Hospitals In Focus

Building Biden’s Health Agenda With Chris Jennings and Doug Badger


Two health policy experts joined Chip to discuss the new Biden administration’s approach to developing and implementing health policy. With COVID-19 raging across the country, Chris Jennings and Doug Badger touch on Biden’s first 100 days in office and how they expect Biden’s health teams to tackle the health and economic fallout from COVID in contrast to the Trump administration. Importantly, they touch on how the ACA can shore up health care coverage for uninsured Americans. Then they each provide an analysis on how the White House staff, regulatory agencies and Congress work together to achieve their goals. Chris provides the Democratic perspective while Doug responds with the Republican.

Chris Jennings has spent decades working in the White House, Congress and private sector. He spent time in both the Clinton and Obama White Houses as Senior Advisor to the President for Health Policy and helped pass, enact and implement the ACA, Children’s Health Insurance Program (CHIP) and numerous other health reforms. Most recently, President-elect Biden appointed Mr. Jennings to him on the Biden-Sanders Unity Task Force.

Doug Badger has been in public policy for many decades and has been a policy advisor to the White House, U.S. Senate, Department of HHS and the SSA. Doug worked in the Bush (43) administration and developed the administration’s proposal for adding prescription drug coverage to Medicare. Badger represented the White House in negotiations with Congress that resulted in the enactment of the Medicare Modernization Act.

Interested in learning more about how health care coverage can affect a population’s access to care? Listen to Chip’s conversation Advancing Health Equity: Bridging Social Gaps in Health Care with Dr. Chidinma A. Ibe.

Announcer (00:05):

Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.

Chip Kahn  (00:14):

This podcast comes at the beginning of 2021, and most importantly at the beginning of a new presidency in Congress. So its purpose is to give you a leg-up on a new era for health policy with the most thoughtful and perceptive guests we could find. Further, the podcast is a first for Hospitals In Focus, a double-header with two guests rather than one. Our guests both had distinguished policy-making careers and share the experience of assuming primary health staff roles in the White House.

Chip Kahn  (00:48):

First up, Chris Jennings, who held key positions at the White House during the Clinton and Obama administrations. And next Doug Badger, who played a comparable role in the White House for Bush 43. We will hear more about their policy bona fides in a few moments, but suffice to say few in Washington know more about health issues or are responsible for more health policy achievements than Chris and Doug. We will hear their perspectives on working in the White House and the challenges facing the new Biden White House health team, as well as the new administration’s priorities of fighting COVID and covering more Americans.

Chip Kahn  (01:29):

Finally, I should point out that we are recording this podcast on January 14th. With the events of recent days and the continuing political volatility, some of our conversations should be viewed in the context of our taping, but I am confident that the issues discussed in this episode will wear well.

Chip Kahn  (01:49):

First up is Chris Jennings, the President and Founder of Jennings Policy Strategies. Most recently, he was appointed to represent President-elect Biden on the Biden-Sanders Unity Task Force. Thank you for joining us today, Chris.

Chris Jennings (02:03):

Thanks, Chip. It’s so good to be with you today.

Chip Kahn  (02:07):

Chris, will you tell us a bit about yourself and your background?

Chris Jennings (02:10):

Sure. It’d be my pleasure. First of all, I’ve survived working with you over decades, so that should be a strike in my favor certainly I hope. But, I have had multiple lives frankly, a congressional life for a decade in the Senate going way, way back to the so-called Pepper Bipartisan Comprehensive Commission on Health, which you were very much involved with, all the way through the Clinton administration in the White House, working for the president, all the way both for the Hillary Clinton’s effort that you worked on and with and against, as well as the rest of the Clinton administration.

Chris Jennings (02:51):

And then, I went and I opened up my own firm where I’ve done a good deal of work for the policy community and the foundation world. And I was asked to come back to serve in the Obama administration again. And now I’m back out again and I seem to have the fever, I keep on getting back and engage with the next administration, but I can assure you that I have no intention to go back into the Biden administration. I hope that this tape wears well.

Chip Kahn  (03:20):

Thanks, Chris and impressive background and appreciate our long… I won’t say collaboration, it’s been collaboration at times and other times as a nice antagonist with one another.

Chris Jennings (03:32):

It has been. We both believe that in Washington, it’s about respect, not love and I’ve always respected you and occasionally loved you.

