Regain Control of Your Health Dollars

Hannah Anderson has served at the highest levels of American healthcare policy, advising the House Energy and Commerce Committee and the Senate Health Committee, and serving as Deputy Chief of Staff for Policy at HHS. She's negotiated legislation line by line with senators on the opposite end of the political spectrum. Through all of it, the thing that comes through most isn't politics. It's how much she genuinely cares about patients. 

In this episode of Healthcare Rebuilt, host Boe Hartman talks with Hannah about why, after years inside the system, she still believes it can change, and why she thinks the answer isn't more government control but giving patients and employers back control of their own healthcare dollars. She makes the case, across party lines, for a simple idea: people deserve to know what they're paying for and a real say in how their money is spent. 

It's a conversation with someone who has earned the right to an opinion on this, and who clearly hasn't lost the heart for the people the system is supposed to serve.

In This Episode: 

• Why 82 million Americans rationed care or delayed retirement to afford healthcare last year. 
• The "trust gap": why neither party fully trusts patients to manage their own health dollars. 
• What it means for a market to "float," and why healthcare never has. 
• Inside the year-and-a-half negotiation to deliver bipartisan PBM transparency legislation. 
• Why employers can't fulfill their legal duty under ERISA if they can't see their own claims data. 
• The Patients Deserve Price Tags Act and its odds of passing the Senate. 
• Why most medical debt comes from everyday bills, not catastrophic events. 
• Why Hannah believes MAHA, at its core, is about personal accountability and taking back control of your health. 
• The deeply personal reasons behind Hannah's commitment to this fight, and her path from a Bible college in Indiana to Deputy Chief of Staff at HHS. 
• Why direct contracting and association health plans may be ready to go mainstream. 
• What a truly patient-first healthcare system looks like for the next generati

Thanks for listening. To learn more about Nomi Health visit https://www.nomihealth.com

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Follow Nomi Health on LinkedIn: https://www.linkedin.com/company/nomi-health/

Follow Boe Hartman on LinkedIn: https://www.linkedin.com/in/boe-hartman-70a194/

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Transcript

SPEAKER_01 0:02

Think about the last time you or someone you love needed healthcare. Maybe it was a claim that got denied. A bill that made no sense. A drug that costs ten times what it should, or specialists that you couldn't see for three months. Most of us have a story like that. And most of us have been taught to accept it, to assume that that's just how healthcare works. If you're an employer, you're not just living that story, you're paying for it. Today we're going to talk about why and what's being done to change it. My guest today has spent her career inside this fight. She advised the House Energy and Commerce Committee, the Senate Health Committee on Drug Pricing and Health Insurance, served as the Deputy Chief of Staff for Policy at HHS, and now leads health care reform work at the American First Policy Institute. She's seen this system from every angle, and she's still fighting to change it. So I want to welcome Hannah Anderson. Welcome to Healthcare Rebuilt.

SPEAKER_02 1:07

Bo, it's so nice to be here. And like you said, I've gotten really lucky across my career to work for so many amazing people who are really fighting for what we call at AFPI, a patience first system. And that's everyone back to, you know, the time that you and I met when I was working in the Texas delegation on energy and commerce issues, all the way to now, you know, between working on the presidential transition and for this president who really loves patients, to the secretary who really loves patients, and now getting to lead it at America First Policy Institute. And so again, it's really great to be here with you because you also love patience. The reason why, you know, you and I hit it off all the way, you know, back in 2019 was because I felt finally like I was talking to someone who was in healthcare because they wanted to make a system that was easier for patients to use that could connect value better instead of just going and keying around and fiddling around with all the normal things that we do in healthcare policy.

