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Analysis

Donna Shalala's Return to Washington and the Fight for the Cost of Healthcare

By Jack O'Brien  
   April 14, 2020

The nation's former and longest-serving secretary for the U.S. Department of Health and Human Services reflects on her lengthy career shaping the healthcare industry and what policy goals she aims to achieve on Capitol Hill.  

This article appears in the March/April 2020 edition of HealthLeaders magazine.

U.S. Congresswoman Donna Shalala (D-Fla.) has spent her life working for the benefit of others. While serving in leadership roles in academia, government, and the nonprofit sector, Shalala has dedicated herself to improving the healthcare system and expanding access to affordable, quality care.

Shalala says she has "been interested in healthcare" since spending two years in the Peace Corps post-graduation working in an Iranian village. During that experience, she says she was moved by the health issues facing the population, including low immunization rates and nutritional challenges.

Shalala later chaired the PhD program in politics and education at Teachers College at Columbia University. There, she advised many of her nursing students who were writing dissertations on public health policy and the politics of healthcare.

Related: Former HHS Secretary Donna Shalala in the National Spotlight With Coronavirus on Center Stage

According to Shalala, she became "deeply involved" in healthcare during her tenure as president of Hunter College in New York City. There, she led the schools of nursing and physical therapy, as well as the Brookdale Center on Aging.

Shalala spent nearly 30 years as an academic administrator, highlighted by her service as chancellor of the University of Wisconsin–Madison and president of the University of Miami.

Between those positions, Shalala served as secretary of Health and Human Services (HHS) under President Bill Clinton from 1993 to 2001. During her time as the nation's longest-serving HHS secretary, Shalala worked with the Republican-controlled Congress to create the Children's Health Insurance Program (CHIP) and assisted Vice President Al Gore in promoting organ transplants.

In 2008, President George W. Bush awarded Shalala the Presidential Medal of Freedom, the nation's highest civilian honor.

After leaving Miami in 2015, Shalala served as president of the Clinton Foundation until 2017. A year later, she was elected to represent Florida's 27th congressional district during the midterm election cycle.

Following are highlights from Shalala's conversation with HealthLeaders about her leadership in healthcare.

"I went to Wisconsin and ran [UW Health], a huge healthcare system; we had hospitals, a large medical school, and we were real players in healthcare. I've been in and out of the healthcare business for a long time. I've sat on healthcare boards, [including] UnitedHealth Group, and even when I sat on a board like at Gannett, I was involved in the benefits structure and how they provided healthcare to their employees." 

"By the time I got to HHS, I was already a member of the [Council of Councils] at the National Institutes of Health (NIH). I knew a lot about the federal role in healthcare and had on-the-ground experience with hospitals and training programs, particularly in medicine, nursing, physician assistant programs, and physical therapy."

"What helped me more than anything else [at the agency] was that I had run a major research university, and in many ways, that's what HHS is. The people who run the Centers for Disease Control and Prevention, NIH, or Food and Drug Administration are very much like your own deans. It's a highly federated system, and I was used to that because, from a management point of view, I was very experienced."

Related: Former HHS Secretary Donna Shalala Says Azar Failing to Lead

"[As the HHS secretary,] we didn't get healthcare reform done, but we pivoted and got CHIP and a lot of work done on getting children immunized. We [also] doubled the NIH budget; those are huge accomplishments."

"We need to lower out-of-pocket costs by getting a good drug bill and forcing the administration to start negotiating. We're just following the president's lead. He said he wants to negotiate like heck; we should take them up on it."

"I see no reason to concentrate our energy and money on people who already have good health insurance. We need to focus on those that have lousy health insurance or no health insurance—that's the role of the federal government. We shouldn't spend more than two minutes worried about people that have good health insurance."

"I'm a believer in using existing platforms; the ACA is a good package. I'd like lower deductibles, because I think part of our problem in healthcare is that we've moved toward high deductibles. There are some corrections we can make on the ACA, but we may have to wait for the next administration."

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"What's shaped my perspective is talking to people in my community and their concerns about out-of-pocket costs. I'm concerned that while we're revolutionizing the delivery of care, we're forgetting about out-of-pocket costs, and so many businesses have moved to high-deductible plans."

"My view is that we're avoiding a set of hard decisions about the cost of drugs and the delivery of care. We've probably reached our limit in terms of how much we can ask people to pay. People are nervous about their out-of-pocket costs, and they're fearful that one disease is separating them and bankruptcy."

"As we've moved away from large industries to the gig economy, having access to affordable care has been a bigger issue. Raising the income limits on the ACA is going to be one of our challenges in the future as we reach into the middle class, to people that have jobs that pay well but are trying to buy into the market. We've got to start worrying about the people we talk to every day."

Related: Congresswoman Donna Shalala Trying to Protect Healthcare Workers, Expand Free Testing for Coronavirus

“I'm concerned that while we're revolutionizing the delivery of care, we're forgetting about out-of-pocket costs.”

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.

Photo credit: Pictured above: U.S. Congresswoman Donna Shalala (D-Fla.). (Photo credit: Allison Shelley/Getty Images.)


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