Chip Kahn  (03:42):

I both love and respect you, Chris. So let’s get onto it now. With your vast experience in how administrations make policy, interact with Congress in their policy process and implement policy through the agencies, what role do you see for the Biden White House healthcare team and how do you think the COVID crisis might make this health work a little distinct, even from your experience?

Chris Jennings (04:09):

Yes, it’s both. It’s always the same and it’s always different, but this is a once in a century pandemic, at least we hope it’s once in a century, it will be different. There will be in essence, two major health-related teams in the White House, one, which I call core-COVID and the second we’ll be doing traditional health care. And in-between, there’ll be something that I call cross-cutting COVID, and you and I both know that we can talk about COVID core, which is really about the distribution of equitable and efficient distribution of vaccines, therapeutics, PPE, testing across the country, and also very much oriented towards re-opening up our economy, our schools, our businesses. That totally is a core COVID effort. It will be run by a whole separate wing of people, including Jeff Zients and the Vivek Murthy and likely David Kessler and a host of other people who daily will be involved with that.

Chris Jennings (05:22):

The traditional healthcare will interface a great deal with the core COVID because as you know, COVID has big issues in terms of delivery and reimbursement and coverage. And so, they’ll definitely be cross-cutting issues there as there will be on race and disparity issues, on mental health and chemical substance abuse, on the application of technology to make our healthcare system work better and a whole host of different issues, home and community-based alternatives to nursing home care, that sort of thing. And so you’ll see that very traditional core group very much involved. In fact today, the news is that they just announced the person who served in my role, in Jean Lambert’s role, which is Christen Linke Young, who is a extraordinary talented, trained lawyer, but has worked both in the federal and state level, have done a lot of innovative delivery reforms in mental health and someone you’ll get to know very, very well in the days and weeks and certainly years to come.

Chip Kahn  (06:24):

Chris, what do you think are the key strategic decisions that will have to be made on this number one priority for the administration and the domestic side, which is dealing with COVID medication?

Chris Jennings (06:36):

There’s no doubt, this whole White House is governed by getting a handle on the COVID pandemic and doing it professionally and well, and really altering some of the course of actions that have been taken previously by the previous administration. The first priority is going to first establish a baseline and understand where we are, what we have, what resources have already been contracted out, what authorities we have. The worst thing you can do is reinvent wheels that are working, but unfortunately in this transition, the communication and collaboration between the old administration and the incoming Biden-Harris administration has not been good, but you have to start with that. And as you do, you develop what the president-elect has already… He’s announcing today his vaccine, new directions on vaccine distribution, but he will be also be working with the Congress to develop a new COVID package that addresses a whole series of shortcomings to get us back to work and stimulate the economy.

Chris Jennings (07:40):

The hope is that that could be bipartisan. And that will be the initial intent absolutely of the president-elect. His relationships will be forged, have been forged for decades, will be forged even more so, no doubt around this whole issue of the likely impeachment proceedings. And so, we are going into new ground. We have a 50-50 Senate. There’s lots of strategic decisions that have to be made. But first and foremost, the hope is that the president-elect can help bring the country together. And again, his sincere hope is to have a bipartisan initiative on COVID upfront, which will be primarily focused on getting us backup until working, and getting our schools back operational, getting our population vaccinated and having a testing capability that really enables us to surveil both individual populations, but also community population.

Chip Kahn  (08:42):

You just mentioned some of the key areas of tasks that are touched by COVID during the Trump administration, and generally in these kinds of issues, the issue of federalism comes up. What is your take on how the Biden administration will balance the federal and state roles on COVID, maybe in contrast to the Trump administration for all the different factors that you just discussed?

Chris Jennings (09:07):

I think we have to recognize that we have a long tradition of federalism in this country, and particularly in healthcare. Sometimes that works to our benefit, sometimes that works to our detriments. As a general rule, Democrats tend to want to have a stronger federal role and Republicans feel a little bit more comfortable with the state roles. But I think most people who look at what has happened over the last two years has felt that there has been absence of the type of federal leadership that even states themselves would like to see.

