by Jennifer Tiedemann
A career in public policy always seemed like a natural fit for Goldwater Institute Director of Healthcare Policy Naomi Lopez Bauman: She studied economics and government in college, and she loves taking on complex problems and solving them. But why did she choose to work on healthcare? “It’s the most challenging area of policy,” Naomi explains. “To understand healthcare, you must understand federal tax policy, how tax expenditure programs work, insurance market regulations, insurance underwriting, welfare programs, labor policy, economics, and a fair amount of armchair psychology about how politicians think and what motivates them.”
While understanding such a wide range of subjects may be daunting for most people, Naomi embraces the challenge. Today, in her work for the Goldwater Institute, she’s always on the lookout for opportunities to leverage Goldwater’s existing healthcare work—on Right to Try, or off-label communications, for example—or to be heard on new healthcare issues that are percolating. And as a leading expert in a state-based think tank, she’s particularly interested in studying the impact of federal policy on states—and vice versa.
As someone who’s worked on healthcare policy on the federal level and in several states throughout her career—from Arizona to Illinois to California—Naomi has seen firsthand how federal healthcare policy affects states. Her expertise on the subject means she’s frequently called upon to speak with media on the interplay between federal and state healthcare developments and collaborate with liberty colleagues across the country to make reform a reality. “So much of healthcare is impacted by federal policy,” she says. “Take the Affordable Care Act, for example. There is a provision in the law that says that, if an insurer withdraws from the state’s individual market, they cannot return for five years. But what many in Washington didn’t realize was that this language was pulled directly from states—more than 40 have that law or a similar one in place in order to keep insurers from hopping in and out of the market. So when looking at how to restore the individual insurance markets, it is not as simple as flipping a light switch. Even if insurers want to return, will they be allowed to do so? If not, what needs to happen for them to return?”
Healthcare can’t be applied in a “one-size-fits-all” manner, Naomi says, and flexibility is key in making healthcare work for states: “Those in Washington are often unaware of how federal policy impacts states. It is important for states to have a seat at the table.” There’s a growing push for Congress to take action to allow states to regain control over their individual insurance markets—in the face of climbing costs, a rising uninsured rate, and shrinking choices of plans and providers. Earlier this year, Naomi joined more than 30 healthcare experts and conservative leaders in signing an open letter urging Congress to consider Affordable Care Act reform. “The ACA has fallen woefully short on the promises of healthcare access and affordability,” Naomi explains. “Meanwhile, states are quickly learning that there is very little flexibility under the law for state innovation or for addressing the lack of insurers willing to provide coverage or providers offering care under those plans.” Among the reform goals set in the letter are lowering costs and improving patient choices, giving states flexibility and resources to achieve these goals, and setting federal guardrails so people can choose private coverage if they don’t like the options their state provides. As the letter says, what works for Massachusetts might not work for Mississippi, Missouri, or Montana, and so states must be given the freedom to innovate and give more choice over health decisions to patients.
Though Naomi is definitely a problem-solver, she understands that healthcare reform is a long game with no easy solutions. “There are no silver bullets to the problems facing healthcare—and there were many problems prior to the ACA,” she says. “But so many Americans need relief from the high cost of insurance.” One suggestion she has is to implement a stop-gap measure allowing for year-long short-term health plans—Naomi says it would basically function as hospital insurance. “These plans are very low-cost because they don’t cover pre-existing conditions, the ACA essential health benefits, or prescription drugs. This would allow some financial protection to those who are being priced out of coverage and/or are receiving little value from their current coverage.”
But while Naomi knows that giving states more freedom to shape healthcare in a way that works for their residents—and giving patients more say in their decisions that affect their health—are tough fights, she says they’re battles worth waging. “The opportunities for longer-term healthcare reform are rooted in apolitical networks that have the potential to create liberty-driven, disruptive change,” she says—and recent success with passing federal Right to Try legislation is a great example of that. “We saw networks of patient advocates mobilize to help push the Right to Try state-level and federal reforms.”
That’s one of the things that excites Naomi most when it comes to looking at the future of healthcare reform: New informational and social networks are taking the place of the old bureaucratic models of organizing and disseminating information. “This is the scaffold for driving future reform and, more importantly, makes it far more difficult for the government reduce or limit opportunities for individual customization of healthcare: the right treatment for the right patient at the right time.”
Read some of Naomi’s work:
- Naomi makes the case for off-label communication in the June 2017 Goldwater Institute report. Restoring Free Speech in Medicine.
- Last September, Jimmy Kimmel used his late-night show to claim that the Graham-Cassidy legislation that would repeal and replace parts of the ACA would roll back patient protections and add to the ranks of the uninsured. Naomi explained in an op-ed that “while Kimmel’s heart is in the right place, he is mistakenly conflating the program’s intentions with unattained outcomes.”
- Licensing dental therapists would help ameliorate oral healthcare shortages in Arizona, Naomi and John Davidson argue in The Reform That Can Increase Dental Access and Affordability in Arizona. (Governor Doug Ducey subsequently signed legislation to allow for the licensing of dental therapists in May 2018.)
Jennifer Tiedemann is the communications manager at the Goldwater Institute.