IVF Fallout: Top Biden Health Official Sees Dangers Beyond Reproductive Rights

240229_Conversations_Johnson_01.mp3

Speaker 1 [00:00:04] The important topics of reproduction and maternal health are in the
policy portfolio of Carol Johnson. She's the administrator of the Health Resources and
Services Administration known as Ursa, which is an important agency, the US Department
of Health and Human Services.

Speaker 2 [00:00:21] The bigger picture here is about, how we as a nation want to move
forward in protecting women's rights and protecting the autonomy of women's reproductive
freedom, and in ensuring that we are growing and developing a health care workforce that
can support women's health care needs. And that's what we want to do. And this
administration is continue to grow that health care workforce, continue to make sure that
training opportunities are available, to provide the kind of healthcare support that women
need across the country.

Speaker 3 [00:00:51] With a multi-billion dollar budget. HRSa reaches every part of the
country, including Alabama, where families seeking IVF treatment are reeling from that
state's controversial court ruling.

Speaker 2 [00:01:03] It's really important that women have the autonomy and the ability to
make informed healthcare decisions with their health care providers, and so that's why the
secretary was in Alabama this week. That is why we as an administration, are going to do
everything we can to ensure that we sustain and maintain and grow the autonomy that
women have to ensure that their reproductive rights are protected and that they have the
ability, to make the best choices possible. It should not be the case that young women in
this generation have less rights than I did growing up.

Speaker 3 [00:01:36] This is conversations on health care.

Speaker 1 [00:01:47] Well, administrator Carol Johnson, welcome to Conversations on
Health Care.

Speaker 2 [00:01:51] Thank you. Thank you so much for having me.

Speaker 1 [00:01:53] You know, we want to start with the Alabama Supreme Court
decision that frozen embryos are children. And there's a lot of legislative maneuvering
going on right now. The Alabama House just passed a bill to protect providers who engage
in, I believe, hospitals in in vitro fertilization give them immunity. But on February 28th, a
Republican U.S. senator blocked a similar effort in that chamber. Senator Cindy Hyde-
Smith of Mississippi said the bill is a farce, and I quote overreach. We wanted to get your
reaction to the entire situation down in Alabama.

Speaker 2 [00:02:32] Yeah. Well, thank you for raising the question. And thank you for
putting the focus on the families who are now, in very difficult position of, trying to figure
out their next steps, trying to ensure that they have confidence in their family choices.
Again, this is about how families plan and make family choices. And that should be
something that women and their doctors are able to do together. We say that across the
board, it's really important that women have the autonomy and the ability to make informed
healthcare decisions with their health care providers. And so that's why the secretary was
in Alabama this week. That is why we as an administration, are going to do everything we
can to ensure that we sustain and maintain and grow the autonomy that women have to
ensure that their reproductive rights are protected and that they have the ability, to make

the best choices possible. It should not be the case that young women in this generation
have less rights than I did growing up. And we need to change that. And so, the other thing
that I will point out, as you note, we had to, focus on the health and well-being of moms
and babies, through our maternal and child health work. But we are also the home of the
health care workforce investments across the Department of Health and Human Services.
And we continue to see challenges in making sure that people who go into health care
professions are going to go to states, where there are restrictive environments about the
ways that physicians can practice medicine. And so we need to make sure that we're not
only protecting and wrapping ourselves around families and helping women ensure that
they have their reproductive health rights, but also that we're supporting a workforce that
can ensure that those opportunities are available to families. In states where there is a
more restrictive, legislative environment.

Speaker 3 [00:04:29] Well, Administrator Johnson, I really appreciate those comments.
And maybe just clarify, for me a little bit, what what can the federal government do, to aid
families who are in limbo, at this time or questioning what to do? I understand that, moving
embryos out of the state is not an option. Is that all within the control of the state? Just
help us figure out what the federal government can can do in this situation to help.

Speaker 2 [00:04:54] Out a lot of things that are within the jurisdiction of states, and a lot
of things that, states will make decisions about, as you noted, there are legislators in the
state who are taking action in the short term here. But the bigger picture here is about,
how we as a nation want to move forward in protecting women's rights and protecting the
autonomy of women's reproductive freedom, and in ensuring that we are growing and
developing a health care workforce that can support women's health care needs. And
that's what we want to do. And this administration is continue to grow that health care
workforce, continue to make sure that training opportunities are available, to provide the
kind of healthcare support that women need across the country. And so, you know, the
secretary was there, in Alabama earlier this week. And, and as part of that said he would
continue to come back and work with all of us across HHS on where there are
opportunities that we can be helpful and supportive. But at the same time, we will continue
to lean in as an administration in supporting women.