Chris Jennings (09:40):

And there’s no doubt that that means more of accurate science space, rapid real-time information to the states, the ability to resource the states well in terms of both finances, but also in terms of supplies, whether that be vaccines or testing or PPE and even necessary support for the private sector to collaborate in the development and production of some of these materials, and to have really thoughtful coordination between the public and private sector with the states. What we saw over the last year, where we had to witness states literally competing against one another for limited resources and blaming one another and blaming the federal government just can’t happen. We have to have a unified federal state, local collaboration. I think you’ll see a commitment from this Biden administration to do just that.

Chip Kahn  (10:41):

One of the issues that always comes up in every administration, but I’m sure in terms of COVID crisis mitigation will be a key issue is how well the White House health staff and structure works with HHS and the key agencies inside of HHS. How do you see that working out as we proceed with the Biden administration?

Chris Jennings (11:06):

It’s a very good point, Chip. The White House makes mistakes if they try to become departments and departments make mistakes if they try to ignore the White House. You really have to have an understandable, close, trusting, productive relationships between the two. The department has the infrastructure, resources and responsibility to both contribute to the policy vision, but most importantly to execute effectively on it. And as it does to provide ongoing data to determine whether we’re being successful or not the policy vision was correct, whether the execution is being implemented appropriately, whether we’re being successful, we have to have some mid-course corrections, really, and also they have to provide for individual agencies a capability to have trusted leaders that are empowered by the White House, trusted by the White House, and also given the platform to communicate on behalf of their agencies.

Chris Jennings (12:08):

That did not happen over the last year. It will happen in the Biden administration. But the White House job has to be done well too. They can’t micromanage, but they need to coordinate. They need to give very clear vision as to what they want to see. They have to enforce accountability amongst all the agencies, and it’s not just HHS, of course. And for the broader messaging, they have to have their own messengers starting with, of course the president-elect and the president and the vice-president and some of their leaders within the White House, I assume that for example, Vivek Murthy, the surgeon general will play both a role from the White House, but also with the department of Health and Human Services as being that effective messenger. But you have to understand the differences of the two as you well know, and from a stakeholder perspective as well, there’s going to have to be relationships developed amongst all of them, because all of them will have an appropriate role to play.

Chris Jennings (13:11):

And if they do their jobs right, that means that he’ll be more busy than ever. There won’t be a one place where you get all the answers, but hopefully there’ll be a coordinating entity within the White House that will be very, very helpful in guiding that through.

Chip Kahn  (13:26):

Chris, we’ve really drilled down on the direct COVID mitigation issues, but there are other health issues that are related to COVID, either because of COVID itself or because of the economic effect of COVID, health coverage, or the loss of health coverage for those that are newly unemployed, maybe an example, what would you see as the other than direct COVID mitigation, the other key Biden health priorities during the first 100 days?

Chris Jennings (13:55):

First, as you know the healthcare and the economy has always been linked for jobs, for innovation, for creativity, on a whole lot of fronts, on that front, but also frankly for costs and wage impact, et cetera. For all those reasons, health and the economy has always been linked, but with regard to COVID, COVID has unveiled so many other issues that… The health community has always known it and therefore shame on us for not addressing it. But COVID has highlighted the extraordinary disparities and equities in our healthcare system, not just in coverage but on how care is provided. And that has to be a priority of this administration, and absolutely it will. I think you’ll see other issues like mental health care, chemical and substance abuse being very, very high. Alternatives to nursing home, looking at workforce issues that bring us into the 21st century and beyond and the economy will be important.

Chris Jennings (15:01):

And of course, coverage is going to be critically important to this president. It is morally reprehensible that we literally have millions of Americans in this country who are living in states in poverty, who do not have access to coverage. And you could see when you heard the president-elect talk and you will be hearing him throughout his administration underscore his absolute commitment to address those issues, because you can’t address some of these disparities if you don’t address that issue head on. And I anticipate fully in that first 100 days, you’re going to be looking at retrenchments of what the Trump administration has done, that actually has increased the number of uninsured in this country, as well as undermine some of the protections on Pre-Existing Condition Exclusion Policy, and also look at other innovations as well as work with the Congress legislatively to push a coverage agenda, both for the short-term for COVID and then downstream developing policies that have longer term effects.

Chip Kahn  (16:08):

To close out, Chris, let’s drill down a bit on the coverage discussion that you were just illuminating. As you said, the Trump administration has not been kind to the ACA. Now that we have an administration that is committed to achieving universal coverage through the ACA framework, what do you think should be done by Congress and the new administration to shore up coverage?

