the White House and Congress but when we were
trying to push a robust health equity agenda in the bil l , I will tell you there was some
uneasiness with folks because every time that folks that tr ied health reform opponents
of this effort try to introduce race and gender into the negotiations to undermine the
attempt .

Daniel Dawes

So we had to really push very very har d to say listen there had been 7000 peer -
reviewed articles have been published on this , we have the numbers showing that it ’s
costing us $300 billion every single year when we don't address disparities among
different racial and ethnic groups so we have go t to do something if we are going to call
the comprehensive health reform . But then when the Tea Party movement with heating
up and that when August Town Halls were h eating up and we had you know folk s
heckling lawmakers who were pro - health reform that we saw the White House again
change course and call it health insurance reform taking a very myopic view on this .
And so we had to steer them back and say, wait a second you promised Pres ident
Obama that this is going to be a comprehensive health reform bill because this is the
serious enough issue worth addressing .

Mark Masselli: Well certainly we ended up with a lot of folks on the other side who saw
so many polarizing aspects of the legislation from the mandatory health in surance
coverage to the so - called essential benefits which cover ed things like birth control .
There were a lot of things that really didn't get discussed , the 62 provisions of the law
that ensure greater a degree of health equity in the country , I am wond er ing if you can
just illuminate that for our listeners .

Daniel Dawes: You know one of the things that we were looking at was dis parit ies in
terms of cancer and it dawned on us t hat women in wheelchairs had a higher rate s of
disparities than breast cance r screening s because the medical equipment wasn’t
accessible or we noticed that black women they were dying at higher rates it just didn’t
make sense . If the screening s were showing that they didn't in fact have breast cancer
why were they dying at higher rates? Come to find out that the equipment was never
developed with black women or Latin a women in mind who tend to have more dense
breasts .

And so we wanted to put in provisions in there requiring medical device companies and
the pharmaceutical companies to look at how their drugs their medical devices impact
all groups. So there is this push in the law now to increase the diversity of the clinical
trial s including all groups that have been traditionally been outright discrimi nated and
prevented from doing so . The law also actually elevated the health equity and created
Office of the Minority Health and Health Equity at six different agencies so every
regulation now , every sub - regulation , any policy coming out of these agencie s are
supposed to employ an equity lens.

And then there were provisions in there, the nondiscrimination provision s. And what we
wanted to do was to give individuals a private right of action because you know not

Daniel Dawes

every law provides an individual with the opportunity to go and sue in court on their
behalf . Let’s say women have been discriminated in coverage just because of their sex
because their reproductive age they now would have a private right of action to go in a
court of law , as an LGBT individual goes into a hospital or to a healthcare facility. And
so provider refuses to use their preferred pronounce those providers could be in a lot of
trouble and we wanted hospitals to stop their aggressive debt collection practices . So
those are some of the provisions in the law that we a re very proud of we talk about the
62 provisions .

Margaret Flinter: Maybe just one of your – just perhaps a significant piece of the 62
provisions , I think one is the creation of PCORI, the Patient Centered Outcomes
Research Institute really sought to improve the value of care by focusing on out comes
and making sure that patients were telling us what the outcomes that we needed to
focus on –

Daniel Dawes: That’s right.

Margaret Flinter: -- what was important to them. And the second was an “I” [PH] to
improving workforce development particularly in terms of fostering of coordinated
models of care and maybe just a brief comment on both of those measures .

Daniel Dawes: You know providers are moving towards quality , increasing their quality
and accountability and what we try to do was to educat e o u r policymakers during the se
[PH] negotiations to make sure that the states with th e higher quality scores actually
were employing equity lens. So as th is law pushes to increase quality we wanted to
make sure based on the Institute of Medicine on equal treatment report and the
crossing the quality chasm report and so we a re moving full speed ahead with the
Medicare Access and CHIP Reauthorization Act , MACRA which passed last year . But
what we are concerned is that it will exacerbate the disparit ies if they don't get this right .

Mark Masselli: We are was speaking to day Daniel Dawes, health law attorney and
author of a “1 50 Years of ObamaCare”, he is the Executive Director of the Health Policy
and External Affairs at Morehouse School of Medicine and he found and chair ed the
National Working Group on Health Disparities and Health Reform as is cofounder of the
Health Equity Leadership and Exchange Network. You want to connect a couple of
do t s because you have spent a long time , a lifetime of focusing on health equity in the
health equity arena , you a r e a data guy as well you are looking very much at outcomes .
And I am wondering how are you charting the impact on the law on underserved
populations especially what do you focus and what are your metrics ?

Daniel Dawes

Daniel Dawes: We are very very pleased that we have now achieved the lowest
uninsuran ce rate ever in this country at 9.1% and 20 million new Americans getting
insurance , so that’s incredible . And what we have been tracking of course is from the
1950s we a re looking at Medicare and Medicaid and when that law was passed and the
effect it had on the uninsurance rates . So moving our uninsurance rate from 24% down
to 14% , imagine how much more of a decline we would see in the uninsurance rate s if
every state expanded Medicaid? So today what we are seeing is, yes the uninsu rance
rates among Blacks h as decreased by 50% but when you look at Latinos they still suffer
the highest uninsurance rate s, only 25% of uninsured Latinos have gained insurance .

We actually did a series of roundtable s last year to meet with leaders from th e se various
communities to figure out what was going on . And a lot of these Latino folk s have been
told that you know health insurance is like having auto insurance if you use it you are
going to be penalized, it's so unfortunate. And there of course chu rches around the
country that refuse d because of what you had said Mark earlier about the preventive
care for women and that that issue with the clergy . And so we are really working with
our Health Equity Leadership and Exchange Network this is exactly wh y we established
it. A lot of these health equity provisions what the Obama Administration has done is
the pump it to the state government s but it means that champions in those states are
going to have to work a little bit harder now to effect the changes that they need for their
communities .

