Elective Surgery: Obamacare’s 15th Anniversary, Federal Healthcare Reform, and California’s Medi-Cal Woes

>> Bill Whalen: It's Thursday, April 3rd, 2025, and welcome back to Matters of Policy and Politics, a Hoover Institution podcast devoted governance and balance of power here in America and around the globe. I'm Bill Whalen. I'm the Virginia Hobbs Carpenter Distinguished Policy Fellow in Journalism here at the Hoover Institution.

 

I'll be moderating today's conversation. I'm not the only Hoover fellow who does podcasts though, and I recommend you go to our website, which is hoover.org, go to this link in particular hoover.org podcast. There you'll find audio, podcast, video series, all kinds of stuff we're doing. So today we're going to talk a bit about an anniversary that went by unnoticed in March.

 

And that was the 15th anniversary of the signing of the Affordable Care Act, March 23, 2010, the actual date when Barack Obama put pen to paper and signed the aca. And well, it changed public policy and it also changed politics. I remember that once he signed that bill, we thought, my goodness, how long before a Republican president comes along with the Republican president Congress, and they do away with Obamacare?

 

But here we are 15 years later and Obamacare is quite alive and ticking. What's also curious, the reason why I wanted to do this podcast today is because the Trump administration has been in power for about 74-75 days. Now, I believe haven't heard much about health care now, maybe that's just a reflection of Donald Trump is making news every day.

 

Elon Musk is in the news every day. We're getting overwhelmed by doge and layoffs in federal workforce, and of course, today the world exploding over tariffs. So maybe just not a lot of bandwidth for healthcare. But helping me make sense of this and more matters on healthcare today is my colleague Lanhee Chen.

 

Lanhee Chen is the David and Diane Steffey Fellow in American Public Policy Studies here at the Hoover Institution. He also co-chairs Hoover's Health Care Policy Work Group. Holani was also policy director for the Romney Ryan presidential campaign back in 2012. His job coming up with positions on matters like healthcare.

 

Lanhee Chen might be familiar to a lot of you in California because if you got a ballot in 22 there he was on the ballot as a candidate for Republican state controller. He holds a distinction of being the Republican candidate and gets the most votes in America in 2022.

 

By the way, Lanhee, thanks for coming on the podcast.

>> Lanhee Chen: Hey Bill, great to be with you. Thank you.

>> Bill Whalen: So question for you, my friend. Where were you in March of 2010?

>> Lanhee Chen: March of 2010, I was working for a guy called Steve Poizner. He was running for governor of California.

 

And that was before the primary election, when he lost. I think the primary was in June. So I was in Sacramento at the time.

>> Bill Whalen: Okay, Steve Poizzner, by the way, is an interesting trivia question. The only Republican other than Arnold Schwarzenegger to win a statewide office in California in the last, what, 30-35 years?

 

>> Lanhee Chen: Yeah.

>> Bill Whalen: 2010, Lanhee, was quite a colorful year, eventful year in American politics. It began In January of 2010, you might recall, when there was a special election in Massachusetts. This was to replace Ted Kennedy, who had passed away. And the election produced a shocker in that the Republican candidate, Scott Brown, won that election.

 

I went back and did some sleuthing, Lanhee. I looked at the exit polls. 52% of Massachusetts voters said they opposed the idea of ACA at the time. It had not been signed yet by Obama, not for a couple months. 42% of voters who voted for Brown said they voted for him for that express purpose, to make sure that ACA never happened.

 

Then, of course, Obamacare happens. We have an election in 2010. It's a wipeout for Democrats. 63 House Democrats are tossed out. Lanhee, including, I quoted one study I saw by para-political scientists. Thirteen House Democrats lost their jobs due to their vote on Obamacare. We continue on with this.

 

I was looking at NBC Wall Street Journal polls, for example, the Affordable Care act underwater from 2010 to. And then in 2017, something kind of interesting happens, Lonhi. It suddenly becomes a lot more popular, and maybe that coincides with Donald Trump coming to office. Here's my question to you, Lanhee.

 

Once Obamacare was signed into law, was it always going to be here? Or did Obamacare get a new lease on life on July 27, 2017, when John McCain came back to Washington and famously cast the no vote on the skiddy reform.