SPEAKER_01 2:02

And you know what? I felt the same way when I first met you. The first off, that Texas grit on how to take a hard problem and to really change it, which coming from banking was really weird for me that this is a massive problem and folks were having challenges. One of the first uh the first things I always like to get into is I always like to start with the numbers. And these are numbers that you you know well, but I always like to remind folks out there is healthcare is $5 trillion in the United States and going up. If you look at our military spending, it's about a little over a trillion dollars. And if you look at the interest we pay on our debt is over about $1.3, $1.4 trillion. So even those two numbers added together don't even make it to the halfway point of what we spend on healthcare. A recent study came out that shows $82 million Americans, one in three, skip meals, ration uh medications, and barred money, delayed retirement just to pay for healthcare in the last year. And this isn't people without insurance. A quarter of the households earning over 90,000 are making the same impossible choices, and you spend a career trying to fix that. Do these numbers surprise you as we go through them?

SPEAKER_02 3:05

No, it horrifies me. And you know, this is something that you and I have been in healthcare, like we get we talk to people at church, we talk to people who are in our family and our friends, and we hear about the horrible stories that they're facing. I mean, I'll add on top of that, you if you have an Obamacare plan, you're probably spending $9,000 on a deductible before your insurance even kicks in. If you're an employer sponsored or private insurance that's not Obamacare, you're getting crazy high prices on drugs. You don't know that you can go ask for the cash price at the pharmacy counter. And you think that in banking, and and you know this, is any other sector that has like up, you know, a fifth to a little bit less of that of the GDP, you're talking about something that consumers could normally take down and really drive down prices and increase the quality because that's what American consumers have done in every other sector, including banking. So, what is stopping us from doing the same in healthcare? And again, you and I really go back to the patients because all of those numbers that you just listed out have been used year over year over year. I mean, I have heard that from the floor of the House to the Senate to all the way, you know, people advocating against us. Uh, in, you know, when I was with Secretary Kennedy saying, well, this is why we need more government control. And those numbers to me say this is why we need more personal control of our health dollars, because without personal control of our health dollars, we're never gonna get back our control of our health in our health care.

SPEAKER_01 4:33

One of the big things that I love talking to you about this, but I'm gonna put it out there so others can hear, right? Is just that when I first met you with um Representative Crenshaw, it was so he talked about it's kind of like going to a supermarket and the price, you know, the prices change by the time you get uh get up to the till. And I always said, Yeah, but it's actually the prices change along the way on the way up there. Being the fact that you've been on the inside of the beltway and you see how um it interacts, what is the main blocker of just bringing what you just described? Simple, easy to understand, easy to purchase, easy to execute uh healthcare in the United States. What is that biggest, biggest barrier, would you think?

SPEAKER_02 5:12

Well, you know, I'm gonna give you a little bit of an esoteric philosophical response. Um it's it's uh we don't there's a lot of people that don't trust the patient. Um, you know, the president trusts the patient, Secretary Kennedy trusts the patient, a lot of our friends in Congress trust the patient. But largely when you start talking about healthcare, there's a lot of people that are like, you know what, we like another few layers. We believe that the patient can't be trusted to stay for their medical expenses. We can't trust the patient to make the right decisions for their families. We can't trust the patient to, you know, think about how to lower their costs. And instead, it's been a bipartisan block on trust for patients. And this is patients in Medicaid and Medicare with private insurance. This is patients in the VA system and the federal government system. We just don't trust that people can actually make their best decisions for themselves. And that that would be the number one thing. I'd say more tactically speaking, there's plenty of reasons why. I think a big part of that is, you know, if you talk about decentralizing control of healthcare from when, you know, all these huge entities really only have to look out for government regulations and instead actually have to provide value to the patient. I I think that's part of a huge reason. Because, you know, if the government is no longer the main customer of the main dictator of healthcare, now you have to go do the hard work and go sell your stuff to the patient and tell them why it's better for them. And so, you know, 330 million individual customers is a lot harder than one, you know, mammoth customer.

SPEAKER_01 6:46

That that that that is so true. And we we witnessed it over the last six years on the on the journey of Nomi. And again, uh the folks have heard me say this is when I came from banking into this world, the thing that just blew my mind was the fact that it's a market that does not float. And and as you say, you got it from my time in banking. When a market floats, right, within you know certain uh certain uh guidance, it actually finds the right uh market medium. And it's incredible that the market works that way. To your point, I remember growing up, there was a handful of doctors in the county I came from, and everybody knew hey, this doctor was really great at this, that doctor was really great at that. And you went to those doctors for those things over time, and the market adjusted itself to to reflect that. So I, you know, I really, really look forward to hopefully one day we can get there.

