Episode 10: Health Policy in Cancer

[0:00:00 Speaker 2] We are a resource for learners, including every member of the Livestrong cancer institutes on track

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[0:00:25 Speaker 2] This is cancer uncovered. An education and empowerment podcast by the live strong cancer

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[0:00:43 Speaker 0] Hello

[0:00:46 Speaker 1] and welcome to cancer uncovered. This is nick smith Stanley with the live strong cancer institutes and I’m excited to be your host for this month’s podcast.

[0:00:54 Speaker 0] It’s

[0:00:55 Speaker 1] been over a year since the covid 19 pandemics forced us into lockdown. But finally, life is slowly getting back to normal. A new normal Anyway, people are starting to return to work more and more parents are choosing face to face learning for their school aged Children in stores and restaurants are looking more and more like business as usual. This includes the texas State legislature, which meets every two years at the capitol in austin texas. The State Legislature tackles numerous issues including education, civil rights and health and human services. Many of these issues directly impact cancer care and people with the disease. I wanted to learn more about how this biennial meeting of the state legislature operates and the effects they’re decisions have on cancer and research. This month, I sat down with lisa kirsch with UT Austin’s Dell Medical School to hear about her work in health policy and how it impacts care and people with cancer. Lisa is the senior policy director at Dell Med and has almost 20 years of experience in health policy and social services at the federal, state and local levels. This is cancer uncovered. Mm I

[0:02:03 Speaker 0] kind of came to help policy a circuitous way. And it’s one of those things that I think you don’t necessarily know you’re going to be when you’re a little kid because you might not even know what it is. But I attended the University of Arizona for my undergraduate degree where I majored in spanish and latin american studies and I really didn’t know what I wanted to do as a career, but I knew I was interested in public service, public policy. My dad for a long time directed catholic community services of Southern Arizona. So I got to see through his work, a lot of programs that helped some of the more vulnerable folks in Southern Arizona with healthcare, childcare, immigration services, things like that. So I think that did influence how I ended up getting into this area. And then after undergrad I didn’t work, I went straight to graduate school and I was deciding between the university of texas at Austin and the University of Chicago. And frankly I picked Austen because the city and its weather really seemed like a better fit for a Tucson girl since both schools had really strong programs and what I was interested in. And I went to the LBJ School of Public Affairs at U. T. I graduated in 1996 and you know, people ask what does public affairs mean? And there are a lot of public policy schools around the country that focus more on the development and implementation of policies. The LBJ school combines that with more of the administrative side of it. So it’s both public policy and public management, depending what you decide to do in your career at the LBJ school, I didn’t study health care at all. I actually focused on social policy and as I was looking back, my professional report that I did for my masters was on restricting legal immigrant public assistance eligibility. So there had been a bill that passed in 1996 that affected what kinds of benefits legal immigrants in texas could get, like food benefits or health care benefit. And that was something that I did in grad school. And then also did an internship at the Commission on Immigration Reform. So, you know, touching on help, but not quite there yet. And then after I graduated, I spent a couple years at Arizona’s Legislative Budget Committee, which is the equivalent of texas’s Legislative Budget board. So the staff that develops the state budget for the legislature, I did that for a couple years and ended up having Arizona’s Medicaid budget as part of my portfolio. So I started to learn a lot about health policy. Then I had met my now husband in Austin. So after a couple years I ended up coming back to texas, I worked for about five years for a home health and community care agency that provides a lot of services to older Texans that needed help in their homes, also care for Children that have very high medical needs, who needed nursing and other services in their homes. And then in 2003 I got a job with the texas Health and Human Services Commission and that was really where I began a strong focus on health policy. I worked for the texas Health and Human Services, Medicaid and Children’s health insurance program for over 13 years, doing a ton of different policy work, moved up in the ranks there and then after a long tenure there had the opportunity. Really fortunately when Del Med was just starting, I connected with Clay johnston with many Callen and others and they were looking for a person to do policy for the Dell Medical School and just kind of right place, right time. I mean I’m super fortunate because I have a lot more flexibility at Dell med in my previous position, I was managing a lot of people towards the end of my tenure and now I get to really focus on research and analysis and working with a lot of different colleagues on ways that we can hopefully use health policy to do what we want to do with Ahmed, which is improve the health of central Texans and beyond right, try to address a lot of different issues in health care.

