Obamacare’s Founders Seeing It Through in State Health Jobs

When Pennsylvania’s Republican-controlled legislature joined the push in other red states to install work requirements for Medicaid recipients, Teresa Miller made it her job to respond in kind.

After Gov. Tom Wolf (D) vetoed the measure, Miller moved to put the focus of the state’s public assistance programs on access to jobs, rather than on Medicaid.

“It got us thinking: what are we doing to support people getting back to work,” said Miller, Wolf’s secretary of health. “If that’s the idea then we should take a look at our employment programs and see what works.”

The resulting plan the Wolf administration rolled out last week, to combine the state’s health and labor divisions, could freeze the Republican effort by addressing the same goal.

It was another move by former Obama administration officials who, by taking their influence in health policy to the state level, may make it more difficult for congressional Republicans and the Trump administration to gut the Affordable Care Act (Public Law 111-148), their former boss’s signature policy achievement. They’re helping engineer Medicaid expansions in states that previously blocked them, or preventing changes that would remove people from Medicaid rolls.

“The attacks on the Affordable Care Act and the other things that have been going on have been keeping me in the fight,” said Carole Johnson, commissioner of the New Jersey Department of Human Services. She served in the White House under the Obama administration as senior health policy adviser and member of the Domestic Policy Council health team.

Pushing Back

Former Obama administration officials are now leading health departments in Michigan, North Carolina, Pennsylvania, and Wisconsin as well as New Jersey.

Jeanne Lambrew, who served as deputy director of the White House Office Reform during the early implementation of the Affordable Care Act, will lead the effort to expand Medicaid in Maine. That state’s former governor, Paul LePage, was so opposed to expanding the health program for the poor that he fought a voter referendum approving it.

Some of them say they’ve stayed in public service because of the Trump administration’s aggressive efforts to roll back Obama-era policies. They’re looking for ways to finish some of the work they started years before at the federal level. Some of them say they simply found opportunities they couldn’t pass up.

The group stays in touch and they often turn to each other when hiring staff or sometimes just for words of encouragement.

Johnson helped lay the foundations for tackling the opioid crisis while working for the federal government and as a member of Bob Casey’s staff (D-Pa.) on the Senate Special Committee on Aging.

In New Jersey, she’s working at making it easier for Medicaid beneficiaries in the state, which was among the earliest to expand the program under the Affordable Care Act to get addiction treatment. The state has worked to cut down prior authorization requirements in the program that add bureaucratic barriers to access medication-assisted treatment, Johnson said.

Managed Care Transition

In North Carolina, Mandy Cohen is leading the effort to transition the state’s Medicaid program to managed care, a model where the state contracts with private insurers to accept a per-person, per-month payment for coverage. The transition came after Republicans in the state legislature complained about how much Medicaid spending in the state fluctuated year-to-year.

North Carolina’s health department has a $20 billion annual budget and the state pays for about half of all births through its Medicaid program, Cohen said. The state has one of the country’s largest Medicaid programs despite not expanding under the Affordable Care Act.

The managed care organizations that the state contracts with are being asked to look at social and environmental factors that impact the health of beneficiaries, Cohen said. They’ll look at how food, housing, and transportation needs are or aren’t being met, she said.

“We’re trying to think more holistically about people, not just their physical needs but their unmet social needs,” Cohen said.

Creating Models

The program was influenced by Cohen’s work in the Obama administration and is meant to eventually lower the cost of covering North Carolina’s poorest residents.

These states are creating models for policies to improve the Affordable Care Act and public health programs like Medicaid that will lay the groundwork for other states to follow suit, left-leaning policy groups said. Just as Massachusetts’s experiment in health reform led to the creation of the Affordable Care Act, these changes could lead to future universal health coverage policies.

“These provide a road map for shoring up the Affordable Care Act and building up for a future administration that’s looking to expand coverage,” Maura Calsyn, managing director of health policy at the Center for American Progress, said.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Bernie Kohn at bkohn@bloomberglaw.com; Paul Hendrie at phendrie@bgov.com