SPEAKER_02 7:34

Yeah. One of the things that actually But Bo, and and we're already starting to get there. And sorry to interrupt you here, but like, man, we've done this in banking, right? Like we have given people, you know, we have moved from complex defined benefit structures where you're saying we don't trust the person to save for their own retirement. We we have to define the benefits that they're gonna get once they hit 65. That's incredibly high stakes. That's the highest stakes possible because you're talking about are we gonna trust people enough to provide for themselves when they can no longer work or should no longer work? And we said, you know what, we moved from a defined benefit because pensions weren't working out for people, they weren't being funded the right way. And we said, we're gonna move to a defined contribution, which is how we got 401ks and IRAs and all sorts of a diverse array of investment tools so that you could save for retirement in more ways than one. The thing is we've done at high stakes and we can do it in healthcare. And so, you know, again, with your banking background, like I know you appreciate, like we've done it once, we can do it again.

SPEAKER_01 8:38

You know, uh, that's a lot of folks tend to forget about um about the aspect. The 401k's concept was about being able to contribute early and you control it and it can move with you, right? Because when the steel mill started to fail in the United States, people lost their pensions, right? And so it was a guard against that, and that's it. Using that as a pivot point into the next line of questioning, um, and I'll use this as the bridge. Uh so my oldest daughter, um, and I know you uh you have uh family as well. My oldest daughter, um, she uh approached my wife recently and she said, Hey, when do we talk about me um getting off of your insurance? And I I said basically can't happen fast enough. No, I'm I'm joking. Um, but she said, Hey, when are we gonna do it? And it's interesting that she was getting that concept. Um, but the two things she asked about was one 401k uh 401k contributions, which she's putting away $50 a month now. And I went, she goes, I know it's not months. I said, it's perfect, start now. And the second one is the insurance aspect of it. Like um she she in her mind kind of picked it up as the hurdle into adulthood, right? Using that as kind of the the backdrop here, um, there's a lot of juggling going on in Washington right now around healthcare issues. And um, if you had to pick one thing that could make the biggest uh difference for employers and workers for the next year, what would you pick?

SPEAKER_02 10:00

A transparency. I mean, my joke is like transparency would solve 80% of the problems in healthcare from fraud and waste to actually knowledge about what's going to improve your health to prices to quality. But really, it goes the reason why we care about transparency so much is because we care about people being able to shop. And so when I sit down and have the same conversation with my family members, with my aunts, uncles, cousins, employee, you know, employees, coworkers, everything in between, and they say, you know, what do we do with this health insurance? I say, it's just a tool. It's just a tool. It's not an end-all be-all. It's just one tool that you can use to shop around to finance your health care. And when we talk about financing your healthcare, you can use cash, good old-fashioned cash, you can use a credit card, you can use any other means. It's okay, right? Like it's just one tool. But don't just use it because it's the tool they're telling you to use. It's like going to a car dealership and you have $25,000 cash to buy the car that day and choosing to finance just because everyone says to finance. Unless you have a strong reason to finance that car, and you know, maybe you have a different reason you're saving that $25,000, maybe you need it for something more urgent. Why are you going to choose to finance that car if you have the cash for it? Similarly with healthcare, like why are you going to choose to use an insurance tool that's going to make you pay $40 for a copay for a drug that you could pay cash for $3. Right? So the reason why we talk about transparency is because it activates the thing about American consumers that are like the most amazing thing in driving value, which is it allows them to shop. And that's really, again, I go back to my friends and family and I say if you are not shopping around using insurance as one of your tools, you're doing it wrong. And that's why, you know, when when we look at why people have medical debt right now, it's not because they got hit by a bus and have $100,000 of debt at the hospital. It's because we're seeing, and this is what Commonwealth Fund put out, $500, $600,000, $700 of medical debt is the most common, you know, under $1,000, under $2,000. And it's because they're going to an outpatient clinic or getting some sort of imaging or diagnostic. And they're being told after they got an unnecessary, potentially, maybe necessary, but after the diagnostic saying this is how much you owe for that. And they're putting it on a credit card. They're putting it, you know, in a some sort of pay later program with the hospital. That's why they have debt. And it's because they don't have transparency and they can't shop around to see, is this something that I need? And is this the cheapest place to get it?