Chris Jennings (16:32):

Well, certainly we have to look at building on, and as you know, the whole Democratic primary was a debate between soon-to-be President Biden and the rest of the Democrats on whether we build on the Affordable Care Act or whether we go to a Medicare for all type model. And clearly he’s chosen the former, and there are… Even pre the dismantling policy interventions of the Trump administration, there were shortcomings of Affordable Care Act in terms of affordability and complexity. Those have to be addressed. I think you can look at that through increased subsidies to address both cost-sharing and premiums. You also have to target the Medicaid programs that have not expanded. He’s very, very interested in finding ways to do that. They go beyond the type of approaches that the Obama administration took to address those issues.

Chris Jennings (17:36):

And yes, clearly we can’t just spend our way out of this challenge. We can’t spend our way into affordability, we have to address healthcare costs in this country. And that means looking at alternative delivery reforms, it means looking at pharmaceuticals and a host of other things to address both price issues and use issues. I think there’s going to be a heavy emphasis too on looking more broadly about health and healthcare, and talk about the integration of social drivers of healthcare and how we can address those more significantly and more constructively. So I see this as being a very, very broad agenda with some incredibly both creative, innovative and extraordinary talented people within this administration, given pretty much empowerment by the president to do so, because this has been a priority, in fact, it’s one of the few issues that people even remember from the debates.

Chip Kahn  (18:37):

Chris, that was great. Thank you for your time, and I’m sure our audience learned a great deal from the insights you provided in the last few minutes. Thanks a lot.

Chris Jennings (18:47):

I appreciate the praise, [inaudible 00:18:49] though it may be…

Chip Kahn  (18:51):

Joining us now is the loyal opposition, Doug Badger. He is both a Senior Fellow with the Galen Institute and a Visiting Fellow in Domestic Policy Studies with The Heritage Foundation. Glad to have you with us today, Doug.

Doug Badger (19:05):

Thank you, Chip. Glad to be here.

Chip Kahn  (19:07):

Doug, just to get started, would you tell us a bit more about yourself and maybe set some context for our audience?

Doug Badger (19:13):

Sure, Chip. Chip and I actually have known each other for many years. He was serving as staff of the House Ways and Means Committee when I was staff director for the US Senate, Republican Policy Committee, and later as Chief of Staff for the Republican Whip Office. Subsequent to that, I served in the Bush administration in the National Economic Council where we worked on the Medicare Modernization Act, the creation of Part D Health Savings Accounts and so forth. And then as deputy assistant for Legislative Affairs, the office in the White House that works with Congress. I’ve also been a partner at Washington Council Ernst & Young and with the Nickles Group, both of which are Washington-based lobbying firms.

Chip Kahn  (19:55):

Doug, you touched on your time in the White House and that’s what we’re most interested in getting your perspective on today. From your time in the White House, how do you see things playing out with this new administration where they’ve decided to set up in a sense of a COVID operation because that’s job one for them in the White House, and they’ll have the kind of policy health staff, that role that you played, how do you see playing that out? What are the issues that it raises and what should our audience know and be looking for?

Doug Badger (20:29):

It does raise some management questions, Chip. Something we had during the Bush administration after 9/11 was the creation of the Homeland Security Council. So now you had a council that was created to look at things, some of which were in the area of emergency response like FEMA, some that may have been in military area and others. And the lines between those offices, sometimes weren’t exactly smooth. It’s hard… In the White House staff, there’s some territorial behavior that’s going to have to happen and we could talk a little bit more about that later, but it’s a tough one. And I think probably the Clinton administration did too. They used to be one policy council for domestic policy, not as the Domestic Policy Council. And he broke off the National Economic Council separate from that. And I served as a staffer in the National Economic Council, and I will say from time to time, there were jurisdictional disputes over who was in charge of some of the healthcare issues, whether it was NEC or the Domestic Policy Council.

Chip Kahn  (21:34):

Even as you bring it up, we’re talking about these potential for overlaps, hopefully collaborative work, but possible conflicts inside the policy centers in the White House. But then we get to the agency, particularly in this time of COVID where we’ve got HHS and the secretary, and then the agencies under it that all have various responsibilities that are critical in this challenge, this crisis. How do you see that working out? What issues are going to be raised over the next few months, the first 100 days when they focus on COVID, between the White House and the agencies?

