By Jennifer Eder
Health reform promises to be in the spotlight in the coming months.
The Supreme Court is expected to reach a decision by the end of June on the constitutionality of the Affordable Care Act (ACA), President Barack Obama’s signature policy achievement. Whatever the decision, the issue is certain to feature prominently in the campaign for the presidency.
At the crux of the health care reform law is a provision known as the “individual mandate,” a government requirement that all Americans have health insurance and the source of a major political divide.
Yet many voters are likely unaware that the individual mandate was originally a Republican idea. And its roots trace back to a George Washington University health policy professor.
As a health policy aide for former U.S. Sen. John Chafee, R-R.I., Christine Ferguson, now a professor in the School of Public Health and Health Services, garnered support among Republican senators to craft legislation containing the individual mandate and health insurance purchasing cooperatives, which were similar to today’s health exchanges under the ACA. That legislation became the main GOP alternative to President Bill Clinton’s health-reform proposal in 1993.
Ten years later, Ms. Ferguson, who was the commissioner of public health in Massachusetts at the time, proposed the idea of the individual mandate to newly elected Gov. Mitt Romney, who was looking at high state health costs and considering how to reform the health care system at the state level.
Today, she brings this political savvy and real-world experience to the classroom and her research projects, including the STOP (Strategies to Overcome and Prevent) Obesity Alliance at GW.
“I’ve been really lucky to work on very important issues my entire life, and I’ve developed the ability to pull the right group of people around the table at the right time to think through and build a consensus for options to solve tough problems,” said Ms. Ferguson, a recognized expert in health care financing and management, Medicaid and state health policy. “I feel like I’ve been able to really make a difference in the world, and that’s an amazing feeling.”
After receiving her law degree from American University in 1986, Ms. Ferguson went to work on Capitol Hill. Several years later, the Republican Party was working on an opposition plan in response to President Clinton’s health reform blueprint, and one of the party’s core principles was personal responsibility, especially when it came to health care.
“I worked with all the Republicans at the time on really understanding how health care worked and what the major financing and economic issues were,” Ms. Ferguson said. “And we came to the conclusion that the individual mandate made sense.”
But once the Clinton reform plan fell apart in 1994, the Republicans abandoned their own plan too.
After 15 years on the Hill, Ms. Ferguson became secretary of the Rhode Island Department of Health and Human Services, where she helped reform the state’s Medicaid program. In 2001, she ran for one of Rhode Island’s two seats in the U.S. House of Representatives but lost in the Republican primary. Two years later she was appointed by Gov. Romney to serve as Massachusetts’ public health commissioner, where she led the administration’s efforts in emergency preparedness, substance abuse services and early childhood education and child care.
At the time, Massachusetts, which claimed it was working toward universal coverage, had a waiver from the federal government for how it administered its state Medicaid program. Massachusetts hospitals paid a tax, which was then matched by the federal government. This pot of money was then used to pay hospitals for any uncompensated care the hospitals provided. But in 2004, the Bush administration said it would no longer give Massachusetts the extra money unless the state established true universal coverage.
“At that point, what’s the choice? Is Gov. Romney going to say, ‘OK, we’ll let Massachusetts lose all this money.’ No, of course not – that’s irresponsible,” said Ms. Ferguson. “So at that point the state really started the health reform conversation again because we were at risk of losing all this money.”
As Romney’s administration began contemplating how to achieve universal coverage, Ms. Ferguson proposed the idea of the individual mandate, reminding the team of the Republican health reform plan in 1993. The state could use the money it already had from the hospital tax and the federal match to subsidize health insurance for low-income individuals. This idea became a key component of the health care reform law passed by Massachusetts in 2006.
“Gov. Romney had to make the best decision for Massachusetts. He wasn’t saying it was the best decision for the country,” she said. “In Massachusetts, there was already money in the system that could be used to subsidize people’s purchase of health insurance. This would have never been proposed if we had been in Texas, Kansas or Florida or virtually anywhere else in the U.S. except for areas where the coverage level was already high.”