SPEAKER_01 12:43

And the credit card thing is really important, right? Um, people think credit card debt, people have $25,000 uh credit card debt constantly because that that's a Silas's headline, right? But it's actually the folks that have that, like you said, $2,000, $3,000 sort of dollars that weighs on them over time and it builds up because they have to go get medicine, they have to go do some other stuff. So absolutely, people need to think of it's built brick by brick. It's not one major thing. Catastrophic things do happen, but it's brick by brick. You recently wrote about a new law about the first time around the the you know, PBMs, man, uh middleman around drug benefits to employers. Talk a little bit about that. Talk about the significance of it, talk about where you really uh think this is important as it as it actually uh makes its way through.

SPEAKER_02 13:31

You know, I have such a heart for this bill. Right. Okay, so you know, you said I was on the inside. And so one of the little things about being on the inside is there's some people who have to do the hard work of actually arguing about every if and or but in the law. And that was one of that was me, right? And so I'm sitting in there two, three in the morning with my counterparts, you know, the Democrats, because I was working for the Republicans in the Senate at the time, and I was one of the lead negotiators on this bill, negotiating on behalf of the Senate Republicans. And I'm sitting there with my counterpart who's advocating and negotiating on behalf of the Senate Democrats, specifically Bernie Sanders. And I'm a free market populist conservative, and he is a socialist. I would he would describe himself sometimes a communist, Democrat. And we have to come to an agreement on every if and or but. And so let me tell you, this process took a year and a half to get agreement on every single little word. Um, really bringing bipartisan transparency to a piece of the healthcare ecosystem that not a lot of people know about. And so it's really laborious work. I have a lot of affection for it, right? Because I spent a lot of two, three, four AM uh kind of toiling over, you know, what is the word gonna be? And and it really gave me an appreciation for again this part of the healthcare system that people don't really know about. They just know that yeah, they got their little insurance card. Their insurance card may say it's Aetna, and then it also says Care Mark. And they're like, well, I don't know what that means. All they know is when they go to the pharmacy counter, they, you know, get something really cool, which is the price that they owe right at the pharmacy counter, because in the medical part of their benefit, they don't get that, but they get exactly what they owe at the pharmacy counter. And all of that is being adjudicated by something that Bo you and I know well, but no one else does, which is the PBM. And the PBM is the person, the entity in the middle of it that is trying to negotiate with the pharma companies, with your employer who's giving you your health care. So in this case, it would be Aetna and CareMark. I think what people we have an appreciation in America that, you know, we're not buying directly from the farm or we're not buying directly from the company. We have a lot of different intermediaries that are helping us purchase. Like I even the laptop I'm I'm working off of. Like I bought this at the Best Buy, and the Best Buy purchased it from, you know, what is this? Like Adell, right? And there's a lot of middlemen, and that's okay. And we've accepted that. Except in healthcare, when the middlemen are no longer serving and providing you value, me, Hannah, the customer or the patient, that's a problem. And so when we were starting to investigate what these PBMs were doing, we were finding, especially when it came to your employer, you know, know me or AFPI who brings me my benefits, my healthcare benefits, my employer wouldn't get an itemized receipt. So my employer is going to the PBM and saying, hey guys, we're buying all this healthcare for Hannah and her coworkers. We'd like to know what we bought, or at least an aggregate, right? Like we'd like to know what the prices were. For people who work in again, complex business-to-business purchasing, or even, you know, if you're not involved in that part of any kind of business, you're at least getting an itemized receipt when you go to the grocery store or a restaurant. You're expected to get that because that's just good business. That's how you shop. But when an employer can't get that from a PBM, and maybe you're not a small business buying, you know, maybe $100,000 worth of healthcare, but maybe you're a large business buying $100 million worth of healthcare, you need to know your prices. Like, so we worked on a PBM bill that at the end of the day, this is why Senator Sanders and my boss at the time, Senator Cassidy, could come together and agree on something like transparency. Because even though they were at two way far edges in the healthcare system, they could agree on one thing is that people deserve to know what the cost of the drug is before it's purchased. And not just me, but the person above me who's purchasing on my behalf. Because if AFPI or any of my employers that I've worked for can't actually get the price of the drug so that they can negotiate, that they can like assess what they want to purchase, how they can give me better care, because it's still an employee benefit. They need it to retain and recruit talent. I'm not going to go work somewhere that I can't get a healthcare benefit. They need it to help get more talented people into their company. And so if you can't know at the employer level what the price is, how am I ever supposed to know what the drug cost is? And therefore, how am I ever supposed to know how to shop around? So the very long answer is I love that bill. I'm really hopeful for that bill. They've started implementing it over at HHS. And I know that because I've only texted them a hundred times about it. And I'm really, and um, I'm really excited because this is gonna be a such a huge step forward. And for the American patient who's like, wait a second, they weren't giving a receipt to the people purchasing the care. You're like, that's that's basic. And I'm telling y'all, that's how far we have to go in healthcare to get transparency. Because the whole system doesn't want you to have transparency because it means you can't purchase. And if you can't purchase as a consumer, you can't help negotiate down the cost. And if you can't help negotiate down the cost, well, I don't know. So I just let me get off my pulpit here. But that's just it makes me so frustrated because it it impacts it impacts normal people. Like there's there's these these lawsuits going on right now where people are finding out that the drug that they could have gone to the Walgreens and paid $40 if they just said, hey, I want to pay cash, actually cost them $10,000 because of what their employer and the PBM concocted. That's a huge difference.

