Working at the Hub of Policy, Practice, and Education

    • June 9, 2014

Context. Like many people who have devoted their careers to improving health care, Robert G. Frank, PhD, watched with satisfaction in 2014 as millions of Americans signed up for coverage from insurance exchanges established by the Affordable Care Act. For Frank, who now serves as president of the University of New Mexico, the sign-ups also struck a sweet personal chord: More than two decades earlier, as a Robert Wood Johnson Foundation Health Policy Fellow, he had helped to draft legislation outlining the concept of health care purchasing cooperatives, which eventually became Obamacare’s health insurance exchanges.

Frank’s 1991–92 fellowship placed him in the office of Sen. Jeff Bingaman (D-N.M.), who introduced a bill to make health insurance more portable. “We were trying to overcome state regulations and create a broader health care marketplace that had better fluidity,” Frank explains. “We were especially interested in working on access for a state like New Mexico with high levels of uninsurance, and also helping states that have residents in two markets—who may live in one state and work in another such as Missouri, Kansas, and Illinois.”

The Robert Wood Johnson Foundation Health Policy Fellows program provides exceptional mid-career health, behavioral, and social science professionals an opportunity to better understand federal health policy. Fellows participate in the federal policy process and use that leadership experience to improve health, health care, and health policy. For more information on the program, read the Program Results Report.

Combining health practice and policy. Before the fellowship, Frank was a clinical psychologist at the University of Missouri-Columbia, directing a program for people with brain injuries. Realizing that problems with housing and employment complicated his patients’ rehabilitation—factors that had more to do with policy than with health—Frank began working with state legislators to change policies. He also came in contact with Michael Whitcomb, MD, then-dean of the school of medicine at the University of Missouri-Columbia and a former Health Policy Fellow, who recommended the program.

The fellowship “changed my life,” Frank says. By bringing practitioners together with senior policy-makers, the fellowship acts as “a hub [of] policy, practice, and education where you can see the interaction,” he explains. “I left having an understanding of what policy is, how it’s made, how it works.”

Moreover, he adds, “The camaraderie was important. I still turn to [former Fellows] for guidance on issues and on life; they’re still my best friends.”

Continuing the work. After the fellowship ended, Frank continued advising Sen. Bingaman on health care and worked with Missouri’s state government to create the ShowMe Health Reform Initiative, a health reform effort to provide quality, affordable health care to state residents that was spearheaded by then-Governor Mel Carnahan and the state Department of Health. Working on federal and state reforms simultaneously was exhilarating, he says, providing a birds-eye view on both the change process and the power of special-interest lobbies to stop reforms.

Frank also helped establish a college of public health at Kent State University, where he was provost and senior vice president for academic affairs from 2007 to 2012. At the University of Florida, where he was dean of the College of Public Health and Health Professions from 1995 to 2007, he established the College of Public Health and the Florida Center for Medicaid and the Uninsured, which examines Medicaid policy at the state level with a focus on access, quality, and cost of health care for underserved populations. In 2011, Frank was appointed to the Defense Health Board, a federal advisory committee to the U.S. Secretary of Defense, tasked with providing advice to maximize the health, safety, and effectiveness of the U.S. Armed Forces.

Frank finds the lessons he learned about health policy equally applicable to education. Both fields have experienced state budget cuts and difficulty ensuring equitable access for all populations. Both require “multimodal solutions” rather than a silver bullet, and both “seek less costly interventions that rely upon consumer engagement,” Frank says.

New Mexico has plenty of health policy issues to resolve. Home to one of the largest Native American populations in the country, it is a “majority-minority” state. “We’re facing the issue of how one navigates [policy issues] when there is no ethnic majority,” Frank notes. New Mexico also has large numbers of undocumented immigrants and people living in poverty, further complicating efforts to ensure health care access.

Still, the take-up of health insurance under the Affordable Care Act is promising, Frank says. “In 10 years, we’ll see that a lot of progress will have come out of this,” he predicts. “And I was at the forefront of it with Sen. Bingaman in 1991, so I feel I got a chance to be part of history.”

RWJF perspective. “The RWJF Health Policy Fellows program is a flagship program for the Foundation and one important way we seek to improve the health and health care of all Americans,” says Michael Painter, JD, MD, senior program officer and himself a 2003–04 RWJ Health Policy Fellow.

“It is critically important that health care professionals—physicians, nurses, behavioral scientists, and others—realize that they can and must play important roles in promoting impactful, positive, informed change. The program provides a great way to help them learn how to do that and to learn firsthand the important relationship between politics and policy."

“I absolutely could not do what I’m doing today without that experience,” Painter adds.