In the Classroom: In Congress
Massachusetts devotes about 40 percent of its roughly $40 billion budget to healthcare and public health efforts. As the legislature worked on the 2018 budget this spring, six students came to the office of Representative Jeffrey Sánchez, chair of the Joint Committee on Health Care Financing, to learn about how the budget is created—and make a few proposals of their own.
Earlier in the semester, Sánchez had visited PM760: Health Policy Making, taught by Assistant Professor of Health Law, Policy & Management David Jones, to share his experience, and invited students to come to the State House to present their own policy briefs to him and his staff. Qing Wai Wong, Jennifer Keefe, Emily Dore, Nicole St. Lous, Linke Xu, and Elsa Pearson took him up on the offer. (Another student, Cynthia Kambuni, also submitted a brief, but was not able to attend in person.)
“The budget itself can be a policy bill,” Sánchez told the students gathered around the table in his office. He explained how the hefty document—and the work to bring the Governor, Senate, and House into agreement—represents the push–pull of different priorities, interests, and advocacy. In crafting any proposal, he said, it is vital to think about the people, the policy, and the politics at the same time.
“You shouldn’t think of your MPH in a silo,” said Sánchez, who counts several SPH graduates among his past and present staff members. He encouraged the students to keep the larger context in mind—especially because they will soon be out in the world, finding where they fit in the health policy ecosystem.
Each student’s proposals led to a lively back-and-forth between the students, Sánchez, and the committee counsel, Erin Liang (SPH’14). The proposals ran the gamut, from marijuana tax rates to the requirement for businesses with more than 50 employees to offer health insurance coverage.
A couple of proposals ran parallel to ideas recently discussed by the Special Commission on Provider Price Variation, which met from September 2016 to March 2017 and was co-chaired by Sánchez. That gave the students a chance to join ongoing debates and learn more about the pros and cons of their ideas.
Pearson’s proposal, about a potential way to expand MassHealth insurance coverage, hadn’t already been imagined, and held up to initial scrutiny as Sánchez and Liang tried out potential weak spots. “That’s actually really interesting,” Sánchez said after going over the details. “That’ll be something for us to keep in our toolbox.”
Perhaps the biggest learning opportunity came when Sánchez presented an opposing perspective. The exercise showed the students just how complex the healthcare and public health system is in Massachusetts, and what factors come together to maintain the status quo.
After the meeting, the students said it had been an invaluable experience. “It was fascinating to put what we’ve been learning in class into practice,” Pearson said, and to know “people here at the State House are willing to talk to us about having an influence.”
For Dore, it was a taste of what it will be like to advocate as a public health professional. “He was open to listening,” she said of Sánchez, “and willing to inform us and talk to us as equals.”
Wong said that was a little bit of a surprise. “I thought, ‘We’re just students, what do we know about real policy work?’” she said. “It was gratifying to know that we do have ideas to contribute.”
Jones said that was a central lesson he wanted to get across in his teaching of the course. “They don’t have to wait until later in their career to speak up and shape policy,” he said after his students reported back from the meeting. Beside Sánchez, other visitors to the class included former Kentucky governor Steve Beshear, who saw his work to implement the Affordable Care Act in his state dismantled by his successor, and Licy Do Canto, one of the country’s top public health lobbyists.
“Policymakers are hungry for help from smart people, and our students are hungry for real-world experience,” Jones said. “It’s exciting for me as a teacher to connect the two.”