From left to right, Kathy Jo Hayden, Director of Health Policy, Novartis; Greg Slyfield, U.S. Head, State & External Affairs, Novartis; Sara Johnson Davis, Assistant Director, State & External Affairs, Novartis; NBCSL President, Rep. Joe Armstrong (TN); NHCSL President Eduardo Bhatia (PR); Kathy McBride, Associate Director, State and External Affairs, Novartis; Rick Knapp, Executive Director, State And External Affairs (West) Novartis; Neely Frye, Assistant Director, State & External Affairs, Novartis. With the first round of enrollment completed and the second round underway, the National Black Caucus of State Legislators (NBCSL) in partnership with the National Hispanic Caucus of State Legislators (NHCSL) convened to discuss lessons learned, best practices, and current issues regarding the Affordable Care Act (ACA).  Through the continued support of the Novartis Pharmaceutical Corporation, over 60 legislators gathered to hear presentations from policy experts, health providers, consumer organizations, Congressional members, and the Obama administration on the state of the ACA and what is on the horizon. This year’s symposium was held September 11-13, 2014 in Chicago, Illinois, with the theme: Bridging the Gap: Strengthening Connections Between Health and Health Care.  The Windy City welcomed lawmakers from 33 states including Alabama, Connecticut, Hawaii, Minnesota, and Georgia, as well as Puerto Rico.  

The ACA, President Barack Obama’s signature law, has been touted as one of the greatest achievements of his presidency.  What have been the results thus far?  Has the ACA reached those it intended to reach?  How is it impacting health providers?  Answers to these questions and more were discussed over the two-day symposium where legislators attended panels and policy sessions featuring health providers and experts in their field.  The symposium also featured breakout sessions and a town hall meeting with Health and Human Services (HHS) Region V Director Kathleen Falk.

NBCSL President Joe Armstrong opened the symposium by welcoming both caucuses and acknowledging Novartis for its continued support.  NHCSL President Eduardo Bhatia expressed gratitude for Novartis working to bring both caucuses together for the meeting.  Greg Slyfield, U.S. Head of State and External Affairs, spoke about Novartis’s healthcare reform priorities: transparency in plan offerings, fair appeals processes for unapproved medications in drug formularies, and benefits that do not discriminate against those with chronic diseases.  Serving as moderator for the symposium was Anton Gunn, Founder and President of 937 Strategy Group, LLC.  Mr. Gunn previously worked as the Director of External Affairs in the Office of Intergovernmental and External Affairs (IEA) at the U.S. Department of Health and Human Services (HHS) under Secretary Kathleen Sebelius.  He was also an active member of NBCSL while he served in the South Carolina House of Representatives. 

Opening speaker José Plaza, with Enroll America, gave an overview of the organization’s results in the first round of enrollment.  Enroll America reached out to those living in the 13 most uninsured states, with the majority of uninsured African Americans living in Florida, Georgia, Texas, North Carolina, and New York.  Mr. Plaza noted significant disparities among minorities, stating 15% of African Americans and 32% of Latinos are uninsured.  In order to reach the unenrolled, Enroll America went to community colleges, partnered with Latino organizations, and spoke to the faith-based community.  One barrier to enrollment is the lack of knowledge and information.  In the second round of enrollment, Mr. Plaza said Enroll America would enhance outreach by working with more Spanish-language organizations to provide materials and assistance to those in Latino communities.

The first panel focused on health providers and their challenges.  The panel’s first speaker was Julia Paradise, Associate Director of the Kaiser Commission on Medicaid and the Uninsured at the Kaiser Family Foundation.  She provided a systems overview of what health providers are now navigating (particularly related to Medicaid expansion), changes in provider payment and incentives, and delivery system reform.  Through each of these platforms, the ACA is able to increase the quality of care patients receive and improve health outcomes.  Dr. Blase Polite, a specialty doctor with the University of Chicago Medicine, and Dr. Carolyn Lopez, a family physician, reinforced those points.  Both doctors emphasized the need to connect primary and specialty care in maintaining healthy individuals.  It is futile to provide screenings at no or low-cost in the primary care practitioner’s (PCP) office without being able to offer comparable care with a specialty doctor when the diagnosis of those screenings are illnesses like cancer.  They also spoke about payment models and ensuring that doctors are not only paid for the quality of care they provide but are also fairly compensated for the time they put into treating their patients, which includes lab work and consultations.  Dr. John Jay Shannon, CEO of the Cook County Health & Hospitals System (CCHHS), shared that some hospitals face challenges in workforce diversity and delivering culturally appropriate services.  By partnering with community organizations, hospitals are better able to perform outreach and provide education to those greatest in need.  Congressman Danny Davis greeted the legislators during lunch and applauded their efforts in the states, and expressed continued support to President Obama and the ACA.  

The second panel consisted of a presentation and breakout sessions.  Brian Webb and Joshua Goldberg with the National Association of Insurance Commissioners (NAIC) began with policy considerations and concepts critical to creating a competitive insurance marketplace.  They also helped legislators understand the current insurance climate.  Armed with a series of policy levers such as rate review, standardization of cost sharing, and planned marketing and sales, legislators were broken into groups representing different perspectives (individual consumers, small employers, health providers, and insurance carriers) in which they discussed how each policy lever could be used to benefit each group.  

Policy experts provided insight to their assigned breakout group: Jose Plaza informed the Consumer group, Dr. Carolyn Lopez informed the Health Provider group; Jesse Greenberg with the Small Business Majority served as the session expert for the Small Employer; and Sinéad Madigan with Health Alliance Medical Plans was the session expert for the Insurance Carrier group.  

During dinner, Congresswoman Robin Kelly, a former state legislator, congratulated the caucuses on a successful symposium and for their work in the states.  Jesus Leal, Vice President and Head of the Novartis Critical Care Business Unit, spoke about the importance of screening and specialty care for cardiovascular diseases to end the day’s meetings.

Saturday’s program began with concurrent breakout sessions to facilitate a greater understanding of specific populations impacted by the ACA, and determine how legislators can improve their outcomes.  Dr. Tim McBride of the Brown School, Washington University at St. Louis, led a discussion on how the ACA is working in rural communities and what legislators can do to expand outreach and healthcare delivery.  Chad Brooker, Policy Analyst with Access Health CT, spoke with the legislators about using the best technology options for developing and maintaining their state exchanges.  John Bouman, President of the Sergeant Shriver Center on Poverty Law, spoke with the legislators on how the ACA could enhance the health outcomes of children and youth.  In the second part of the day, HHS Region V Director Kathleen Falk elaborated on the results of the first round of enrollment. She also spoke about lessons learned and how the administration was working to fix glitches and increase outreach.  

The day concluded with a legislative workshop featuring Senator Mattie Hunter of Illinois and Assemblymember Roger Hernandez of California, discussing their work on Medicaid expansion bills in their respective states.  The panel also included Director Julie Hamos of the Illinois Department of Healthcare & Family Services and Dr. Nneka Jones-Tapia, who serves as the First Assistant Director for the Cook County Department of Corrections.  Both practitioners discussed the impact Medicaid expansion had in the communities they serve, including providing continuing care for behavioral health and substance use disorders.    

The ACA is a revolutionary policy that continues to unfold.  This year’s Promoting Healthy Lifestyles Symposium introduced legislators to diverse perspectives from across the country on the ACA’s progress and provided them with solutions to challenges that must be addressed.