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- [00:00]
Podcast Host
Welcome to Advancing Health Amplifying Hospitals Messages and stories is essential for keeping health care healthy. April's Leadership Dialogue podcast explores how the healthcare field's advocacy on things such as affordability is getting through to lawmakers and spurring action.
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Dr. Mark Boom
Thank you everyone for joining me today. I'm Dr. Mark Boom, I'm the President and CEO of Houston Methodist and I am the Board Chair of the American hospital association in 2026. As we continue this series of discussions this month, I want to shift our focus slightly to advocacy. As you know, and hopefully many of you attended, we just held our annual membership meeting for the aha in Washington, D.C. where the attendees participated in many sessions on a lot of key topics within the field and were able to hear directly from lawmakers and policy experts. A major theme of the meeting and of course a core principle of the AHA's work on behalf of our entire profession and field is advocacy. So I thought this would be a great time and opportunity to further spotlight its importance to this broader audience. So I'm very pleased today to be joined by a very impressive individual who does this every day so well for the AHA, and that is Stacy Hughes, who is the AHA's executive vice president of Government Relations and Public Policy. If you don't know Stacy, she oversees the AHA's legislative, political, regulatory, grassroots and legal advocacy efforts and is widely recognized for combining her deep understanding of very complex healthcare policy with tremendous political acumen and experience. Before joining aha, she held multiple leadership positions in the Senate and immersed herself in healthcare policy, managing major legislation, coordinating with various members and offices on both sides of the aisle, and running House Senate conference committees. Before we jump in the conversation, you know many of you have heard me speak. Know that one of my guiding principles applies significantly when we talk about advocacy and policy. And that's me talking about what I see as a sacred and when we really need to be thinking in terms of and rather than or and obviously that is something in the advocacy and political realm. We oftentimes do see a lot of or thinking and I believe when we embrace and mentality when we listen to others with different viewpoints, we work with others from really across the spectrum. It opens up space to listen to understand compromise in ways that allow us to find common ground and we can thereby advance the care and health for our patients. We're facing very challenging times, no question, but we have a profound responsibility to advocate for all of our patients and for our communities and to be effective in doing that. It means we approach change the Challenges and the opportunities with that and mentality that I describe. So now let's jump into our discussion. Stacy, again, thank you for being here. Let's start with the intersection of policy and advocacy. You've had, as I mentioned before, an impressive career working with both lawmakers and policymakers. Give us a little insight on how those stakeholders think about and how they approach the healthcare issues that are important and what things when we advocate breakthrough with them.
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Stacy Hughes
Yeah, it's a great question. I think it's very cyclical in terms of how the stakeholders look at health healthcare policy through that prism. You can't not have any prison without mentioning the debt. We have a $39 trillion annual debt in 2026. We pay over 1.1 trillion a year just for net interest. So a lot of those stakeholders, quite frankly, because Medicare and Medicaid as well as subsidies are such a significant piece of the federal budget, many policymakers are looking exclusively at that through the lens of the taxpayer. Are we able to sustain these services? You know, others, I think almost all do also look at the patient first. You know, in terms of what's happening with access, is there high quality care? But right now, I would say if you're looking at this Congress and looking ahead, it really is about affordability. And I think what you're starting to see is more policymakers trying to balance that issue around affordability as well as taxpayer and being able to have a healthy approach to looking at the deficit and debt. But also in terms of what is actually the care people are receiving. One of the biggest topics is obviously around affordability is drug pricing. And if you look at any polling boom, you always see that it's one of the highest political yields in terms of getting your arms around the drug pricing issue as well as commercial insurer accountability. I think those two issues have really taken the forefront of this Congress and probably will for the coming year in terms of trying to find ways to take some of the friction out of patients ability to access care and to access innovation as well as access the care that they need.
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Dr. Mark Boom
I mean, it seems to me like thinking of that and, and thinking about really what our sacred purpose is as health institutions, which is to serve people. When those individuals we're talking about are responsive to their constituencies. Right. They're serving humankind as well. It seems to me there should be great alignment there around finding solutions to some of the toughest problems, things like affordability. I mean, do you think we can work together and, you know, focus on that and, and focus on those commonalities to drive that and to get there.
