Key GOP Adviser Regrets Lack Of Bipartisan Health Accord

In the summer of 2009, six key senators from the Finance Committee met behind closed doors for weeks trying to hammer out a bipartisan compromise on a health care overhaul. Much of the country watched and waited impatiently. President Barack Obama and Senate Majority Leader Harry Reid urged the senators to reach a deal, but the talks eventually broke down. Mark Hayes, the minority health policy director and chief health counsel on the Senate Finance Committee, had a clear view of those failed negotiations.

He says most people pressing for a quick resolution didn’t understand that Republicans and Democrats had reached agreement on a broad array of issues but that the remaining points were complex and the senators needed more time. “People were naturally impatient,” he says, but adds that those who pushed for a quick agreement “didn’t have an appreciation for the issues we were attempting to resolve.”

Colleagues say Hayes has a knack for translating complicated policies into easy to understand language. He started his Capitol Hill career with Sen. Christopher (Kit) Bond, R-Mo., where he used his degree in pharmacy to work his way from staff assistant to a health care policy adviser. Although he left the Hill for several years to work for the pharmaceutical firm Hoffman-LaRoche and then to return to his hometown of St. Louis to work on a community investment project, he was eventually drawn back to the Capitol. He spent time on the staff of the Senate Committee on Health, Education, Labor & Pensions and worked for Sen. Olympia Snowe, R-Maine, even while getting his law degree at night. In 2002, he became a health policy adviser for Sen. Chuck Grassley, R-Iowa, ranking member of the Finance Committee.

With Grassley leaving his leadership role on the committee this year and the passage of the health law last year, Hayes said he felt it was a “natural” time to leave the Hill. In November, he joined the health care practice at the law firm Greenberg Traurig. Hayes sat down with Kaiser Health News’ Bara Vaida to discuss his career and to reflect on being in the middle of the drafting of the health law. Here is an edited excerpt of that conversation.

Q: What got you interested in health care policy?

A: My family has been involved in health care in various ways. I grew up in a funeral home and you get sensitized to what people go through in a time of crisis, and I learned from my father the importance of helping people. I worked for a pharmacy in high school and the owner was someone everyone in town respected, and I decided I wanted to study to become a pharmacist. My sister is a nurse and her husband is a nurse practitioner and when we get together we talk about health care policy.

Q: What brought you to Washington?

A: I got an internship to work for the American Society of Hospital Pharmacists and through that process I learned about the Hill and I got Potomac fever. I just decided I wanted to see what happened from the inside. I went by Sen. Bond’s office and just by blind luck, they needed someone.

Q: Key Democrats, including Senate Majority Leader Harry Reid, D-Nev., recently said their biggest regret was allowing the Senate Finance Committee leaders, your former boss Sen. Grassley and committee chair Max Baucus, D-Mont., to spend so much time trying to forge a bipartisan compromise on health care. What do you think about that criticism?

A: We really devised much of the health care framework even before the Gang of Six Senate (Finance Committee) leaders started meeting. In the summer of 2008, Sens. Grassley and Baucus held a summit and we were chugging along with planning our roundtables and it is my understanding that the leadership was frustrated with us that we were moving too quickly and they wanted us to slow down. We got agreement on 80 percent of the framework even before the Gang of Six started meeting to take on the remaining 20 percent. People were naturally impatient but the complexity of the job, connecting the dots and making the model work is a huge challenge so those who pushed for it to be done quickly were watching the clock and likely didn’t have a full appreciation for the issues we were attempting to resolve. The idea that the health care law could be done quickly and be done right is like saying you can go to the moon on the first try.

Q: What were the pieces that had been agreed to and what was the remaining 20 percent?

A: We agreed on the structure of the exchanges, state regulation, insurance reform, delivery system reform, the creation of the innovation center and financing mechanism. The last pieces that needed to be resolved and became problematic were the amount of funding, the offsets and the way the individual mandate would be implemented.

Q: What do you feel best about in the final law and what is your biggest regret about it?

A: It was rewarding from a professional standpoint to have been a part of the process and be on the inside for the development of health care reform. The delivery system reforms and value-based purchasing incentives, I think, will be the most transformative in the long run. As to regrets, I wish we’d been able to have a bipartisan Senate compromise so that the public could have embraced it and so much of it wouldn’t have been buried in controversy.

Q: Why did you pick Greenberg Traurig as your next landing place?

A: I wanted to go to a law firm and I wanted to practice law because I love the combination of the legal analysis and policy analysis and the in-depth work that you can do with the combination of the two. I just love it. And there is so much happening on the implementation side of things that it’s a really busy and exciting time to be in health law. And the opportunity to work with Nancy Taylor, (a former aide to Sen. Orrin Hatch, R-Utah) who runs the health practice, was just a great one. She has been a really close friend for so many years. I always learned something new from her.

Q: What is some of the work going to be on the implementation side?

A: We are working on a number of implementation issues because we work for the Business Roundtable, whose members are actively engaged in evaluating specific provisions of the law and providing concrete policy suggestions to the administration. We are also working with clients who want to do some innovative demonstration projects with the Center for Medicare and Medicaid Innovation. These are people who are trying to think about a cutting edge way to deliver higher quality care. Another issue is working on dual eligibles, those who qualify for Medicare and Medicaid, and how to fix the financing system to provide better care.