Doug Badger (22:11):

Yeah, I think it’s more, Chip of a process issue or a personal issue. Mr. Becerra, the incoming secretary has accomplished a great deal in his career. He’s won state-wide election in California as Attorney General. And undoubtedly has a certain expectation of what he’s going to be dealing with. Tommy Thompson, who was a HHS secretary under President Bush had been governor of Wisconsin, and he said, “When I was governor, I walked into the office in the morning with an idea and by one o’clock, my staff was working on it.” And then he said, “And then I came to HHS, now I have to run my idea pass 63,000 employees, 12 operating divisions. If I get a pass then, I have to go to the White House Office of Management and the Budget.” And he said, “OMB tells you no nine times out of 10 just to show you who’s boss. If you get a pass then, you have to get it through the White House Policy Councils and the National Economic Council and so forth, and then pass the president.” And he said, “At that point, you get it through Congress, it’s time to retire.”

Doug Badger (23:11):

Now, he was speaking somewhat ironically there, but one of the things that’s going to happen is that you’re going to need a very strong working relationship, not only within the White House staff, but between the White House and the cabinet secretary, particularly on pressing issues like COVID. Disputes will undoubtedly arise, they always do, but how those disputes are handled is going to define the Biden administration’s success in the healthcare area, just to a great extent.

Chip Kahn  (23:46):

Before we go on to some substance and the healthcare topic more generally, I’m interested from your perspective of how important leadership style is in both running the West Wing, staffing health in the West Wing and just running the government, generally?

Doug Badger (24:03):

In my view, Chip, I think there are a few things that are more important than that to the success of president in these various policy areas. Tev Troy is presidential historian and was a colleague of mine of the White House, has written a book last year called Fight House in which he chronicles some of the staff divisions that have occurred over the years beginning with the Truman administration.

Doug Badger (24:28):

And he identifies what I think makes sense to me from my own experience, three big points. One is ideology, we know in the Biden administration, it’s going to be a division between those who are more moderate and those who are more progressive. Second is process, will the president have his Chief of Staff run a very tight process so that people get the opportunity to air their views, but once a decision is made, they feel as though they’ve been fairly treated and won’t go out leaking to The Washington Post or The New York Times about their experience? And finally, it’s a question really for president Biden, his tolerance of infights. Some presidents like the idea of staff disagreements, others are very averse to that. And so how they manage those three areas is going to be very critical, particularly in an area as important as healthcare.

Chip Kahn  (25:23):

Clearly, and I’ve said it already myself, the Biden administration sees COVID as job one, because it’s both a health issue and it’s an economic issue. In a sense COVID economics may define the future fate of the legacy of this administration. Clearly it’ll define part of the legacy of the Trump administration. If we look to the first 100 days, what do you think in terms of this priority, they ought to focus on most and what do you think defines success?

Doug Badger (25:57):

What I’ll think is that they would proceed sequentially, and obviously some of these things are going to be happening all at the same time, but generally there’s low hanging fruit there, right? First are regulations or policy issuances that the president and his new cabinet can reverse fairly quickly. There’s also something called the Congressional Review Act, where Congress can vote simple up or down vote, there’s no filibusters, no amendments, simple majority on resolutions to nullify regulations that may have been issued toward the end of the Trump administration. The Trump administration and the Republican Congress used that 14 times in their first year in office, and I would expect to see a similar thing with the Biden administration.

Doug Badger (26:44):

The next thing I think that they will put a priority on legislatively would be, depending on how they sequence these things, they may do their big COVID bill at the outset. They may, on the other hand pass a budget resolution, which would enable them to then do a budget reconciliation bill. Again, a bill that cannot be filibustered and can be passed by simple majority in the Senate. And a lot of the new spending and a good deal of the new policy direction can actually be accomplished through a reconciliation bill. So I expect that to dominate the first 100 days.