Speaker 1 [00:05:59] And it's so important, as you mentioned earlier, trying to figure out
where are places that people can go and feel safe. 2% of live births result from IVF. It's a
large number, across the country. Where else is the administration focused in on in terms
of states? As you think about where a workforce should go, are there are other states like
Alabama that are considering these, changes to their, constitution.

Speaker 2 [00:06:28] I don't know that I can speak to what decisions are being made in
other states, or what is on on deck in other states. I can speak to what we as an
administration will continue to lean into, which is being having the backs of women and
families across our country.

Speaker 3 [00:06:42] Well, Administrator Johnson, one, area that has been a loud and
clear focus of the administration is the recognition of the, rising rates of maternal mortality
and morbidity and the need to do something about it. And to act first has invested $65
million in community health centers just last year to improve maternal health care access,
launched a maternal mental health hotline, has, special grants to, try innovations in
maternity care. Share with us those efforts and, what are we seeing? On the ground that is
innovative. Is it too early to see results? Tell us about that.

Speaker 2 [00:07:23] Yeah. Thanks, Margaret, for the question. Look, you know, starting
at the beginning of this administration, the president in the vice president said it is
absolutely unacceptable that the United States has the maternal mortality rate that we
have. That is, not something that this administration can abide and that we need to pull
every possible lever to improve maternal health outcomes for women. And what it turns
out is that 80% of maternal deaths are preventable, and they're preventable because they
are caused by things like mental health conditions, cardiovascular conditions, social
determinants of health that we know is an area of considerable need of attention, not just
what happens inside the clinic walls, but what happens in the community. And that's why
across the administration, we have made this a priority. I got to participate in the first ever
cabinet meeting focused on women's maternal, women's health and maternal mortality,
where the vice president pulled us all together and said, this is not just a health care issue.
It is critically a health care issue, but not just a health care issue. This is about, the
Department of Labor and the Secretary of Labor was there. It was. This is about what
happened to the Department of Agriculture when it comes to food, nutrition services, it's
about transportation. And the VA and I sat next to, the secretary of housing. It is about
making sure that we're doing a whole of government response here. Our part at Essa is,
as you mentioned, really focusing on how we pull levers across all of our funding streams.
So we're not just putting more money into health centers. We're putting more money into
training more midwives. We're putting more money into training more community based
jewelers who reflect the communities they serve and can be a voice for women who are
often not heard in the delivery environment and who's who. Know something is wrong, but
don't get the response that they need because the system is isn't structured around them.
And too often what we hear from women is I did everything right and I still had a bad
outcome. That is a failure of all of us as a nation. It shouldn't be on the woman to say, all of
this is on you. It should be us making sure that we've done everything possible for that.
That's why we're investing in making sure that hospitals are prepared for the most
common causes of maternal crises in delivery, like hemorrhage. That's why we're investing
in social determinants of health. So we support the Healthy Start program to make sure
their community supports it can help, ensure people get to prenatal visits and postnatal
visits. And that's why this administration is so proud to say that nearly every state has
extended Medicaid to 12 months postpartum.

Speaker 1 [00:09:58] Going to take a little look at your own data, which shows that
maternal mortality and other adverse, outcomes associated with pregnancy or childbirth
have worsened. The rate in 2021 was 89% higher than in 2018. The maternal mortality
rate among non-Hispanic Black and African American women was about two and a half
times greater than non-Hispanic white women during these years. And I'm wondering if
you could just focus in on what the role Covid played in, in these disparities.

Speaker 2 [00:10:30] Yeah, well, obviously Covid played a considerable part in health
outcomes across all of our metrics. I would also say there's some time lag, in the data. But
nonetheless, Covid had a big impact. Not just on maternal health, which is a critical priority
for us, but on other critical health care needs. Like, again, we are the home of the Maternal
and Child Health Bureau. We take a great deal about children ensuring that they're up to
date on their vaccines. Places like making sure that routine vaccines are delivered. Places
like oral health and children. That oral health was one of the areas where the rebound
post-Covid was the slowest. And so we are focused on making sure kids are getting their
oral health care. But when it comes to, maternal mortality, you know, we think that there
were obviously issues and challenges. During Covid, we saw a lot of states try to do things
like make sure doulas were allowable in hospitals during delivery. There was so much
restricted access during delivery. But yet we have this known way, to help improve health

care outcomes. And they weren't always allowed in the delivery room. So all the kinds of
things that are lessons learned from from Covid are the kinds of things we're working
strategically to improve and grow going forward.

