Former Navy Chief Medical Officer Seeks House Seat

As a physician committed to public service, Steve Ferrara, MD, wants to solve America's 'most important domestic issue' while representing Arizona's ninth congressional district.

A lifelong Navy officer-turned-physician, Steve Ferrara, MD, has dedicated himself to public service for nearly three decades, including as the branch's chief medical officer and in a combat role in Afghanistan. Ferrara now wants to continue his public service career by representing Arizona's ninth congressional district in the House of Representatives.

If elected, it would be a return trip to Capitol Hill for Ferrara, who participated in the National Academy of Sciences congressional fellowship from 2012 to 2013, working on the House Subcommittee on Health. While there, Ferrara helped coauthor legislation, including the Medicare Sustainable Growth Rate (SGR) repeal.

Ferrara told HealthLeaders that both sides of the aisle agree that healthcare has room for improvement in order to provide cost-effective access and quality for patients.

The following transcript has been lightly edited.

HL: What do you think of the current state of healthcare?

Steve Ferrara, MD: I think one of the challenges causing a stalemate about being able to move forward with improving our healthcare system is that people have been hung up on a lot of the terminology. It's been very politicized; there's one side that says repeal and there's one side that says protect [the ACA]. The way I approach the situation is that we need to make healthcare better. I'm less concerned about semantics and more concerned about solutions.

I tend to favor state and local control, because the states are different. I think it's better—just like we do with education—to let those things get done at a state and local level. Then we also get 50 laboratories of innovation by having states do that.

The next thing I would take on is the insurance market, [because] I think we should have healthcare insurance more closely emulate every other insurance product that people buy. I think it should be something that you're able to buy early in your life, not necessarily with a mandate but something of a financial incentive, that you walk into at a lower rate.

Like any product we sell in America, if we expect people to buy the product, it should add value to their lives. And I think part of the reason people are unhappy with their health insurance products are they find that they're too expensive and don't offer much care. We need to look at things from a patient-centered standpoint, using the demand-side model rather than a supply-side model.

The third tenant [of my plan] is addressing preexisting conditions. I work at Arizona's largest safety-net hospital, and we take care of those folks, but we do it in the least efficient manner possible. We force folks to let their condition go untreated because they can't afford care until they're in extremis. Then you end up with a 911 call, an ambulance ride, and an ER visit, and the patient has a poor outcome while the taxpayer gets a huge bill. The whole thing is a lose-lose. We need to look at things prospectively and make sure all patients with preexisting conditions are covered regardless of their ability to pay. People who can pay their fair share should, but people who can't should have a government backstop. It's better for the patient, it's more ethical, and it's also more economical to take care of that patient prospectively.

HL: How do you think the ACA is currently functioning, and what would you like to see done with it?

Ferrara: I think one of the flaws in the ACA was that it was [passed] with a single-party vote, there weren't stakeholders on the other side. I would give equal criticism to the Republican replacement plan because that was a single-party vote. I think healthcare is such an important issue and it's such a big tent—every person in the country is a stakeholder—so it needs to be done in a bipartisan manner. I think unless we do this in a bipartisan way, we're not going to come up with any kind of a quality or endurable solution.

HL: What are your thoughts on Medicare for All? Do you think it's a practical idea, or is it not compatible with our healthcare system?

Ferrara: I think Medicare for All is incompatible with our healthcare system because we've seen from non-partisan think tanks that it would cost $32 trillion and double people's taxes, which is not something people want.

I also think a top-down, one-sized D.C.–run healthcare plan is not agile, it's not flexible. I fear that Medicare for All will rapidly devolve into Medicaid for All. Then we're going to end up with straining an already strained system. I also think it will dilute out seniors who have worked hard and have earned their Medicare benefit. When [Medicare] is expanded, it's going to end up having a deleterious effect on seniors. I don't favor Medicare for All for those reasons, and I absolutely believe we need to have healthcare for everyone, but I don't think that's the right way to go about it.

HL: How do you think the Trump administration has approached healthcare policy, and do you have any advice for them given your frontline clinical experience?

Ferrara: Part of the reason I'm running for Congress is I feel that Congress in general, not only on healthcare, has largely abdicated a lot of legislative responsibility to be done by executive order. I don't agree with that fundamentally, and a lot of the healthcare changes to the ACA have been done by executive order.

I think it's a good thing that premiums are going down for the first time since healthcare.gov opened. I think the administration is trying to do things that are providing more choice and more flexibility for people's healthcare options, which I generally favor. But I think that the best way to [make change] is through the legislative, bipartisan route and then you get codification.

HL: Can you give me a little bit of color about your fellowship on the Hill, and what that taught you about the federal approach to healthcare policy?

Ferrara: It was a rich and educational experience, and one of the first things you become acutely aware of is truly how many stakeholders there are in healthcare.

There are more healthcare lobbyists in Washington, D.C. than any other sector, so the fact that healthcare has more lobbyists, that's telling you something. It's telling you we need to have people in Washington that are in elected office that know what they're doing so the lobbyists aren't making policy.

I had the good fortune of working for great leaders like [Rep. Mike] Burgess, R-Texas, who is currently the chairman of the [House] Subcommittee on Health, and [Rep.] Fred Upton, R-Michigan, who was the chair of the [House] Committee on Energy and Commerce.

Under Upton's leadership, [the committee] repealed SGR after 12 years of not being able to do it. They also passed the 21st Century Cures Act, big healthcare legislation got done, and it was because we approached it with a process of 'we're going to come up with good policy that people are going to have a hard time not getting behind.' Rather than try to do the politics first, and then see if there's a nugget of policy, we did the opposite. We created good policy and then we went to the members and said, 'This is a good policy, and your constituents are going to be better for this.' And people got behind that.

HL: What should hospital executives and health system leaders take away from your candidacy?

Ferrara: I think the biggest thing is my interest in improving the healthcare system in a bipartisan way and thinking about solutions and not semantics while being a problem solver. I'm not running on any platform related to Obamacare. I am running 100% to make healthcare work better for patients on the economic side and the clinical side. I am truly an honest broker when it comes to making healthcare better and I'm not a partisan about it at all, which I think makes me fairly unique.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.