SPEAKER_01 19:36

It uh so first off, love all of that. There's so much in that. And that's one of the things that blew my mind. No, no, one of the things that blew my mind, and I've been very public about it, is I when I came in from banking and I literally landed here, and I'm like, wait, what do you what do you mean I get the invoice four months later after I purchased? What um that's an explanation of benefits, right? Or explanation of payments. And I'm like, how is that even possible? When my wife went through her cancer journey, right? We discovered very quickly about the drugs and getting drugs, and there was a particular drug that she needed to be on for three years straight. And uh the the hurdles and the obstacle courses we had to go through to just get that drug, and it was just mind-blowing to me, where I could have just gone down and said, you know what? Actually, what if I just gave you the cash price for this? Could we just get that done? Right. Uh and it was, you know, it it's it's it's one of those things where you and you and I discuss this, that it's the only market that I've ever seen that does not really float, and you don't really get to choose what you do with your dollars, right? And it just it it is worth it.

SPEAKER_02 20:44

And it's my dollar. And it's my dollar. Yeah.

SPEAKER_01 20:47

It's it's your dollar.

SPEAKER_02 20:48

That's my money. And as an employee, right? That's that's legitimately part of my compensation package. The United States government treats that dollar that you spend. Again, I'm picking on AFPI, that's my employer right now. They treat AFP AFPI's money that they spend on my K, on my benefits, everything down to my little parking pass, they treat that as effectively compensation.

SPEAKER_00 21:12

Right.

SPEAKER_02 21:12

So that is part of my compensation package, that is non like what non-salary compensation. And so if you're messing around with that, you are you were quite legitimately messing around with my money that you are spending on my behalf. And what we're finding is that because of the lack of transparency between an employer and a PBM, you're not able to effectively manage my money on my behalf.

SPEAKER_01 21:39

Yeah, yeah, it it's it's crazy. Let's have a little bit of fun with like uh last uh two or three uh quick questions. Um, all right. So this is the one, this is the one of the things that I've personally loved in recent cultural history is um make America Healthy Again has been polarizing, but should it be? Like at its core, it's about Americans living longer, healthier lives. And for employers, chronic disease alone accounts for 90%. 90% of healthcare spending. You choose you chose to be a part of that mission, right? Why should every employer care about it?