Speaker 3 [00:11:48] Well, administrator, you've you've focused on recommendations that
have gone back many years now, and you're putting them all into place, which is really,
fantastic. In a short period of time, I want to focus maybe just on the health workforce for a
moment. We talked about it earlier, with regard to the Alabama situation, but obviously
making sure that there are enough, nurses, labor delivery nurses, nurse midwives,
women's health nurse practitioners, ob gyns, in underserved areas as critical. I think for
our audience, maybe share some of the strategies that Hurst has to really bring these
critical personnel, through training and get them to the areas where they're most needed.
And I'll add community health workers and health support workers of all kinds, to the list.
Tell us about the strategies for making this happen.

Speaker 2 [00:12:37] Well, thanks for the question. And thank you for your leader thought
leadership on this. Margaret, you have been a real leader in thinking about how, to build a
community based health workforce. And that is very much what we are focused on at her.
How do we ensure that we're training people? We incentivize the creation of training
placements in the community where we want people to practice. That's how we're more
likely to get clinicians who, reflect the communities that they serve. That's how we're more
likely to build a workforce that will be will stay, in those communities. And so, we have a
number of strategies to do this, not least of which is our National Health Service Corps
program, which is where we provide scholarships and loan repayment to primary care
clinicians to practice in the highest need areas in the country, including many urban areas
and many rural areas across this country who would not have primary care providers. But
for the National Health Service Corps. I will tell you, thanks to the president, we've had the
largest investment in the National Health Service Corps in the 50 year history of the
program under this administration, but that program expired at the end of September, and
Congress has not yet reauthorized it and provided the funding necessary for us to continue
it. So we are very anxious for this bipartisan and well supported program to actually get the
resources we need so that we can continue into, to sustain and grow this strategy for
building a workforce in the community. Similarly, we are investing in training nurses,
including advanced practice nurses, who are primary care providers in so many places
across the country. They support investing in mobile clinics so that, nurse practitioners can
get into the community and deliver critical primary care services all across the board,
everywhere. Where can we are thinking strategically about how a do we get a young
person interested in the health care field? How do we support them through, health
professions training with mentoring and other supports? How do we help them with
stipends and tuition support and the like get through training? How do we encourage them
with loan repayment to go to the communities where we need them the most? And so that
continuum is critically important to us. We're investing all along the way.

Speaker 1 [00:14:58] Well, you know that that investment in training is so important.
You're also engaged in, cultivating collaboration and partnership. And I note that Herseth
has, maternal health grantees from 11 states in the District of Columbia in this initiative.
Wondering how you chose those states. And talk to us a little bit of how you anticipate
them learning from each other. That collaborative relationship is so important. And I know
that's one of her six goals.

Speaker 2 [00:15:24] Thanks so much for raising it. We. Last month launched what we're
calling our Enhancing Maternal Health Initiative. And what we are saying here is, is, look,

we know there's a lot of debate in Congress, and we're not done on all of the
appropriations bills, and we don't know what our budgets kind of look like this year. But we
have a lot of investments and a lot of work and support and grantees that we've built up in
communities across the country. So let's look at those places where we have a lot of years
of resources that have been invested, and where the maternal mortality rates are higher
than we'd like them to be. And how do we ensure that all of those grantees are working
together in a way that ensures that the whole is better than the sum of the parts? And so
how do we leverage to make sure that the nurse midwives we're training are available to
and know and can train in our health centers where we're investing in maternal health
work? How do we make sure everyone in our AME program, where we're focused on what
happens in the hospital, that that that relationship with the hospital is also translated into
everyone leaving that hospital, having our maternal mental health hotline number so that
we can treat and intervene in maternal depression as early as possible, like our maternal
mental health hotline number is 833 TLC. Mama, that's our 24 seven text and call way for
people to get emotional and mental health support. And we are finding that pregnant
women, new moms, other family members of new moms are calling and getting that kind
of emotional and mental health support and referral when necessary. So we're thinking
about how do we strategically put all of her Sis grantees together around the table and get
the best possible outcome from that collaboration? Rather than, continuing to fund multiple
different grantees doing important work but not interconnected work.