[0:06:18 Speaker 1] You and I work together at Health Human Services Commission. And so when I made the jump to the medical school as well, I remember seeing you one day in the hallway and I was like, oh this is going to come work here, which I thought was just such a cool opportunity for you. But also for the medical school. I know that there was talk of sort of dipping their toe in the water of health policy. So can you talk a little bit more about what exactly is health policy?

[0:06:40 Speaker 0] That’s a good question. And that’s why I don’t get invited to elementary school career fairs because health policy is, it’s kind of vague, right? It’s like, what is this? It’s not a teacher or a doctor, but what policy is big p policy I think of as all the different levels of government, federal, state and local and both laws and also regulations that affect health. So it happens at all levels. And as my career has gone on, I thought of health policy in a broader way. So it’s not just financing or insurance coverage, but you think about all the things that affect people’s health, right, which is much broader than actual clinical care. And so I do think of health policy in a broader sense that I would say I used to when I was kind of focus mostly on the texas Medicaid program and that specific coverage program for certain low income Texans. I would also say small p policy beyond government. There’s policies that happen in health care clinic or in our community that may not be necessarily government driven. But I think of that as another aspect of policy. So there’s the government side of policy and then there’s more the community structure for policy as well. For example, at the national level, back in 2000, a bill was passed that said that women who were screened for breast and cervical cancer through the national early detection program for those cancers could have a pathway to getting insurance coverage through Medicaid eligibility. So, in texas now we have the breast and cervical cancer program. Women who get screened and who qualify can then get treatment through Medicaid. That was a federal policy that passed in 2000, that’s benefiting women nationwide now, on the state level, a huge thing that happened in 2019 is that texas raised the age to buy cigarettes to buy tobacco from 18 to 21 and we know that smoking is one of the major factors that impacts cancer. So that change is a state policy that I think is going to have a huge impact on health going forward.

[0:09:00 Speaker 1] Can you just walk us through how an idea of raising the age to legally buy cigarettes, the goal of impacting cancer rates? Like how does that go from? Just an idea to actually being a reality and how much of a role does health policy or someone who works in health policy play in that?

[0:09:20 Speaker 0] Like everything in health care, I feel like is a complex process, right? But generally you’re going to have folks that are advocating for certain issues at the Legislature and that could be healthcare provider groups, it could be nonprofits, disease specific nonprofits. So you have all kinds of different entities that have their issues that they want to try to have moved when the texas legislative. And so they would work with key legislators and their staff to get a bill introduced. And it could be introduced in the House or the Senate that would raise the minimum tobacco purchase age from 18 to 21 for example, that bill then goes through a long process. So most of the bills that get introduced in the texas legislature don’t make it through. There’s so many, there’s thousands and thousands, but they get assigned to a committee of jurisdiction. That committee, let’s say it’s Senate health and Human Services. They would then review the bill. They might make changes to it. If they pass it out of the committee, then it goes to the floor of the House or Senate to get voted on by that full chamber. If it passes there, then it goes over to the other chamber where they decided to a committee that has to pass it and then it also has to pass their floor vote. So there’s multiple steps in the legislative process for a bill to make it through, which is why a lot of them don’t make it. One really significant thing is whether it is perceived that the bill will have a cost to the state. So if it’s determined in this whole process that a bill would add to texas’s budget, then you also have to get funding for that bill into the texas budget in order for it to probably move forward as a real program or a real initiative. So there’s a lot of steps and then once it passes out of the House and Senate, the governor has an opportunity to veto a bill or to sign it or let it become law without his signature. So typically bills that are past in the spring of a year, spring of 2019 become effective september 1st of that year. It’s a long process. But I know for public health advocates that change is really significant. That was a big win in the texas Legislature in 20 and texas has done. I think, a really good job of anti tobacco campaigns, if you look in the last 10 years, both nationally and in texas, you’ve been reducing our smoking rates and certainly my experience with my kids in school, this is hit hard, right, the dangers of tobacco. So I think kids are getting an education on this, but I didn’t get, you know, when I was in school and that makes a big difference. Texas has done a good job at this in terms of a public health campaign. So that raising the smoking age was another step in hopefully continue down that path.

[0:12:09 Speaker 1] Yeah, I would agree with that. I remember when I was younger, it was red ribbon week was all about saying no to drugs. And now kids are they’re talking about that. But they’re also talking about the dangers of cigarettes and they’re talking about how poor nutritional choices can lead to diseases and cancer, things like that. So I do think that they’ve done a good job this particular Legislature also showing support for cancer research through the renewal of secret, which is big as well. So I wanna dig in a little bit and talk about the differences that you’ve seen in working in health policy for a state agency like Health and Human Services Commission and then moving to Dell Medical School, which is an academic health system. But it’s also a lot of ways to start up in March.