SPEAKER_02 22:12

Oh boy. I love, I love Maha because it it gets back to the root of it. And let me tell you this is so, you know, we are working on the presidential transition. And again, some girl has to write the like the guide to what do you do when you get into the building on day one? Right. More so than where are the bathrooms, which was also an adventure. Yeah. Uh I locked myself out a few times because you have to you have to badge in in and out to get to the bathroom. And so, you know, there were some frantic calls made. But other than that, right, you have to write a guide of like what do you do when you get into the building? And you kind of take some guides from off the shelf because you have a lot to do and you can't write a 200-page guide, you know, from scratch. So you're working off of old materials and you're looking at it. And the guide to HHS that I'm starting to edit through, you know, what whatever this was, September of 2024. Nowhere in the old guides was anything about the goal of HHS should be about making people healthy.

SPEAKER_00 23:16

Right.

SPEAKER_02 23:16

And being precocious as I am, I wrote in there, you know, not only should we be having an effective bureaucracy and like efficiency for the taxpayer, we should also aim to make Americans healthier. And it was a dire derivation of that. And I think Secretary Kennedy had just been added on to, you know, the campaign at that point. So this wasn't Maha hadn't quite taken off in the same way. But the goal of Maha is not to get everyone on a peptide. The goal of Maha is to help you take back your health. And that's what every employer should be really excited about. One, because it means that there are now new options for you to help your employers take back, employees take back their health. I think it also is about like personal accountability, which is the only thing that has actually improved people's health is not, you know, massive population health. And I sound like a hater here, but like health is individualized. So the only thing that's going to actually help people be healthy is not like broad scale massive campaigns of like how to do it at an aggregate level. You're going to get results that target the aggregate, which is like the average of the average might do better. But you're not going to actually help people take a hold of their health in a more personalized way. And so that really is what Maha is, which is how do you help people take more control over their health? That's the medical freedom movement, which you know I think took off in Texas. It's the self-determination that's defined us as a nation. That is everything from like a culture that loves more stats about themselves. I've got a whoop, an aura ring. I've got a CGCM. I'm not diabetic. I just like to know. I've got a function test coming up on Thursday. I've got, I mean, I love information. And I finally have a secretary that says, actually, Hannah, I want to do everything I can to make sure that Americans can get healthier. And I I love that about Maha because even though I didn't get trained up in the public health way, I got trained up in the private insurance way. But Maha to me was very intuitive because I said, wait a second, I've been talking about it's my dollar, it's my health, it's my health dollar. And that's very similar to what Secretary Kennedy's been talking about in Maha. So when I had my initial interviews with his team for the position of deputy chief of staff, they immediately recognize that I'm talking about the same thing they are, which is the president's way of addressing healthcare, which is patients first, more tools for patients, more self-directed dollars, more control over their health dollar is the same as Maha, which is a better focus on how to reduce chronic disease, what are the ingredients in your food, how to take back your health. Two sides of the same coin. So I love Maha, but you know, do it that. I mean, it's a great movement. And I think every employer should be really excited that their employees are saying, wait a second, what does it actually mean to be healthy?

SPEAKER_01 26:24

And by the way, uh you turning yourself into a cyborg actually excites me. Um, and the reason is is because uh I slowly but surely slowly but surely, but I have a belief that uh one of the one of my side projects is between all the devices you talked about, right? How could I have a little AI when I wake up in the morning saying, This is how you slept, this is what your day looks like, this is how your activities are going to go, right? This is how you prepare yourself for the day. And as I as I achieve some uh golden ages, I would like to have that sort of stuff that makes me a little bit better. Last two questions, I didn't start out as a health policy person, yet became one. Give us a just for fun, give us a little bit of that journey because I I want folks to get the flavor of because I'm a banker and I'm now here in healthcare. So give give folks a little bit of that journey.