>> Lanhee Chen: I think the reality, Bill, is that the longer a piece of public policy, particularly one that has been through the legislative process in the way that the Affordable Care act was, the longer you have a law in place, the harder it is to get rid of it.

 

I mean, that's just the reality. So to the degree that there was an opportunity to repeal the law, it would have been, you know, right around 2012, when I was working, as you noted, as the policy director of the Rodney Ryan campaign, I mean, one of the things that we spent a lot of time on was, you know, what was the mechanism to effectuate repeal of the law and what would have a replacement looked like.

 

More importantly, what elements of the law needed to be fixed, fixed, which ones needed to be completely replaced. And that was a lot of hard work with a lot of people went into that, many of whom have gone on to serve in a Republican administration. Some of them are serving in government now.

 

So it, I think the opportunity would have been there. But once you got to 2017 and once became as polarized as it did right. The likelihood that anything was going to happen to it in a really substantial way I think was pretty small. And then the other issue, of course you run into is that over time, people get used to it.

 

They get used to the elements of it. There are things about it that become politically more salient. For example, the restriction the law puts on denying coverage based on pre-existing conditions. That was the core center of the debate in 2017. People didn't wanna get rid of that, right?

 

So the law, once it's there for a while is popular and then elements of it become even more popular and it turns the popularity of the whole law. Where if you were to look at survey research today, you would find that, you know, about 60 or 65% of Americans like the ACA, here we are 15 years down the road and the public opinion on it has essentially completely flipped from from when it was first passed.

 

>> Bill Whalen: So I'm gonna read you a quote, Lanhee, from what Donald Trump said in his loan debate with Kamala Harris last year, quote, Obamacare was lousy health care, always was. It's not very good today. And what I said, that if we come up with something and we are working on things, we're going to do it and we're going to replace it.

 

Now let's fast forward to him being back in Office as a 47th president. He has done something on health care. He signed an executive order dealing with health care pricing transparency. And it does relate to Obamacare in this regard. It messes with the enrollment period for Obamacare, takes it back by a month instead of from November 1st to December 15th.

 

It's now November 1st, December 15th instead of the January 15th deadline. So he's tinkered with it. But boy, that's not repeal or replace, is it?

>> Lanhee Chen: Yeah, I mean, I think it speaks to the reality of how hard it is to do anything really fundamental to the law.

 

I mean, I think the administration is going to do some things that are helpful to the health care system, like for example, promoting more transparency around pricing, which is something they did in the first term. Again, not directly related to Obamacare, but I think good for the healthcare system.

 

But the likelihood that they'll be able to really kind of do much about changing the arc of the law, you know, pretty low likelihood. And again, it gets back to how hard it is to change something as entrenched as the ACA. Right.

>> Bill Whalen: Let's talk about what Washington can be doing on healthcare.

 

Lanhee, actually, first, let me ask you this question. So you're doing American public policy studies. That's a pretty big umbrella. How did you end up with healthcare reform?

>> Lanhee Chen: Well, a lot of my initial policy work when I first started in public policy was in healthcare, and part of it was influenced by my dad, who's a medical doctor.

 

And so I had a lot of exposure to the health care system when I was younger, and you had an interest in it. It's a pretty complicated area of policy. I mean, I think all public policy has its own, you know, little, little twists and turns. But I think health care has a complexity to it.

 

And I really took to that when I first did policy work and then when I served in government during the Bush administration. George W Bush administration, that's the agency I worked in, the Department of Health and Human services. So got a view in government, got a view outside of government.

 

And so for me at least, it's just been an area of policy that I find fascinating and I've spent a lot of time and energy over the years focused on it. So that's the story.

>> Bill Whalen: So you wrote a column recently with your colleagues Tom Church and Danny Hile, the title which 15 years later, the ACA has an HSA problem and you can explain HSA to his Health Savings Accounts.

 

It's interesting. So you mentioned the polling on Obamacare, Lanhi. It's about a 6040 split. 62, 37 or so. It drops a couple points if you call it Obamacare instead of ECA. But it's more popular than it's unpopular. But yet there's a question of product demand. And what you point out in the column is this.