[0:12:54 Speaker 0] That is a great question. And you’re right, there are a lot of different ways that you can influence health policy. And one of the things I’ve learned during my career is that for some people, being at a state agency is a really good fit for them in terms of their skill sets and the environment that they work best in some of my other colleagues that Brett helping Human Services Commission for a brief time, They said this is not for me, maybe they really have the heart of an advocate. So, I mean I knew people that we’re not at the state agency for very long and they moved on to a foundation or AARP and advocacy group and that was really a much better fit for their personality, right? There are people who love to interact with the Legislature and then there are other people that prefer to be behind the scenes. I’m a little bit more of the behind the scenes, although I can do both. But I think as people explore this, you’ll see that there are a lot of different job pathways and health policies depending on your interest. And you’re right nick the difference between a state agency and an academic environment is night and day. We may be interested in the same issues, but those state agencies, first of all, I feel like they’re strapped for resources. I mean, it’s hard work. You have a lot of dedicated people there, they’ve got to keep the trains running. So if you’re running the Medicaid program, there are many, many facets of that operations, managed care contracts. How do you decide which benefits? You’re going to cover passing rules all when stuff comes from the legislature, you’ve got to adjust. It’s much more structured. Whereas I do feel in the academic environment there is more freedom. We have a lot of subject matter experts here, amazing resources and we have more freedom to explore different areas of policy, whether it’s research, we’re all state entities and so we all have to be careful around as an agency lobbying or advocating. But I feel like in the academic environment there is just more leeway to explore and to express expertise and both are very valuable and important. I’ve definitely enjoyed, enjoyed my colleagues both places. I think that from Dell Med, we do have a little bit more bandwidth to uh like I said, to go in depth and to explore some of these issues more fully and I think that can complement the work that the agencies are doing.

[0:15:25 Speaker 1] I’m glad you mentioned the lobbying piece as being a member of the state entity. You are prohibited from lobbying. And there’s a big difference between lobbying and policy work. But I want to talk about the difference between political issues in partisan issues where health care is a political issue, but it’s not necessarily partisan. And so can you talk about your role in working in these political issues, in this political climate of being careful not to cross that line of partisanship? Sure,

[0:16:00 Speaker 0] and you’re right that the work we do has to be nonpartisan people have different views on things, were always going to have diverse views. But as the policy director of Dell meg, what I see my role as is conveying information and data that can help inform the politicians or political discussions about the future of the state. So we try to do that in a very mutual manner. And I think this is an age where sometimes people have different versions of the truth, right? I think our media it’s really challenging because people are getting different. We all do. We all get different news sources and so our facts may be different. And so I do see part of our job as helping to continue to share solid facts where we got those facts from having discussions. If people disagree. Let’s talk that out. Let’s see why we’re seeing things a little bit differently. That’s a huge role. I think the data and information, good policy only comes out of having good information to build it off of politics or politics. And sometimes good information doesn’t win. But you gotta keep putting it out there because that’s how we move forward and that’s how we learn, you know, as a society. What options we have to make health better for. I want to go back to

[0:17:22 Speaker 1] talk about specific state health policy and legislation. Is there anything in particular in this legislative session that’s going on right now that we should be keeping an eye on, particularly from the cancer perspective.

[0:17:36 Speaker 0] So this legislative session, I will say that general health care issues are not necessarily in the top tier of what our leadership has said are some of their big priorities. There’s a lot going on, as you know, between covid and big snowstorm, the big storm we had in february. They’re dealing with a lot of different issues. Two areas where I am really hopeful that there will be good progress that our leadership and the Legislature and the Governor’s office have said they’re interested in advancing one is broadband and this is national and state. So there’s a recognition that a lot of texas doesn’t have access to high speed internet connectivity and whether it’s for school purposes or for telemedicine telehealth purposes, having broadband throughout the state, that will allow people to connect in more real time with healthcare providers for school is critical. I think that we will see definite movement on broadband at the state level. And we just saw on the package that was discussed yesterday by President biden that he also has funding for broadband initiatives in some of the national packages. The other big thing is telemedicine and telehealth and during the covid pandemic there were flexibilities that were given to increase access to telehealth and telemedicine that are still in place. And so I think we’re going to be exploring which of those flexibilities should remain in place for access to care post covid. And I know that when we had discussed this with our different experts at Dell made cancer here is one of the areas where they said they thought there was a huge benefit from greater access to telehealth during Kobe for families and for patients. So I’m hopeful. I think that’s just a pure access to care issue. If we want more people to have access to good care. That is one vehicle to help increased access.

