Generating Bipartisan Solutions to Complex Healthcare Problems w/ David Jones
Emily George had the chance to speak with Dr. David Jones, Associate Professor in the Department of Health Law, Policy and Management at the Boston University School of Public Health, about his research on how to generate bipartisan solutions to some of our most complex healthcare problems.
Dr. Jones’ expressed his deep interest in the “political determinants of health,” which he defines as the way policymakers see the world and make decisions.
Dr. Jones: “The bulk of my research time is spent interviewing policymakers. I like going to state capitals, in particular. It's kind of my favorite thing to do on the research side … talk with legislators, talk with executive branch officials to find out how they decided what problems to focus on and how from within that they navigated all the different options.”
A big focus of his research is analyzing qualitative data to identify overlapping views on healthcare policy between Democrats and Republicans. This common ground is known as bipartisanship. For example, survey results from two years ago showed that the second biggest healthcare priority for both Democrats and Republicans was reducing healthcare costs.
Dr. Jones: “…the number two, biggest priority was reducing healthcare costs. So we said, okay, everyone seems to agree on that. Let's really focus on that and make that a focus of bipartisan conversations. And so I went to Topeka, Kansas, and I ran a focus group of state legislators which was the first time I'd ever done that. And it was just super fun sitting around having breakfast together with Republicans, Democrats for the house and the Senate and putting out there like, what do we have in common? What can we work on together?”
He demonstrates the importance of bipartisan support in shaping health policy by walking us through the politics surrounding the Patient Protection and Affordable Care Act (ACA) legislation. While the passing of the ACA may have been seen by some as a bipartisan exercise, bipartisanship broke down in its implementation. A clear example of this was optional, rather than mandatory, Medicaid expansion for states. Dr. Jones goes on to explain how this policy implication created inequitable access to care in the United States, which we see frequently in rural areas of the country.
Dr. Jones: “…if you live in Clarksdale, Mississippi … a place where I've been spending a lot of time lately and you're poor, you don't have access to health insurance unless you are a parent or a pregnant woman and your income is like 26% of the federal poverty level…so you have to be a quarter poorer than the federal poverty level to qualify for Medicaid…it's an impossible threshold….whereas if you live across the border in Helena, Arkansas, or … in Kentucky or somewhere else, then you qualify for Medicaid up to 138% of the federal poverty level because of the state implementing the ACA Medicaid expansion... our approach to policy really opens up huge equity problems.”
To learn more about Dr. Jones’ research and its implications for health reform, listen to the full interview on Season 2, Episode 1 of our podcast series -- Unlocking Accountable Care .