 

You note that the Congressional Budget Office back in 2010 predicted that there'd be 24 million Americans buying insurance on exchanges by 2019. But if you look at the actual numbers, it turns out to be 10.6 million. You also predict enrollment will be declining this year. So if the product is popular a lot here, why don't we see it reflected in the numbers of people signing up?

 

>> Lanhee Chen: Well, because I, I think fundamentally the product that's being offered is not a great fit for what people want. People want to be able to choose a healthcare coverage product that makes sense for their lives, that is adaptable, that's flexible, not one that's relatively rigid. Generally speaking, fairly fulsome in benefits and pretty high in cost.

 

Right. And I think that's the explanation. If you look at the coverage gains that have come through the Affordable Care act over the last 15 years, the vast, vast majority, by some measure over 80% of the coverage gains have not come from private health insurance. They've come from an expansion of a program called Medicaid, which in California we call Medi Cal.

 

But fundamentally what Medicaid is, is it's coverage for lower income Americans. This is government run coverage. And there's been research about whether coverage under Medicaid is any more effective or efficient at promoting health outcomes than having no insurance at all. Now, I think it's hard to make that case, but the reality is that Medicaid is a program that is riddled with a lot of challenges.

 

And so the, the idea you're speaking about, which is private health insurance offered through marketplaces, which was definitely a part of the Affordable Care act, it hasn't been as popular as I think the Congressional Budget Office originally thought it would be or people who originally advocated for the law thought it would be because the insurance offered through it is expensive and it doesn't fit what most people want.

 

And so part of the answer there is can we create a system that offers a little bit more choice, a little bit more variance in terms of pricing so that people can get access to plans that maybe suit them better at a price that works and is free of some of the bells and whistles that a lot of these plans have on the Obamacare marketplaces?

 

I think that's really the fundamental issue.

>> Bill Whalen: Let's look at three matters being discussed right now, Lanhee, and you tell me what the significance is. The first one how does health care relate to the upcoming conversation on tax reform?

>> Lanhee Chen: Well, it's a significant relationship because a lot of what drives health care policy is tax policy.

 

The single biggest element of why we have the health care system we have is because of a provision in the tax code that says that if you get your health insurance through your employer, that insurance as a benefit is not taxable to the employee and is a write off is a tax deduction for the employer.

 

And so that interpretation of the tax code drives so much of not just tax policy, but health care policy in this country. So when we have a discussion around health care reform, it's going to be a conversation around tax reform and vice versa. So very close relationship. When they look at changes to the tax code, there will almost certainly have to be impacts on, on health care in some way.

 

Health care is 20% of the economy, it's highly unlikely that you wouldn't find the tax code change to impact health care in the country.

>> Bill Whalen: We're talking about they as in Congress, but are you looking at a he or she, long he, someone like a Bill Cassidy who's gonna be leading this?

 

>> Lanhee Chen: Yeah, I mean, this is a process that's going to be driven by members of Congress in the majority party. In the House, it's Republicans. In the Senate, it's the Republicans, so yes, Senator Bill Cassidy of Louisiana is a great leader on healthcare issues, a guy who knows a ton about these issues and, and cares deeply.

 

On the, on the House side, you're going to have Jason Smith, who's the, the chair of the House Ways and Means Committee, the principal tax writing committee there. They're going to be very, very engaged as well. So it is going to be a conversation for congressional leaders as they figure out how to put together as President Trump says, one big beautiful bill.

 

And when he talks about that, part of that is whether these tax changes go into that bill. Now, there's some skepticism about whether the one bill can contain all of this stuff, but we're going to see some significant legislative activity as we get into the summer and fall months of this year.

 

>> Bill Whalen: Okay, item number two, Lanhee, Medicare, Medicare expenditures in particular, copying from your column, 2.2% of GDP in 2000, Medicare expenditures, 3.7% in 2023, projections showing it going up to 5% by 2034. Now, when we talk Medicare and entitlements, Washington likes to kick the can down the road, doesn't it?

 

>> Lanhee Chen: Yeah. And the reason why we're seeing a higher percentage of GDP spend around Medicare is twofold. One is we have more and more people who qualify for Medicare because we have an aging population and a lot of the boomers are retiring and of Medicare age. But the second reason is because health care is becoming ever more expensive.