Margaret Flinter: And you know Daniel that reminds me I think one of the strengths of
the Affordable Care Act was it recognizes that there is intersection , right , be tween public
house and primary care and mental health and tertiary care, and you can't just separate
these all out into individual parts. And certainly that is so true when it comes to mental
health issues to things like addiction, exposure to gun violenc e and focus recently again
on what happened with lead poisoning in Flint. But I want to speak specifically about
mental health parity for just a moment , maybe just comment for us about why
addressing the gaps in mental health coverage remains such a big c hallenge in that
health equity arena and your thoughts on how we can improve the Mental Health and
Addiction Parity Act?

Daniel Dawes: What a lot of folks don’t realize is that mental health community, the
Behavioral Health Advocates were instrumental in helping us create the strategy to pass
the ACA because of the stigma and the gaps in mental health coverage you know that
we all need a checkup from the neck up as Patrick Kennedy has said, right.

Margaret Flinter: Great expression.

Daniel Dawes: And so what we have been trying to do is to you know raise awareness
especially in communities of color about the stigma , we have been trying to get and I tell

Daniel Dawes

you we actually were trying to push the Obama Administration to get the mental health
parity regs ou t and thankfully we did. But yet what we do continue to find is that mental
health , community mental health centers and other provider groups , community health
centers have done a fantastic job when you talk about the gold standard when it comes
to integr ated care . But community mental health centers are having a hard time trying
to figure out how to integrate care , and they haven’t been given the resources even with
the US Preventive Services Task Force you know the task force give a score something
in A or B then it’s most cost - sharing to the individual , right . And yet for 20 years we
have been trying to get violen ce counseling screened as an A or B but the task force
continues to say there is insufficient data . And yet many African - Americans with all of
the violen ce when you talk about police perpetrated violence and others , many of them
would benefit from this type of counseling and yet the task force still refuses to do that .

And so we are on a campaign now to figure out what are the challenges in communities
across the nation to figure out how we can make sure we reach all communities and
how we can use that to inform the actual Mental Health Parity Act . So we have gotten
data to inform MACRA which is going to impact ev ery clinician ’s reimbursement from
Medicare. And we a re making sure that the folks that are creating MACRA understand
that psychologist , counselors , social workers and others are critical components of a
primary care medical home . So we want to make sure that they to o have some of their
reimbursement tied to many of these quality indicators .

Mark Masselli: We have been speaking with Daniel Daw e s , Executive Director of
Health Policy and External Affairs at Morehouse School of Medicine and author of a
“1 50 Years of Obama Care”. You could learn more about his work by going to
www.150yearsofobamacare.com you can follow him on Twitter @DanielEDawes .
Daniel thank you so much for joining us to day on Conversat ions on Healthcare.

Daniel Dawes: My pleasure , thank you both so much I appreciated it.

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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 the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Well we have been fact checking the republican and democratic
conventions and there have been a few false claims about healthcare. In Donald
Trump’s speech at the GOP convention he said that he would repeal the Affordable
Care Act and “ you will be able t o choose your own doctor again ”. But the healthcare
law didn’t take away the ability to choose the doctor .

Daniel Dawes

The ACA expanded Medicaid and also expanded private insurance coverage , a nd as
most Americans know -- since 55 % of them have private insurance -- the insurers
usually have a network of doctors to choose from , t he ACA didn’t change that.

On the democratic side former Vermont governor Howard Dean said, Trump’s whole
plan for healthcare was to replace Obamacare with “something so much better”. Dean
a dded , s ix - word plan for health care. In fact, Trump has more than 1,000 words on his
plans for health care on his campaign website. Dean was referring to comments from
Trump at a debate in February, when he said, “We are going to replace Obamacare
with s omething so much better.” But in March, he released a seven - point plan that calls
for allowing the sale of insurance across state lines allowing individual to buy their own
health insurance to take a tax deduction and changing Medicaid to a to a block - gra nt
program , 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
maj or political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

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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. Each year more than 1 million
babies die at birth and another 3 million die within the first few weeks of life, often from
preventable causes , a nd when babies are born prematurely the risk s escalate.
Newborns, in particular premies have a considerable amount of difficulty regulating their
own body temperature and without access to incubators babies in the Third World often
succumb to hypothermia. That got former Stanford MBA student Jane Chan thinking,
how do we develop a low cost solution to the problem?

Jane Chan: A l ocal solution , s omething that could work without electricity, that was
simple enough for a mother or a midwife to use , something that could be sterilized and
reused across multiple babies, and something ultra low cost compared to the $ 20,000
that an incubator in the US costs.

Margaret Flinter: Chan said that they developed a cocoon like device called simply
Embrace , a t hermal body wrap that encases the baby and helps regulate body
temperature for up to 6 hours.

Daniel Dawes

Jane Chan: But the magic is in this pouch of wax , t his is a phase change material , i t’s a
wax - like substance with a melting point of human body temperature . You can melt this
simply using hot water and then when it melts it’s able to maintain one constant
temperature for 4 to 6 hours at a time .

Margaret Flinter: Since launching the product in 2010, they estimate that over 150,000
babies’ lives may have been saved with the device, a low cost, high tech, portable
temperature regulator, designed to regulate premies ’ body temperatures , n ow that’s a
bright idea.

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Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Massell i: 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 and brought to you by the Community
Health Center.