Speaker 1 [00:17:18] All right, I love that TLC mama. Sounds great.

Speaker 3 [00:17:22] Absolutely. And, you know, administrator, we're talking about
maternal mortality, but I want to talk just for a moment about infant mortality and note that,
HRSa has reported that the infant mortality rate overall, that we still see some disparities
between groups overall continues to decline and reach even historic lows, which is just
wonderful news. You know, in the past years, you and people in the community had been
promoting messages about taking folic acid supplements, not smoking. Getting early,
prenatal care. What? What do you think we can learn from these infant mortality,
campaigns that can inform maternal mortality? Are they kind of mirror images, or is there
something really different about the two groups in terms of our messaging?

Speaker 2 [00:18:10] It's such a great question. Thanks for the question, Margaret. I think,
one we would be, as you did, like it's very important to note that the disparities still exist in
the infant mortality space as well. And we obviously have more work to do. But I think
you're right that what we've seen here is in infant mortality is really a marriage of, well
thought out public health interventions coupled with clinical interventions coupled with
community interventions, like, unless we're thinking about it in that sort of holistic way,
we're aren't going to make meaningful progress. And so lots of investment in community
prevention campaigns and community education campaigns, lots of investment and
insurance coverage, and in making sure, that kids are covered. And, you know, that was
that, like, chip predates our work in the Affordable Care Act. We knew that kids had to
have coverage and then making sure that we're we are thinking about, early access to
food, early access to school lunch, early access to all the things nap expansion, all the
things that make it possible, for families to be, to thrive. And so, there is much to learn
there, I think. And I think one of the critical things that we focus on is it's been an incredible
success to get so many people covered, both through our Medicaid expansion and the
numbers of folks who took up, Affordable Care Act coverage this year. But your insurance
card needs to get you to a high quality place to get care. And that's why investments in
places like community health centers, in our rural partners, in the ways that we are trying

to build those footprints around the country where primary care is well supported, well
funded, and we're recruiting the workforce to deliver that care is so important.

Speaker 1 [00:19:57] Administrator. The US Government Accountability Office
recommended some improvements in how HHS measures its performance regarding
maternal health, and HHS agreed to these changes. Can you fill our audiences in on the
role and value of such performance measures?

Speaker 2 [00:20:14] We think performance measures are really important, right? Like it's
absolutely critical that we are holding ourselves accountable. These are taxpayer dollars
we are stewards of. And there's a sacred trust with the community that you invest in, the
work we're doing. And then we're going to tell you how well it's going. The one thing I
would say that's really important to to note, though, is that, we, also want to make sure that
new intervention, new innovation and community strategies are part of the equation too.
Too often we hear from, initiatives that have worked on the ground in communities that are
sensitive to communities need and responsive to the community that they they, you know,
they haven't had the resources and capacity to do a study that documents the evidence to
prove that X, Y, or Z happened. But it is clearly making a difference in the community. And
we need to, as we focus on performance measures and accountability, also account for
things that are evidence informed and places where community interventions are making a
meaningful difference.

Speaker 3 [00:21:18] Well, administrator members of the Black Maternal Health Caucus
have highlighted the very important role of Hisa and their goal to pass the Omnibus Act.
That's a great name for a new piece of legislation. What would this legislation do?

Speaker 2 [00:21:33] Yeah. So, you know, I actually had the opportunity to, as part of the
kickoff our of our enhancing maternal health event, initiative. Last month, we, we started
that, initiative by first hearing from the voices of, women who have had adverse maternal
health outcomes, or otherwise experience had experience in the clinical system where
their voices weren't heard and their pregnancies were more complicated as a
consequence. But then I had the chance to to at that event, have a dialog with,
Congresswoman Lauren Underwood, who is the co-chair of the congressional, Maternal
mortality caucus. And who was working on these issues, directly, who spoke, eloquently
about how important investments in herself have been to helping to advance the overall
goals of the caucus. And that is, you know, things like the work we do in Healthy Start,
where, where dollars are going directly to community based organizations where, you
know, I had the chance recently to visit one of our Healthy Start grantees with the
secretary, where women talked about how the Healthy Start grantee was. Their support
during pregnancy was the way that they got, ensure that someone was following up with
them, helping them figure out, how to prepare what was next. And then, once they had
their children being able to get on a pathway to, ensuring that they had tenancy
preparedness so that they could get, apartment, ensuring that they could get into
community college. I mean, that is the way we need to think about, these interventions and
the way that, we're excited about doing more of going forward.