 

So if you look at health care inflation, those percentages tend to outpace core inflation or inflation, other parts of the economy. And so health care expenses are rising, consumption is rising, and as a result, total Medicare expenditures are rising. And that's a trend that we don't see abating anytime soon.

 

So the question will be when policymakers decide they want to make Medicare more fiscally sustainable. And as you know, politically, I think that's a very challenging topic.

>> Bill Whalen: Okay, and item number three, Lanhee, Telehealth expansions. Now, I don't know much about telehealth, but I do know it has to do with distance health.

 

So I start thinking red states.

>> Lanhee Chen: Well, it's great for rural areas where you don't have access to ready access to healthcare facilities. But telehealth essentially is getting access to healthcare, whether a doctor, registered nurse, whoever can help diagnose a health condition via technology. Right. Whether it's a mobile phone or a Zoom call, whatever it might be and that's something that really was a big element of healthcare during the pandemic and right after, when people weren't engaging in as much in-person activity.

 

>> Bill Whalen: Right.

>> Lanhee Chen: And for some Americans, that access is really, really important. And so we want to figure out ways to continue to incentivize the adoption and continuation of telehealth. And those authorities, some of those which were originally created during the pandemic, have lapsed or will lapse. And so we want to create a permanent way of getting access to health care in that way.

 

>> Bill Whalen: What did Covid teach us, Lonnie, about both the promise and challenges in doing telehealth?

>> Lanhee Chen: Well, the promise is access. You get people who are able to see a doctor usually much more quickly, and they don't have to travel hours in some cases to see a doctor.

 

Now, the restriction, the challenge is that there's only so much we can do remotely, right? I mean, there's only so much diagnosis we can do without actually, in some cases, having physical access to a patient, being able to draw blood, being able to take specimens, things that are needed to diagnose disorders, diseases, conditions.

 

It's very hard to do all of it. I think there are certain kinds of health care that are well suited to telehealth. Certain dermatological conditions, mental health, behavioral health issues. Those are things that I think can be handled reasonably well via telehealth. But it's not for everything. And so we have to continue to be mindful of the fact that we need a system that allows for broad access and people to be able to seek care, notwithstanding the fact that they may live some distance from a doctor.

 

>> Bill Whalen: So health care reform was discussed by Congress last year. It was formerly the 482 page Bipartisan Health Care Act. It included telehealth extensions as you've been talking about. It included pharmacy benefit manager reform. It addressed the opioid crisis. It didn't go anywhere, Lanhee. And this is what has me curious about healthcare reform in Congress.

 

2024 is election year, so maybe it just died because of election year politics. 2026 will be an election year. 2027 if the Democrats pick up the House as a divided Congress so it becomes all the more problematic then you're the 2028 into the presidential election year. So does that kinda make us some regards 2025 as kind of a year by default to get things done?

 

>> Lanhee Chen: Yeah, I mean I do think if we're going to accomplish anything on health care, it's going to have to be this year. It's probably gonna be part of the one of a couple of legislative packages we see this year. Highly, highly unlikely that it happens in an election year.

 

A, because it's complex but B, I think a lot of members of Congress don't like to deal with health care. I think, their view is look, we did Obamacare, we did a couple of other big pieces of health care legislation over the last 15 years. Why, why do we need to revisit this again?

 

Right. And so every year there are a few health care provisions that have to get dealt with because if they don't, doctors don't get paid and things don't happen. So we deal with those. But aside from that, the reality is that there's not a tremendous amount of demand amongst members of Congress or frankly amongst presidents to deal with these issues.

 

So I think your assessment of the calendar is right. This is going to be the year to get things done and we'll see if it happens.

>> Bill Whalen: All right, let's shift for a moment to California. Now let's talk about what's going on in Sacramento. It has a real budget problem with Medi-Cal.

 

California is the first state to offer government health care to all low income people. Medi-Cal is the state version of Medicaid. It's the first to offer, as I mentioned, healthcare to low income people regardless of immigrant status. About 1.5 million immigrants without legal status are enrolled now in Medi Cal but California cannot afford it right now.

 

You've also seen, Lanhee, a spike in seniors applying to Medi-Cal, about a 40% increase. And you referenced this earlier in terms of the cost. I looked up the numbers here. It costs California on average about $15,000 per senior enrolled in Medi-Cal versus about 8,000 for non-seniors. So what's Sacramento going to do here, Lonnie?

