Advocating for more managed care

Greg Nash

A lot of people with jobs on K Street used to work for members of Congress. Not many used to work for two at the same time. 

But Jeff Myers has.

{mosads}In 1994, he worked for Rep. Alex McMillan (R-N.C.) on Mondays, Wednesdays and Fridays, and Rep. Fred Upton (R-Mich.) on Tuesdays and Thursdays. Myers had been employed by McMillan full-time, but the North Carolinian was retiring.

“The member he sat next to was Fred Upton, and he turned to Fred and said, ‘Fred, uh, I understand you’re looking for a legislative director. You should hire my boy, Jeff,’ ” Myers explains. “And they literally negotiated my salary during a committee hearing.”

Now, Myers is still juggling many things, but he has just one job: CEO of Medicaid Health Plans of America (MHPA). 

Myers is the top advocate for insurers under Medicaid managed care, where states will contract with a private company to run their Medicaid programs, which he argues is a smarter system than the traditional model of the government paying healthcare providers directly. 

And the model is growing: Nearly 55 million people — about three-fourths of all Medicaid enrollees — are now covered under managed care, a sharp increase even in the past three years, according to a new report from PricewaterhouseCoopers. 

Medicaid, the health insurance program for low-income Americans, is itself also growing due to the expanded eligibility under the Affordable Care Act (ACA). 

While Republican presidential nominee Donald Trump has promised to repeal all of the ACA, including its Medicaid expansion, Myers says he is expecting fixes to the health law, not full repeal. 

“My sense is that whoever comes in, be it Trump, be it [Democratic nominee] Hillary Clinton — either candidate is going to have to address some of the shortcomings of the ACA,” Myers said in an interview at the end of the MHPA’s annual conference. “Even people who really support the ACA know that it needs fixing. The question is what fix. And as those fixes get considered, the way in which that fix runs up against Medicaid is terribly important, and that’s the area where we’ll really look at.”

Much of the focus on fixes to ObamaCare has been on the law’s marketplaces, which typically serve higher-income enrollees than Medicaid. 

The marketplaces, also called exchanges, have been plagued this year by insurers dropping out or hiking premiums due to financial losses. 

But some insurers with experience in the Medicaid business are faring better. And that’s no coincidence, Myers says. 

One point helping those insurers is having a narrower network, i.e., fewer doctors to choose from. But more important, Myers said, are other programs to help low-income sick people make the most of their insurance. 

“It seems to me that the exchange products that work best are ones that, rather than just open up a giant network and provide lots of services, really look at, are there services that we can open up and drive that will improve health outcomes and reduce cost?” Myers said.

“And a lot of that design is obviously built into Medicaid.”

He pointed, for example, to plans that provide bus passes to help people get to the doctor if they don’t have a car. One plan that puts a focus on serving the homeless provides a valet cart service at the community health center so homeless people don’t have to worry about losing their possessions while they’re at the doctor. 

Medicaid plans, though, have been struggling to pay for the ever-climbing cost of prescription drugs, which has seen insurers lashing out at pharmaceutical companies over their pricing tactics. 

“Ultimately, [what] the pharma industry has to wrap their minds around [is] the pricing model has changed from 1975,” Myers said. “You no longer can just price however you want and force it down as many people’s throats as you can.”

Myers, and many insurers more broadly, want to shift toward a system that is already gaining traction in the rest of the healthcare industry, called paying for “value.” That means that insurers and drug companies would work out a system where payment depends on how well a drug actually performs in patients. 

“Drugs are the last ones that don’t take risk, right?” he said. “It’s fee for service. ‘You bought a pill, the pill costs X number of dollars, whether it works or not, it’s not really my problem.’ I don’t think that can continue.”

One possible source of some awkwardness: After leaving Capitol Hill, Myers worked for drug companies, including stints at Cephalon, Biogen Idec and Hoffman-LaRoche. 

“They still love me,” Myers says with a laugh. “But they’re just like, you know, ‘We’ve just got a difference of opinion.’ It’s just like a cousin that’s gone wrong.”

More seriously, he adds: “If you’ve been in this town for a long time, you know that ultimately you cannot work for something you don’t actually believe in. Life is too short for that.”

“I really believe that there are lots of sectors where change is better for everyone,” he adds. “When I criticize the pharma model, I’m not criticizing individuals.”

When not debating drug prices or advocating for the insurers that make up his group, Myers spends some time in the stands watching his children, 15 and 9, play lacrosse, soccer and baseball. 

“I think my sport right now is, um, cheering,” he said. “What’s better than yelling at your child to run faster?”

Tags Donald Trump Hillary Clinton
See all Hill.TV See all Video