Chip Kahn  (27:23):

One of frankly the Federation’s priorities for our patients and a key issue generally, both because of COVID and because of the COVID economy is coverage and coverage in this case for the newly unemployed, but as an issue however you feel about ACA the Trump administration’s years were not kind to it. So there has been some degrading. I guess I have a question which I’ll pose in two parts. First, knowing that Republicans have been for many, many reasons, opposed to ACA since its inception, do you think there’s any chance in the upcoming 100 days or beyond that they’ll cross a Rubicon and be willing to compromise on the ACA on technical changes on other changes to help expand coverage? And if so, what do you think the degrees of freedom are? What could work for them, assuming that they were willing to sign on to anything regarding ACA? Because we still have very tight margins in both chambers. And as you were talking about one bill versus a budget reconciliation, there are limits to what you can do in budget reconciliation in the healthcare area if it’s not related directly to spending and revenues.

Doug Badger (28:46):

Yeah, that’s absolutely right. I do think there’s been a change in the way Republicans view the ACA. You don’t hear, repeal and replace anymore. I do think they’re going to have to attack differently on the preexisting condition issue. President Trump had that cognitive dissonance where he said he wanted to protect people with preexisting conditions, but he was suing in federal court to have the Supreme Court strike down the preexisting condition laws in the ACA. I expect Republicans are going to embrace that at some point. Where I think you run into issues with Republicans and I do think you’ll continue to see resistance will be in, for example, enlarging the ACA subsidies.

Doug Badger (29:34):

You will definitely see resistance to the public option. I would probably call that a non-starter on the Republican side. And so, one that will be a very difficult thing for the administration and Democratic leadership to manage. You’ll probably see softening on things that facilitate people signing up for ACA coverage like the use of navigators and so forth. But I think on some of the big expansions that the Biden administration has identified as areas of priority, I think you’re still going to see Republican resistance there.

Chip Kahn  (30:15):

You did bring up the public option. Let me just expand on that with a short question. Do you see an alternative to it that’s been mentioned of lowering the Medicare age or allowing some kind of Medicare buy-in below 65? Do you see that in the same way, or how do you view that?

Doug Badger (30:33):

Lowering the Medicare age could be a very, very complicated issue, right? Because you’re looking at a hospital insurance trust fund that goes bankrupt in 2024. So if you just dump a whole bunch of people into that trust fund, you’re going to hasten that date of insolvency. So they’re going to have to have a different way to finance it, probably through general revenues as opposed to the payroll tax, which some of the HR funders currently finance, I don’t know where employers are going to come down on that, probably to be able to move older workers off their health plans sooner, will be a boon to them. Some of the private insurers will feel the same way certainly if you can… I don’t know how much you improve the risk profile for the exchange-based coverage by moving people in their early to mid-sixties off those plans and pushing them into Medicare. But I expect that all of those kinds of factors will weigh into where Republicans will come down.

Doug Badger (31:36):

I think they’ll be initially skeptical, but I don’t see that necessarily as an issue of crossing the Rubicon, depending on how it’s structured and financed, it’s conceivable they can have some sort of discussion about that and went over some Republican support.

Chip Kahn  (31:54):

So let’s go beyond coverage and maybe even beyond COVID for a moment, even though it rightfully is the centerpiece of any healthcare thinking right now. And so maybe we go beyond the 100 days. What do you think in the rounds of policymaking once we get past a COVID bill or COVID-related items, what do you think may be or ought to be on the health agenda?

Doug Badger (32:20):

Well, in terms of what may be… When you look at the uninsured and CBO, where congressional budget office has done a recent analysis of this, we also have it through the Kaiser Family Foundation, which has analyzed it, most people who are uninsured right now have access to coverage. Most of them have free coverage through Medicaid, others can get free or virtually free coverage through the exchanges, a big chunk of people decline employer-sponsored insurance. The two big pockets of the uninsured that you can say don’t really have alternatives are those who are not lawfully present in the United States and that excludes them from coverage. And also people in states that have not expanded Medicaid and therefore are excluded from any federal support for their coverage. How you navigate that? I think the former one, I expect there’ll be some discussion of immigration reform as we move on and we think about people who have been here for a long period of time, but are excluded from certain federal benefits.

Doug Badger (33:27):

As to the second one, I’m not sure that Congress will resolve the Medicaid expansion, but the two big pockets of the two big states that haven’t expanded are Florida and Texas. Both of them have gubernatorial elections coming up in 2022. People who wanted to expand Medicaid have done very well with referenda, putting that on the ballot. So I expect that that issue may be resolved by the states rather than by the federal government.

