Lisa Dubay and Brad Herring: Public-Private Partnership

Lisa Dubay, Ph.D., Sc.M., is Associate Professor at Johns Hopkins Bloomberg School of Public Health. Her research interests center on assessing the impacts of public policies on insurance coverage, access to care, and the health of low-income populations. Brad Herring, Ph.D., is Assistant Professor at Johns Hopkins Bloomberg School of Public Health and researches economic and public policy issues around health insurance. Brad has served as a Senior Economist in the White House’s Council of Economic Advisors.

We asked Lisa and Brad about their SHARE project that evaluates reform efforts in five states that are expanding coverage to adults via Section 1115 demonstration waiver authority. They talked about snowballing reforms, circuitous paths, and hoop dreams.

Your SHARE project examines fives states that use incremental reforms through Section 1115 waivers to expand health insurance coverage to adults.

HERRING: Despite the fact that pursuing small-scale insurance expansions for uninsured adults is a common state strategy for expanding coverage, it has received less attention than the large-scale expansion in Massachusetts or the various SCHIP expansions. Whether the country moves forward to cover the uninsured at the federal level or the action remains at the state level, it is important to address the issue of uninsured adults. If we can show that these efforts were successful, we hope it will snowball into larger efforts to expand coverage.

DUBAY: Historically, most states engaged in health reform have done so through expanding Medicaid, for which single adults have been categorically ineligible. Using 1115 waivers has allowed states to target uninsured adults, who are the vast majority of the overall uninsured.

HERRING: The states we are examining use different means to that same end. Maryland, Illinois, and New Jersey are largely focused on Medicaid expansions through public insurance; whereas Oklahoma and New Mexico have subsidized insurance in an attempt to expand coverage.

Your project employs a strong mixed-methods approach. What does the qualitative piece entail?

DUBAY: For policy analysis projects, it is critical to combine qualitative and quantitative methods. Without qualitative data it is difficult to interpret quantitative data. We are excited to have our team member, Christina Moylan, take the lead on these case studies.

HERRING: We are interviewing policymakers involved in the passage of state legislation and members of special interest groups that want to impact reform, such as state hospital associations and state medical associations. We also want to interview leaders of different advocacy groups involved in organizing forums or garnering support for or against proposals.

Tell us a little bit about your research team.

DUBAY: We have a great interdisciplinary team that includes researchers with backgrounds in sociology, economics, and political science. This diversity really lends itself to our mixed methods approach.

HERRING: My background has largely been in private health insurance markets and Lisa’s background is largely in public health insurance, particularly Medicaid and SCHIP. Christina’s Ph.D. studies are in political science. We make a good team considering that many states are mixing public and private expansions. It is going to be a neat learning experience.

How did your paths to Johns Hopkins differ?

HERRING: I started out studying biomedical engineering. During that time I also took some economics courses and got interested in applying economics to the health care industry. This resulted in a Ph.D. in health economics. I taught at Emory and left the excellent restaurant scene in Atlanta to join Lisa at Hopkins. Most recently, I served on the White House Council of Economic Advisors, where I was exposed to the federal policy making process.

DUBAY: I also took somewhat of a circuitous path. I majored in sociology and then worked at a rape crisis center for four years. After returning to public health school, I worked at the Urban Institute where I stayed for nineteen years. I always wanted to teach but knew I could never do that without a doctorate, so mid-career I went back to school. I love teaching and working with students. Right now I teach a course called Health Policy Analysis and Synthesis, which is designed to show students how you can use available evidence to influence policy. Teaching is challenging. I’ve never worked quite this hard before.

If you hadn’t become professors and health services researchers, what would you be doing?

DUBAY: I am interested in brain science, particularly the environmental influences on the brain. Going back to school for that pursuit would have kept me in school for a long time.

HERRING: I liked physics and math, so I could have continued my undergrad path and become an engineer. My unrealistic choice would have been a professional basketball player. Unfortunately, there are certain God-given abilities that were just never there.