SPEAKER_02 27:14

Um, so yeah, I didn't start out as a healthcare policy staffer. Um I I I don't mean to go so serious so quickly. Um, I actually my um my dad died of cancer when I was six years old. It was an environmental cancer, probably. It's why, you know, you know family history of lung cancer, no smoking. He ended up, you know, because he died, we ended up, you know, my mom was had three young kids in the house. We ended up on all the social safety net programs that a lot of people, you know, they have an you know appreciation for, but again, you know, had to live through that. So I grew up on these programs. Um, and my mom first job, when she finally was able to get a job, she folded letters for envelopes and benefits packages through a company that did benefits consulting. And so she would come back and talk to us, and she finally, you know, she had the first appreciation for shopping for your health care and your health insurance. So, you know, when she was finally able to move us off of chip because we were on chip, we were on Medicaid, we were on any kind of private insurance she could purchase, whether that was giving $100 to the local doctor or, you know, uh, you know, being uninsured for a while as well, she was able to teach us like how to shop around for it. And so I heard that all growing up as, you know, my mom's coming home and telling me about the benefits packages, that she's literally mailing them out to people and she's folding these letters and sending them out. And um, so you know, like life goes on, I end up winning a sweepstakes. You know, I I went to a Bible college in Indiana. I wanted to be a high school history teacher. God had other plans. I want a sweepstakes to go to DC for spring break, and I loved it. And so I came out here for an internship. My housing fell through. I slept on couches and asked random people if I could stay there. Cause again, like I didn't have the money to stay in a place that wasn't for free. And stayed out here all summer, came back the next summer, was able to have a real internship and a real roommate and a real house. And then by the time I graduated, uh, it was the only thing that I knew how to do was be in DC. So I came back out and I was a scheduler. And for those who don't know, like schedulers are the ones who are doing all the calendaring for the members of Congress. So you get a real appreciation for all the priorities that they have to put together. And I did that. Um, I ended up moving to New York City and working at a firm called the Boston Consulting Group, which I joined as a scheduler because folks in New York need executive assistance as well. And I fell into the healthcare practice. At some point, they realized like I was really bored just scheduling. So they said, you're probably not gonna get it, but we're setting up a pilot program for non-target B schools. Because you know, the BCG New York office was only hiring from the Whartons of the world and certainly not bachelor's degrees from Bible colleges in Indiana. So they said, you're probably not gonna get it. And out of all the things, I got into the program and started being like what's called a client services assistant. So I was tagged to the healthcare practice. I helped my partner kind of keep the institutional knowledge. I was at the client site four days a week, all local New York clients, um, all in healthcare. And ultimately I came back to the hill doing the only thing I knew how to do, which was now healthcare policy.

SPEAKER_00 30:42

I'll see.

SPEAKER_02 30:42

So, and off to the races. And I mean, by there, like now, all of a sudden you're a healthcare expert. And, you know, I like to say that if you can cross-reference through like a Bethmore Bible study between the prophecies in Daniel to Revelation, you probably know enough hardcore research to actually be able to do the really legal research of what it means to amend ERISA and amend the Public Health Service Act. And what I love about DC and Capitol Hill is that it's the last place in the world that you can work your way up, right? Like I got a bachelor's degree from a Bible college in history and psychology and a lot of hard work and elbow grease and self-taught. I was able to work up to deputy chief of staff of health and human services and really thrive. And so, and I had the trust and respect of the secretary and still do. And so I could not be more thrilled with what God has allowed me to do in this life because it really goes back to can you work hard? Can you like climb the ladder? And it shows that the American dream is alive and well. Because I remember my very first meeting sitting with the Medicaid team. Now I'm gonna start crying. Um and I get to sit there um and say, like, what are we doing for kids? Um and just like, I mean, what, 24 years ago, like I would have been a kid on Medicaid, maybe 20 years prior to that. And I get to say, what are we doing for single moms? You know, I get to talk to the administration for children and families, which administered a program where I got to take AP tests for free, right? A P tests are what you do to get college credit when you're in high school. I took six of them in one year for classes that I wasn't even in because there was a program from the federal government that allowed kids on the free and reduced lunch program to waive the fees for the advanced placement tests, which was the only barrier I had to taking them because they were $80 a pot. I couldn't afford that. So I got to walk into the building that said, you know what, we're gonna still protect the American dream for the kids in this program. Um, and I got to say like a huge thank you to Alex Adams, who's administering that now, to Dr. Oz, who's administering the Centers for Medicare and Medicaid Services, which includes the CHIP program. And I got to say the words like, what are we doing for kids? So that's my very long way of saying like it is amazing that I got to do what I've done because it means like the American dream is truly alive and well.

