As part of her Harkness Fellowship in 2016/17, CORU Director Christina Pagel worked on a project to understand US policy maker health policy priorities during President Trump’s attempt to repeal and replace Obama’s flagship health reform (The Affordable Care Act, aka Obamacare). She designed and administered a survey to every US state politician serving on a health or appropriations committee asking them to rank their top health policy priorities. Nearly 400 people from across the US responded, almost exactly evenly split between Democrats and Republicans. Republicans said decreasing the role of government and reducing health care costs were among the most important issues for them. On the other hand, Democrats focused on increasing access, improving overall health, and reducing disparities. However, Democrats also rated reducing costs as a high priority, suggesting that tackling costs could be ripe for bipartisan policymaking. Follow on work by Dr David Jones at Boston University and the Milbank Memorial Fund showed however that Republican and Democratic state politicians had very different perceptions of what “reducing health care costs” actually meant.

Effective solutions to curtailing health care costs are unlikely until there is greater consensus on what “reducing costs” actually means. Without making transparent different perspectives of the nature of the problem, leaders will continue to talk past each other. In a new project, funded by the Milbank Memorial Fund, Christina Pagel and David Jones are working to explore further state policy makers’ priorities for reducing health care costs. This involves the design, administration and analysis of a new survey about health care costs followed by in depth interviews with legislators in some states to validate the survey results and to examine more comprehensively the potential points of consensus.

Relevant publications:

  • Pagel, Bates, Goldmann, Koller, “A way forward for bipartisan health reform? Democrat and Republican state legislator priorities for the goals of health policy”, American Journal of Public Health, Aug 17:e1-e3. doi: 10.2105/AJPH.2017.304023, 2017
  • Jones, Pagel, Koller, “The Future of Health Reform – A View from the States on Where We Go from Here”, NEJM, 379:2189-2191, 2018