- [05:17]
Stacy Hughes
I do. And I think one thing we're seeing, and it's not unusual, but it certainly seems very heightened right now, and that is each of the stakeholders in health care are kind of turning on each other. You know, there's this enormous blame game of who's responsible for access issues, affordability issues. I think that you're starting to see some fatigue with members of Congress and stakeholders and policymakers that they really just want to get to a place where we can take some friction out of the system. And I do think there's more opportunity for bipartisan solutions. I think we saw that even though it didn't get across the finish line on trying to look at ways to extend the Biden era, enhance premium tax credits. I know we worked hard on that with you and your team, but they didn't get there. But there was legitimate, authentic bipartisan conversation to try to get to a solution. And I think you're seeing more and more of that as these, particularly senators and congressmen, their constituents are fed up and the system isn't working for them. So I do think there's opportunity. It will take all stakeholders. And to your point, at the end of the day, these members really care about their constituencies and they care about their hospitals, they care about their ability to access care. So I do think there is an opportunity. As often as the case in Washington though, you often need an urgent situation or an emergency or a action forcing event. And whether that's going to be the budget and deficit or whether it's going to be just political demand as a result from their constituencies, it's going to require something that's going to force action.
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Dr. Mark Boom
Affordability is this obviously very key topic. We all see that. Do you see that as a very bipartisan issue right now, that something you're hearing from both sides of the aisle is critically important? Is it going to stay that way? Could it become more of a partisan type issue as we've seen some issues become? Because clearly that is a major area of focus for us and we believe that hospitals should help convene that work since we should all be on that same page about moving that forward for the people we serve.
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Stacy Hughes
I totally agree with you that that is going to be the primary issue that's going to bring bipartisan conversations together. And the one thing about affordability, it is everyone, right? It's drug pricing, it's devices premiums for health insurers, it's the employer is trying to continue to stay in that market for their employees. It's hospitals wanting to continue to provide their services while not being paid at cost for their service. So everyone's trying to make it work. I do think affordability is here to stay. I think that it's often, you know, as we've gone through a period of inflation, you know, it's often hard to get that genie back in the bottle. And I think that there's just been an incredible increase in constituent polling. The number one issue just at a Gallup last week or a couple weeks ago was polling that reference that health care is the number one issue. So I think even though the success of the aca, that pendulum is swinging back and to your point about finding solutions, I think even Democrats recognize that while the ACA was a primary crowning achievement during the Obama years, people are recognizing it's still unaffordable. And there is bipartisan recognition that we need to look under the hood and figure out how do we do this? We've got people access to coverage, but is that coverage meaningful and can they afford it? So I do think this theme is going to stay with us and define much of the health care policy discussion in the coming years.
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Dr. Mark Boom
You know, as we talk about affordability and that theme, you know, one of the things that certainly frustrates me as a health system leader is because hospitals and doctor's office are where the action is, right? It's where things happen. We often seem to get pointed at around affordability issues when what's constantly being missed in that is the input pricing to what we do is actually coming from other sectors and other parts. And so we end up sort of on the tip of that spear. So the with that, it seems like along the lines of affordability and everything else we do in advocacy, it's really important that hospitals are able to tell their stories and really both communicate with elected officials and constituencies and others the importance and the noble nature of what hospitals and people who work in hospitals and physicians and nurses and everybody do, and amplifying those stories and also bringing a deeper understanding to some of the complexities and maybe some of the misperceptions that are sometimes there. So what's your advice on how to most effectively do that? I've heard you many times talk about how critically important getting those stories out throughout the country, in every state, from all of our members, is so important. How do we all best go about doing that?
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Stacy Hughes
Well, you almost did it in your question, Dr. Bam. You really did lay out beautifully some of the challenges that we face and being able to Unpack it. I think there's a real art in advocacy and I think that. But most of it is authenticity and it's what the impact is of a policy is on patients and the patients we're serving. And to your point about it's a noble profession, we want to care for our communities and being able to really showcase through real stories, real challenges, but also data. I mean they want to understand what's going on in their backyard, the hospital that's in a members district, they want to understand and they need to know what is the payer mix, what's happening, what can't we do? Perhaps when the obba, the one big beautiful bill for business start to come online, what are the choices that we're gonna have to make that may interrupt some access to certain services? And I think to the degree that we can be as specific as possible, make sure we keep the patient as the center of our policy imperatives and we make sure we explain well what these different policies mean to our community is really important. But I think it is taking the time to have these conversations over and over again bringing these policymakers into your facility, show them what you do every day, what your nurses and doctors, what they're doing every day is really important. And I will say on an optimistic side, members of Congress and senators, they really love their hospitals. I think while we're feeling some of the pressure, some of the other stakeholders finger pointing, I do think there is a real opportunity to peel back that onion of all those input costs and what challenges we face. But also to your point, we have an obligation to also find creative ways on affordability, find ways that we can contribute to make the system more efficient, less expensive, reduce infection, all the things that we do and bring those ideas forward as well. So we're contributing to a patient experience that's both more affordable and efficient.