 

Because you have the fiscal reality of having to balance a budget. California has to balance a budget, unlike Washington. Now, we can get into smoke and mirrors if you want to, but you also have a governor with presidential ambitions who has been in the last month or so trying to show a little leg, suggesting that maybe he's a little more moderate than you think.

 

And you have this hot button issue of undocumented Californians getting public benefits. So your thoughts on how this gets resolved?

>> Lanhee Chen: Well, it's the same way it gets resolved every year, which is that they end up kind of reducing the amount that they pay physicians to see patients.

 

And so if you look at the broad spectrum of how healthcare providers get paid, if they see a patient through commercial insurance, you know, the insurance you get through your employer, let's assume for a moment that the provider gets paid a dollar. If they're seeing a Medicaid patient, Medicare patient, excuse me, this is the old age program.

 

They're seeing a Medicare patient, maybe they're getting $0.70 or $0.80.

>> Bill Whalen: Right.

>> Lanhee Chen: If they're seeing a Medicaid patient, they're probably getting a quarter or less.

>> Bill Whalen: Right.

>> Lanhee Chen: So the, what traditionally has happened is as Medicaid budgets have been strained at the state level, they've compressed down and they essentially pay providers less.

 

And the way that they deal with this is they crunch down on providers every year. So what happens? Predictably, providers say, I'm not gonna see Medicaid patients anymore. And then you end up with a, with a real supply problem on health care in the Medicaid program. So there are other things states will do.

 

Like they'll restrict access to certain prescription drugs they think are too expensive or certain therapies they think are too expensive. But regardless, what it results in is it results in some form of rationing of care. We don't call it rationing, that's not popular in America. But that's what it is, right?

 

Care is rationed because the supply of health care is constrained. And that's fundamentally what happens. And that's the only way that the math works when it comes to the Medicaid program.

>> Bill Whalen: There's something else Sacramento could do, Lanhee, they could write to Washington saying, please send us money.

 

>> Lanhee Chen: Well, And Washington sends California a lot of money.

>> Bill Whalen: Right, send us more.

>> Lanhee Chen: I mean, one of the deals with the Affordable Care act was that the population that got health care through the Medicaid expansion contained within Obamacare.

>> Bill Whalen: Right.

>> Lanhee Chen: That population gets reimbursed at over 90% of the cost the state puts out.

 

So the state's putting out a very small percentage of reimbursement for that population, the traditional population, which is a little bit cheaper to cover because it's primarily kids. And kids tend to be cheaper to cover that population. They're probably getting, I don't know, somewhere around 60 cents, maybe between 50 and 60 cents from the federal government for every dollar they spend.

 

So, yeah, I mean, the feds could send more, but the feds are fiscally constrained as well. So the notion that they can look to Washington is kind of, kind of ludicrous. A, because Washington's already sending plenty of money, and if they were going to send more, every state would want more, and we wouldn't have enough money to pay for everything else.

 

>> Bill Whalen: Well, the reality of Republican Congress is going to send California $3 billion because California underestimated the number of undocuments who signed up for Medicaid. Yeah, just not going to happen. Pretty unlikely. Robert F Kennedy, Jr. do you know him? Have you met him?

>> Lanhee Chen: Yeah, I mean, look I think he is a different, a very different model of AL Secretary.

 

And I've known.

>> Bill Whalen: I'm glad you mentioned that. I went back and actually looked up. So if you go back to the history of HHS and then HEW. Before that, you're talking about 70 years of secretaries or about 26 of them. I think there's nothing close to Robert F Kennedy, Jr.

 

>> Lanhee Chen: I mean and I was gonna say, I've known a number of HHS secretaries pretty well. I served one under one. And so it's a different model, but as it's a different kind of presidency, it's a different kind of administration. And if you look at the work they're doing, for example, to consolidate some elements of the agency, yeah, I think some of that work is overdue.

 

I do think some of that consolidation is good. Some will be disruptive, there's no question about that. But overall, it's a very different way of understanding the role of the health secretary. I'll give you one example, which is the focus on food and on the impact of food on our health and our ability to remain healthy as a society.