Speaker 1 [00:23:22] You know, I think all Americans would hope that Covid was in our
rearview mirror, but it's still with us, quite private. And you had a catbird seat because you,
previously served on President Biden's White House Covid 19 response team. And in your
area of focus was testing. Just want to ask you, to address how do you think hearses
handled this year's Covid season and what will you be doing differently when the vaccine
campaign starts up? In the fall.

Speaker 2 [00:23:52] Yeah. And you know, it is really amazing, but but in my prior seat, at
on the president's Covid response team, how often we turn to her to, to be able to make
sure that there was equitable access to services. And so, as I like to say, I know more
about which health centers in America have a loading dock versus not because we we
delivered pallets of, tests and masks and all kinds of, of things directly to health centers.
So that and then they did the incredible work of packaging it up, wrapping it up with fact
sheets in the language of the community, and getting it out to people with through their
community health workers, through, those kind of interventions. And health centers
delivered more than 20 million, doses of the vaccine. You know, it is it is amazing what we
what health centers and rural health clinics. First time we were ever able to give direct
funding to rural health clinics, really being able to think about where our trusted people in
the community, who are they? How do we get these resources to those folks? Because
that's who people are going to turn to. And we see that again and again, and we see that
now in this, review season, as we tend to call it. Right? Because there's a lot of stuff out
there right now. And we know that that's going to be important going forward. It's really
important for particularly, for older adults who we, we interact with through who we deliver
care through, either through health centers or rural clinics or even in our HIV work, making
sure, that, we leverage all those touch points, to get people up to date on vaccines.

Speaker 1 [00:25:36] You know, let me just follow up on that around the financing, the
funds that are available. We're at this, inflection point in Washington where a budget hasn't
been passed. Tell us about what the budget looks like for her to hope for, and also maybe
how this will slow down. What's the larger picture look like now? As we still have no,
completed, resolution on the budget.

Speaker 2 [00:26:04] Yeah. You know, we're at a critical inflection point at her. So, we
fund, 1500 community health centers across the country. That's the 30 million people,
regardless, ability to pay. They're the go to source for health care in communities all
across this country. We fund more than 20,000 people in the National Health Service
Corps who are getting scholarships and loan repayment to practice in those high need
communities. We fund teaching health centers that are training new providers in those
communities. All of those programs have expired. They have to get funded in this new
package. They have to be part of the deal in order for us to continue, just to continue
keeping the lights on and doing the work we're doing. But the president said in our budget,
we actually should be doubling the investment in health centers. There are proven model
that works. We know people need access to primary care and this is a way to do it. So,
you know, we have, you know, seen some fits and starts, on that effort, but we're going to
keep at it, and lean into what we need to do to continue to grow those investments so that
people can get community can people can get primary health care, that is sensitive to their
culture, that is responsive to their needs. And that is a place where we can do all the
things that are really priorities in this administration. You know, my goal, our goal,
president, his goal is to get mental health and substance use disorder services delivered in
community health centers. You know, the reality is, we're in a moment where everyone in
America now understands how critically important it is to have mental health and
substance use disorder treatment services readily available. And we have made incredible
investments in this administration and across the board in growing the footprint of those
services. But if we're not leveraging primary care to help expand access to mental health
and substance use disorder, then we're missing a huge opportunity, both because there is
so much that can be done there, but also because that's a trusted provider that people are
willing to talk to about their behavioral health needs. And if we are not ready to respond,
then we're missing an opportunity. So I firmly believe that behavioral health has to be part

of primary care. And whenever someone raises their hand, we have to be there to be able
to meet those needs.

Speaker 3 [00:28:28] Well, administrator Carol Johnson, thank you for joining us. Thanks
to our audience for being here. Be sure to subscribe to our videos on YouTube, find us on
Facebook and with our account name, CHC radio. As always, you can go online to CHC
Radio.com to sign up for email updates. And please share your thoughts and your
comments about this program. Administrator. Thank you so much. For joining us today.
Thank you for the work that you're doing in the federal government to really improve health
and health care for everybody in this country.

Speaker 2 [00:28:59] Well, thank you, Mark and Margaret, and thank you for having me
and for the work that you do.

Speaker 3 [00:29:06] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
express written consent from Community Health Center, Inc.. The views expressed by
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