SPEAKER_01 33:24

First off, thank you for sharing. And the reason I want to say thank you, Sharon, is all of us, every single one of us, has either a healthcare story about your dad, right? Um, to getting healthcare. And then also the way that you came up to that process is also an inspiration for other folks to look at. And you're saying that these are important. Let's make them work for the people they should work for, right? And and that to me is important. I always I love operators for me. Uh, it's all about you know, my years as an operator, you as an operator. And if you look at the bottom of every operator I've ever met, including myself, there are stories like that that actually leads down that journey. So that that is that is outstanding and awesome. Well, I'm gonna bring you down to the very last one, and then um, and it's uh it's it's something that I I love, it's not a gotcha. It's fun. Well, fun. Um is uh as you know, I left Ollman Sachs to come to come do this, right? I left the world of banking that I absolutely positively loved. And I came here because of the promise of I thought I could make a difference, right? From the ground up. Let's let's blow it up and try it again. You've been fighting for change, as you've just described, in DC for a long, long time. Can it be fixed? And if it can be fixed, does it come from DC? Does it come from somewhere else? Or does it come as a partnership of those two things that actually gets us to the place where we do have what I would call a functioning environment?

SPEAKER_02 34:52

It comes from both, right? You have this is the best, biggest opportunity to have a paradigm shift in healthcare because you have a secretary and a president who are fighting for patients. And not just the lip service of more access or more coverage, but truly giving patients more ability to control their health care. And you also now have patients who are looking around and saying, maybe this isn't providing me the value that I want. And so it's also coming from patients who are going around and saying, because of President Trump's reforms and the bipartisan congressional reforms, wait a second, we can actually get access to our prices. We can ask for the cash price at the pharmacy. And that's the thing that I'm telling everyone right now. If you're paying more than $10 for a generic drug, ask for the cash price because you might find that you're going to get a way better deal. There is a huge, like I think people are looking around and saying, why am I spending $500 a month in a premium to meet a $5,000 deductible when I'm not really a high user of healthcare in the first place? Because if you're only spending, you know, I did some back envelope math the other day, if you're spending almost no money on healthcare and you go to a dermatologist and you're getting, you know, a $40 copay, or maybe even you have to pay the full amount because you haven't hit your deductible. So maybe it's $150. If you use your insurance, like no other benefit aside, you know, all the other benefits aside, it's better for you to finance that $150 visit on a high interest credit card and make minimum payments because it will be cheaper than using your insurance, especially if you don't use it every, you know, if you don't, you're not a high utilizer of healthcare. And I'm not saying and not dismissing the catastrophic element of health insurance because I love my my insurance for healthcare should be kicking in. If I got hit by a bus or got cancer, I want everything covered. But I actually, if it's gonna be cheaper for me to finance a $150 visit in a different way, let me do it that way. So I think there's really a movement. I'm really hopeful that you know people have started seeing that taking back your health actually does mean taking back control of your healthcare dollars because you're not gonna get one without the other.

SPEAKER_01 37:07

Beautiful. And I believe that. I believe everything you just said there. Well, Hannah, people come to Washington because they believe they they believe in something. A lot of them believe believe in a lot less, right? You're still fighting for every employer trying to do right by their people, and that's what matters uh to me and to us at Nomi. Thanks for being here. I love speaking to you with one of my favorite people. We are going to get that coffee next time you're down in the great Republic of Texas. And uh we appreciate all the work that you're doing to make healthcare better.

SPEAKER_02 37:41

It's truly my pleasure.

SPEAKER_01 37:43

For show notes and more, visit NomiHealth.com. Until next time, this is Healthcare Rebuilt.