 

That is something that previous secretaries haven't spent as much time on, quite frankly, as RFK has and will. And so, as I see it, I don't want to argue whether it's good or bad. I'll just say that it's a very different model. And this administration is gonna do business very differently, whether it's an economic policy or certainly in healthcare policy.

 

>> Bill Whalen: Right, it's an enormous challenge. I mean, it's a enormous, enormous bureaucracy he's taking over.

>> Lanhee Chen: It's 80,000 people.

>> Bill Whalen: Right.

>> Lanhee Chen: Right, it's big, big, big, big agency. A lot of responsibilities and, and a lot of different things going on, some of which is very critical, some of which we'll see.

 

But he's made the decision that a lot of that needs to be consolidated down. And, he may be right, he may be wrong, but time will tell.

>> Bill Whalen: Right. What do you think he's going to do on vaccines?

>> Lanhee Chen: I don't know. There's sort of two very different ways of thinking coming out of it.

 

I mean, there certainly he has expressed a measure of skepticism. I think the way the agency has approached it is in a much more skeptical fashion than previous administrations. In some ways, the activity of your vaccine approval and drug approval is moving as. Has been the case in previous administrations.

 

In others, I think there is a little more skepticism. And so how much of that works its way into what actually gets approved, what actually the marketplace tolerates, what people are going to do? Again, time will tell. But his attitude and his mindset is we want, you know, we want the.

 

The science to be rigorous, and we want to make sure that we're making decisions based on that. And for some people, that's going to result in outcomes that they don't like, and I think they're willing to accept the blowback for that.

>> Bill Whalen: It would seem to me he's benefited from having Elon Musk in Washington as well.

 

Must get so much attention that there's been relatively less attention so far directed toward RFK. Now, he's been in the news from time to time, but, boy, it's Doge, Doge, Doge every day.

>> Lanhee Chen: Yeah.

>> Bill Whalen: So disruptors going into town. So you've run for office, you've thought about serving in public office.

 

Your thoughts on disruptors getting involved in federal and state government? For example, look at California. Could California benefit from a Doge and someone like Musk coming into Sacramento?

>> Lanhee Chen: And, I mean, I think California could definitely benefit from someone taking a very critical look at how we're spending money.

 

I mean, that's one of the reasons I ran for controller was because I felt that there wasn't someone taking a very critical eye toward. It wasn't so much. I mean, yes, we spent a lot of money, but it wasn't so much the amount, although that's an issue, was how effective that spend was.

 

And that's what bothered me. It felt like when you talk to policymakers in Sacramento and you'd say, like, hey, are we solving this problem? They'd be like, yeah, of course. Look at all this money we're spending. And they never stopped to ask the question, like, is the money actually working?

 

And so, to me, it's about. I want to divorce it from the Doge conversation for a moment, because I think Doge has become very polarized. I think the reality is that we haven't spent a ton of time really getting into the nitty gritty of is our spending really going to what we say it's going to, and is it effective in the way that it needs to be effective to solve the problems Californians have.

 

>> Bill Whalen: Right.

>> Lanhee Chen: And so we need some form of examination in California. We have a bunch of different officials who could be engaging in that activity already, but politically, it doesn't serve their Interest to. So they don't. The controller who did get elected, I don't think she particularly cares.

 

My sense is she hasn't really spent much time thinking about these issues either. Maybe busy trying to figure out what job she wants next. And, that's the reality of politics in Sacramento.

>> Bill Whalen: Well, she's never in the news. But, with Musk, it's interesting because he comes from a tech culture, and tech does things in terms of hours, days, weeks, sometimes months.

 

But government, as we know, doesn't do things about government, does things in terms of years. So it's fascinating to me to watch that clash of the Musk culture versus the federal culture.

>> Lanhee Chen: Yeah. But I think that's part of the issue with government. Right. Is that it does move so slowly.

 

It's tough for change to happen sometimes because once you try to change something, it's no longer current. And, and this is part of the debate we can have about Trump and Musk. And what they're doing is whether they're doing is good or bad. I think the reality is that you're not going to be able to make significant change by moving incrementally, and they're moving quickly and they're going to make mistakes.

 

They have made mistakes, I think. But there's also ways in which those changes wouldn't happen if they didn't move in the manner in which they've moved. So it's a little bit of a tough dichotomy because on the one hand, you are going to make mistakes and there are going to be things that are going to happen that people don't like.