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Dr. Mark Boom
As we have those dialogues, it strikes me, I believe this firmly in the bottom of my heart that hospitals and physicians and really the caregiving side of the equation or part of the whole healthcare ecosystem, we're the ones with the relationships with the patients, just as our legislators have relationships with their constituents. And it's not pharma, it's not supply chain, it's not the payers. And that's, I'm not knocking them in saying that it's that we're the people right there at their side in an exam room taking care of them, taking, helping them in some of their toughest times, helping manage their wellness and everything else. So isn't it logical with the storytelling, everything else that hospitals step forward and help convene and help be that and kind of glue to help drive some
- [12:12]
Stacy Hughes
of this forward 100%. And I think that in your leadership with our board and our association, we've really started to lean in more significantly on that conversation and dialogue and how we can start convening more of a conversation on that point. And I think that we are very effective at it. I think members of Congress do appreciate what you just said, the role we provide in the community. A community can't exist without us. I think telling that story is critical and we have an obligation as well
- [12:38]
Dr. Mark Boom
with all of that. And I talk about the sacred and one of the big underpinnings of that is the beauty of people coming at questions from different angles, different backgrounds, and coming to compromise or coming to consensus. I mean, it's something I think, and we'll talk some more about this a little later with the aha. We do, I believe, very well and very critically since we have such a broad, diverse membership of so many different kinds of hospitals and health systems across the country. But a big part of that then is compromise, and that has to play out in politics as well. Do you have any insights on kind of the current status today, what advocacy approaches might be most effective, effective in finding solutions that can be bipartisan and where compromise happens?
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Stacy Hughes
I think in terms of compromise, one of the things that, you know, when you think through is how does the whole ecosystem, all the stakeholders, come together and put forth something on the table that will help ease some of this friction, Right. And so I think that there is an opportunity for compromise. The question is everyone's going to have to be willing to come to the table was something that at least addresses whatever that pain point is. It's a pain point. You know, you mentioned how much we, we have hands on patients. And I think that you're seeing a lot of backlash, bipartisan backlash against the middleman, you know, the middles, as some call it, whether it's PBMs, whether it's the insurers, we need to bring forth ways in which we can, we can help identify solutions for that pain point. So I do, you know, looking across the whole system and there may be things that we're doing that we need to say, hey, we can make this a little better, a little smarter, a little faster. So I think there are opportunities for compromise. And I think that at some point, as I mentioned earlier, even Democrats, notwithstanding the ACA success, they recognize that there are more issues out there in terms of the coverage that people have that are precluding their ability to get access to care.
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Dr. Mark Boom
So I want to close then asking a question about really unity within the hospital systems. A major and right, as I mentioned, we represent, you know, 5,000 hospitals. We represent hospitals of every sort and hospital systems of every sort across this great nation. Oftentimes, you know, what's good for one may not be good for another. What sometimes things are good for all. How important with all of this focus, especially as we tackle tough issues, compromise, working on affordability and things like that, how important is it that we remain unified as a voice within, as a field and as a profession?
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Stacy Hughes
Well, I will tell you, it is our superpower. We'll always be able to find solutions within the field writ large that benefit our hospital and health system. And certain provisions might benefit some, but we'll always be working, rowing in the right direction to advance the field at large. And we are the envy of other trade associations. No other trade association, no other sector in health care is the number one employer in every congressional district. Basically every congressman, senator has a hospital in their district or state. And we do incredible work and they know it. And I think that we are the nv. If you look at pharma, they've got, they're in the Northeast, that's it. You know, a little bit in the South, a little bit North Carolina, you know, we have. And we, when we use our unity to bring forth our agenda for patients, it is beyond compare. And while there may be certain provisions and proposals that address some inequities around the field, we're going to work on those, too. I think we all benefit when we're all working together because our voice is incredibly powerful.
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Dr. Mark Boom
I love that. It's our superpower. So unity and is our superpower. I love that. I'm going to probably steal that. You may hear that from me again sometime. Well, Stacy, thank you so much for your time today, sharing your always amazing insights. Thank you for the wonderful work you and the team do for all of the members through the American Hospital Association. As always, as healthcare leaders, when we're focused on our mission and we're focused on the patient at the center, and when our elected officials are focused on their constituents who are our patients and communities. And together we can make very positive change. And together we can advocate for policies that will allow us to continue to enhance the care for all those that we serve. So thank you for taking the time to listen today. I'll be back next month for another leadership dialogue conversation.
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Podcast Host
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