[0:19:30 Speaker 1] That’s interesting because when you said broadband, my first thought was, well what does that have to do with health policy? But you’re so right as we are really looking at what life will be like after covid both for patients for positions for kids, going back to school for work. It’s crucial and it’s easy for you and me to log on and have a conversation like this over the internet. But for some of the more rural areas that may not be an option. So it’s interesting to hear how something as basic as internet really has this far reaching impact throughout health. A lot of our listeners maybe interested in the health sciences or health care or maybe even policy, What would you say to someone who is considering a career in health policy?

[0:20:17 Speaker 0] So what I would encourage folks to do if you’re and like I said, there’s a lot of different things you can do in health policy. But what I would encourage is that there are a lot of different ways you can learn about what’s out there. So whether it’s internships with the state agency, certainly working at the Legislature when you’re young is a great way to get exposure to a breadth of issues that you might be interested in, advocacy organizations or trade organizations or another place where you can get good experience. I went straight from undergraduate to graduate school. I think people that worked in between or tried some of those internships, I think there’s a real value in that in learning what you want to do and for me, it just came a little bit later as my career evolved. The other thing I would say is that relationships are so important. So I am not naturally an extra vert in health policy. You need to foster those relationships. I mean, the relationships that I have with colleagues that I built over the last 20 years is why I’ve been successful is that I know if you come in with a question and I don’t know the answer to it, I bet you I know someone that knows the answer and I can call on them because we have mutual trust and respect and that’s just been built over years of working together. Right? So I would just thrust the importance of building those networks and for a lot of people that aren’t sure what they want to do in my mind once you start working and people see what your work ethic is, you’re going to build those networks and people are going to know that you do good work and you go from there. So I will say that a lot of our med students, I’ve been so impressed at the interest. I’ve done policy talks for Dell med students undergrad for residents. I did one this week for a nutrition class, underground nutrition class at U. T. And I’m just super impressed and how much students now are interested in learning about this stuff because I think it’s really easy to get in your niche, right? And I think doctors are so busy, other medical health professionals are so busy, but this is the backdrop that really influences their work and their patients lives. And so I think there’s a growing interest among students in understanding this stuff because it affects what they do and it affects the people that they want to help.

[0:22:37 Speaker 1] We’ve seen interest from high school students and educational programs through the cancer center as well. We have one program that’s intended to introduce high school juniors and seniors who identify as female. He introduces them to cancer and cancer research. And at the end of our pilot year, one of the students said that she was not going to see a career in the health sciences, but she was going to go into health policy because she felt that her skills and her personality could make a bigger impact on health care disparities through healthcare policy. So we’re seeing interest in the younger age too.

[0:23:12 Speaker 0] I do find that amazing people are drawn to this work. So I feel like just knowing that you’re doing this work with a lot of others that are passionate about improving health and health care is a great thing and I can’t say enough for a lot of the colleagues that I had at texas health and human services. I feel like bureaucrats get a bad rap. You have just many smart, really dedicated people working there and of course a Dell med. I mean my gosh, the breadth of knowledge and passion of our colleagues is huge. It is important to have good people working in government regardless of if it’s republicans or democrats or a joint power situation. The work that we do, the foundational work that you do, whether you’re in the budget committee or estate agency is really critical and I really believe I wouldn’t still be doing this work and I’ve seen it. People making a difference from those different roles regardless of the overlying political structure. And I loved my work in Arizona and I really loved my work here. So it’s just kind of knowing this is the role that I’m playing right in this big system and by me doing this well, I think I can make it.

[0:24:25 Speaker 1] Thank you to lease a curse for joining us this month to share her incredible experience and knowledge around how policy can improve the lives of people with cancer. I’m nick smith Stanley with the livestrong cancer institutes and this has been cancer uncovered. For more information about the Livestrong cancer institutes. Check out our website at Dell med dot utexas dot e d u. You can follow our director on twitter at s gail Eckert Eckhart is spelled e c k h A R D T. If you’d like to learn more about the live strong cancer institutes or have ideas of topics that we can uncover. Send us an email at Livestrong Cancer institutes at Dell med dot utexas dot e d u. Please make sure that institutes is plural. And of course, if you enjoyed the podcast, make sure you subscribe