 

But you wouldn't have had the changes people did like if you didn't have the ones they didn't. So, this is the problem.

>> Bill Whalen: Okay, so tell me what the Healthcare Policy Working Group is coming up.

>> Lanhee Chen: Well, we just had a great conference about a month ago where we brought, some of the leading thinkers in healthcare policy to the Hooper Institution and sat for two days and talked about all these different issues.

 

We talked about Bill, the tax code and, private health insurance, about Medicare, Medicaid, drug approval, really important topics in health care. And our goal is to continue writing and researching and connecting the academic and analytical work that's being done in healthcare with policymakers in a way that they can understand and use and deploy to actually make better public policy.

 

And that's really the secret sauce of what we're doing with the working group is providing that linkage between the research and the thinking and action. Because I think a lot of times in healthcare, and this is true in a lot of policy, you have a lot of good thinking and research and stuff that's being written, and then you have the policymakers, and it's not clear that that connection is always made.

 

And so we want to make sure that we're drawing the connection and providing that connective tissue and helping people understand, helping policymakers understand in particular, how it is that the research that's being done about the health care system can impact how they do their work. And we feel very strongly that there's a need for that, and we're excited about the opportunity.

 

>> Bill Whalen: Right, and finally we've talked a lot about healthcare reform at the federal level. We haven't talked much about the states, though. So is there anything worth looking at in terms of Austin, Tallahassee, innovative states?

>> Lanhee Chen: A lot, I mean, look, I think, Bill, so much of the important work of healthcare reform, because the Federal Government is so intractable in a lot of ways, it is gonna happen at the state level.

 

And whether that's innovative programs to cover more people, ways of reducing cost, increasing transparency, bringing together the public and private sector. So many states have done interesting work. Georgia is doing a ton of interesting work. They have a program called Georgia Access that's designed to make a healthier marketplace so that people can get access to healthcare plans that make sense for them.

 

You look at a state like Alaska that's done a lot of work at figuring out how they can make insurance more affordable for populations who are tough to insure. You look at other states like Idaho and Utah, Texas, as you mentioned, Florida. All these states are doing some really interesting work across a whole host of healthcare areas.

 

And by the way, not all red states. You've got some blue states that are experimenting with different health care plans. Some of it I agree, with, some of it I don't. But, that's the beauty of a federalist system, is that you have states that can experiment and the good ideas succeed and the bad ideas fail.

 

And that's what our system is for.

>> Bill Whalen: Okay, final note, any conversation Lanhee Chen has to include his incredible love for the Los Angeles Dodgers. As long as I've known him, he's been a Dodgers fan, he has not jumped on the bandwagon. I'm confused, Lanhee, I should hate the Dodgers?

 

They're from Los Angeles, you gotta hate Los Angeles. They've spent a lot of money to bring in a lot of talent and they win. They're what, eight? No, as we go into this podcast right now. But my God, it's a fun team to watch. I'm having a hard time disliking them.

 

>> Lanhee Chen: Yeah, it's very entertaining. And the ways in which they're winning games, I mean, the last couple of games they've won by coming from behind. The most recent game was a, was a walk off home run by Shohei Ohtani. And it's a fun team to watch. There's so many personalities and fundamentally good people led by a strong manager who I think is a good guy at core, Dave Roberts.

 

So it's a great team, it's the kind of golden age of Dodger baseball. I'm really excited to get to share it with my family and my friends and we'll see how long it lasts, right? No dynasty lasts forever. It's not really a dynasty yet, they've won one championship.

 

But hopefully it can be a dynasty. And it's a great time to be a Dodger fan, for sure.

>> Bill Whalen: Well, like you, I'm always getting asked questions by reporters. Point me to something in California that works and I have to point them to the Dodgers because it's just an incredible business model they produced.

 

>> Lanhee Chen: Yeah, no, you're right, it is. And it's always, it's fun to watch for those of us who are fans. And I'm glad to hear it's fun to watch for people who aren't fans as well.

>> Bill Whalen: Yeah, okay. Lahnee, enjoyed the conversation. Thanks for doing this.

>> Lanhee Chen: Thanks, Bill.

 

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