Chip Kahn  (33:56):

Lastly, just to conclude, I want to make sure. So, then in a sense maybe that may be the real Rubicon, which is what happens at the state level regarding the structure that’s already there for Medicaid that ACA included back in 2010?

Doug Badger (34:18):

That’s right. And the Biden administration has talked about it. Actually, in Biden’s campaign documents, what he said is they don’t have to expand Medicaid. We will enroll people in those states in the public option, but that gets into a circular discussion as to whether there will be a public option. My own view is that this is more likely as you say, to be resolved at the state level than the federal level, but it will certainly be a topic of conversation.

Chip Kahn  (34:43):

Well, this has been really terrific, Doug and I just so much appreciate you taking time to be with us and to provide us the insights that I’m sure will be useful for our audience.

Doug Badger (35:00):

Thank you.

Announcer (35:00):

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHhospitals, and follow Chip @ChipKahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with health care leaders.

Chris Jennings, Founder and President, Jennings Policy Strategies

Chris Jennings is an over three decades-long health policy veteran of the White House, the Congress and the private sector. In 2014, he departed from his second tour of duty in the White House where he served President Obama as Deputy Assistant to the President for Health Policy and Coordinator of Health Reform. He served in a similar capacity in the Clinton White House for nearly eight years.

Outside of government service, Mr. Jennings has been a senior health policy advisor to ten Presidential campaigns; the 2008, 2016 and 2020 Democratic Platform Drafting Committees; and multiple gubernatorial and Senate candidates. Most recently, Vice President Biden appointed Mr. Jennings as one of his members of the Biden-Sanders Unity Task Force. Recognizing his pragmatic nature and experience with key Democratic policymakers, the Bipartisan Policy Center (BPC) sought Chris to serve as a senior advisor on a number of health reform projects, including reports and recommendations on access, delivery reforms, cost containment and long-term care.

From his positions in the executive branch, Mr. Jennings helped implement the Affordable Care Act’s access and delivery reform provisions (for President Obama) as well as played leadership roles in the development, passage and implementation of bipartisan health reforms, such as the Children’s Health Insurance Program, the Health Insurance Portability and Accountability Act (HIPAA), the Prescription Drug User Fee Act (PDUFA) of 1997 and major Medicare reforms in the Balanced Budget Act (BBA) of 1997 (for President Clinton).

In his decade of service in the U.S. Senate, he served as the Deputy Director of the Special Committee on Aging for three Senators (Glenn, Pryor, and Melcher) and led major reform efforts in the areas of long-term care, prescription drug coverage/cost containment and rural health care. In this capacity, he also served in a major role for the U.S. Bipartisan Commission on Comprehensive Health Care (also known as the “Pepper Commission”).

Jennings Policy Strategies (JPS) is a nationally respected health care consulting firm committed to assisting foundations, purchasers, health systems and other aligned stakeholders develop policies to ensure higher quality, more affordable and sustainable health care. He has consistently worked to develop administrative, legislative, and private sector policies/interventions to ensure better stewardship of and a greater return on investment on the nation’s $4 trillion investment in health care. In addition to his consulting work and his collaborations with think tanks Mr. Jennings is a frequent contributor on health reform issues to publications such as the New England Journal of Medicine, Health Affairs and The Atlantic.

Doug Badger, Fellow, Galen Institute

Doug Badger’s career in public policy spans more than three decades and includes stints as a policy adviser to the White House, the U.S. Senate, the Department of Health and Human Services and the Social Security Administration. He has a distinguished track record of creating and advancing conservative, practical ideas to help lower American’s health costs and expand their choices.

Doug served as Special Assistant to the President on the National Economic Council, where he advised President George W. Bush on health-related matters, including the creation of Health Savings Accounts. He later served as Deputy Assistant to the President for Legislative Affairs, where he helped formulate Administration policy and legislative strategy on a broad range of issues, including health care, energy, taxes, financial services, pensions and employee benefits, intellectual property, trade and telecommunications.

After leaving the White House, Doug became a partner at The Nickles Group, where his practice included where his practice included health care, intellectual property and financial services. He also has been a partner at Washington Council Ernst & Young, where he had a similar practice.

Doug also served for a decade as a U.S. Senate aide, serving as Chief of Staff to Assistant Majority Leader Don Nickles and Staff Director of the Senate Republican Policy Committee.

Related Resources