As a professor at SPHHS, Ms. Ferguson makes her graduate students confront similarly difficult scenarios. In her State Health Policy class, she plays the role of a new governor and requires her students to develop a plan for addressing health and health care in a particular state. Each student plays the role of secretary of health and human services. During the semester, students give a thorough overview of the state’s budget, health care delivery system, the health status of the population and health reform requirements as well as an analysis of the most important health care issues facing the state. For the students’ final project, they must convince Ms. Ferguson to adopt their recommendations.
“I tell my students at the beginning of the semester that I won’t be giving them the answers. Instead, I’ll be asking them questions all the time, and almost every question I ask has been a question I’ve been asked in the real world,” said Ms. Ferguson. “I want them to understand that in policy, there are no right or wrong answers. I show them how things actually happen.”
Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy who recruited Ms. Ferguson to GW, first met her while working on the Hill. She said Ms. Ferguson is one of the most creative and energetic thinkers she has ever encountered.
“She has an extraordinary set of skills that place her squarely at the intersection of politics, policy and the real world where abstract choices play out on a daily basis. It is this combination of skills, plus her exuberant personality, that make her an unusually good teacher,” said Ms. Rosenbaum, who holds appointments in both SPHHS and the Law School.
“Christy is an amazing member of our faculty and has a distinguished career as a public health practitioner, researcher and an advocate extraordinaire,” said Josef Reum, SPHHS senior associate dean. “Professor Ferguson has been at the axis of public policy in a way few of us in university life experience. She brings to her research and our classrooms a viewpoint too rare in Washington.”
For Sydney Etheredge, M.P.H. ’11, the biggest take-away from Ms. Ferguson’s class was the vast difference between state and federal health policy, especially regarding the budget process.
“In Christy’s class, I never wanted to check my emails or text a friend. With Christy, you understand that all of her advice is a lesson that comes from real-world experience, so you want to soak that all in,” said Ms. Etheredge, who now works at Planned Parenthood Federation of America as a health care reform implementation data analyst.
Sara Mostafa, B.S. ’12, was inspired to apply to GW’s SPHHS for her master’s degree in public health after taking Ms. Ferguson’s undergraduate course, Introduction to Health Policy.
“She taught us how health care policy functions from an insider’s perspective and inspired us to go out and improve the system,” said Ms. Mosfafa, co-captain of the GW women’s basketball team. “Her practical experience in the field enhances her teaching ability greatly.”
When Ms. Ferguson isn’t in the classroom teaching the next generation of health policy professionals, she’s building a GW obesity policy team and leading the STOP Obesity Alliance – a collaboration of consumer, provider, government, labor, business, health insurance and quality-of-care organizations united to drive innovation and practical strategies to combat obesity. Housed in the SPHHS Department of Health Policy, the alliance aims to break down cultural and systemic biases around obesity, conduct and analyze research on the barriers preventing people from achieving healthy weight loss goals and provide recommendations on how to strengthen policies and systems that will help address the obesity crisis.
Last year, her research team released a report called “The Cost of Obesity,” which analyzes wage discrepancies for obese white women. This year, they have been convening meetings with the U.S. Food and Drug Administration, clinicians specializing in obesity, stakeholders from the pharmaceutical industry and drug safety advocates to discuss the risks and benefits surrounding the regulatory approval of new obesity drugs.
Ms. Ferguson is also a consultant to Planned Parenthood Federation of America, serves on two committees for the Institute of Medicine and is a member of the board of directors of Blue Cross Rhode Island.
At Planned Parenthood, Ms. Ferguson is helping the nonprofit rethink how it approaches management of care in preparation for the influx of women entering the delivery system in two years when most Americans will be required to have health insurance and when primary care benefits are expanded.
“We’re really going to need these women’s health centers because we currently don’t have enough capacity to deliver care to everyone entering the system in two years,” she said.
Ms. Ferguson travels back and forth from the District to Jamestown, R.I., where her husband runs a veterinary hospital, and Madison, N.J., where her son attends college at Drew University. She may not be directly involved in politics anymore, but she still keeps a close eye on political issues – including the presidential campaign of her former boss, Gov. Romney.
“I think he’s one of the smartest and most competent people I’ve ever worked for. He was like a sponge – he picked up on things really fast,” said Ms. Ferguson. “And what I loved most about Gov. Romney is how thoughtful he was about innovative solutions to key health care issues.”