The Healthcare Policy Podcast ® Produced by David Introcaso

This past Tuesday Senate Democrats passed a $3.5 trillion budget resolution what would allow Congressional Democrats to fund significant health care reforms along with education, immigration, climate crisis and other termed “care economy” policies.  Among other healthcare policies Congressional Democrats are working to fund are expansions to Medicare coverage, boost by $400 billion Medicaid Home and Community Based Service (HCBS ) waiver funding and address health equity issues.  Dedicated listeners may recall I interviewed Matt in March 2017.  During this 40 minute interview, Matt Salo discusses, in sum, the merits of Medicaid reform policies Democrats have already outlined beginning with improvements in long term care, again, expanding HCBS waiver funding.  He discusses several related Medicaid reform policies NAMD has already identified, discusses Medicaid-related social determinants funding, the merits of expanding value based purchasing arrangements in the Medicaid program and issues concerning Medicaid access and provider participation in the Medicaid program.  Mr. Matt Salo has served as Executive Director of the National Association of Medicaid Directors (NAMD) for the past decade.  NAMD represents all 56 of the nation’s state and territorial Medicaid Directors, and provides them with a strong unified voice in national discussions as well as a locus for technical assistance and best practices.  Mr. Salo formerly worked for 12 years at the National Governors Association where he forwarded the Governors’ health care and human services reform agendas.  He worked previously for five years as a health policy analyst for state Medicaid Directors at the American Public Human Services Association.  He also spent two years as a substitute teacher in the public school system in Alexandria, VA.  Mr. Salo holds a BA in Eastern Religious Studies from the University of Virginia.Information on NAMD is at: https://medicaiddirectors.org/about/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

As listeners are likely aware the Biden administration has given priority to addressing health equity, meaning distributing health-related resources based on recipients’ needs.   This is not surprising since, in part, research published in JAMA in June 2019 by Zimmerman and Anderson concluded, "there has been a clear lack of progress in health equity during the past 25 years in the US."  (Think: the failure of neoliberalism.)  When discussing health equity, the issue of social determinants of  health (SDOH) are immediately begged since one’s social or lived environment is substantially more responsible than medical care in explaining one's health status and because the poor and/or minority population’s social and economic circumstances are comparatively far worse.  This explains why, as Trust for America's Health (TFAH) recent report titled, "Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity," notes, race and ethnicity-based health disparities total over $90b annually in excess medical costs.  Listeners of this podcast are aware I’ve discussed the social determinants of health on several occasions over the past nine years.  For example, this past March I discussed the topic with UCSF’s Drs. Braveman and Gottlieb.  During this 32 minute interview Mr. Lustig moreover discusses several of the policies outlined in TFAH's "Leveraging Evidenced-Based Policies" under five categories identified in the report:  access to high-quality health services; economic mobility; access to affordable housing; improving learning environments; and, health-promoting taxes.   Mr. Adam Lustig is Senior Policy Development Manager at TFAH. H is responsibilities include leading TFAH’s Promoting Health and Cost Control in States (PHACCS) project.  The PHACCS project seeks to promote the adoption and implementation of effective, evidence-based state public health policies outside the healthcare sector that will have a positive impact on residents’ well-being.  Prior to joining TFAH, Mr. Lustig was the Senior Manager of Health Systems Transformation at the National Network of Public Health Institutes, where he developed strategies related to improving healthcare systems, alternative payment models, and supporting people-centered health systems.  Mr. Lustig has also held positions at the Advisory Board Company, the National Pharmaceutical Council and the University of Pennsylvania.  He received his MS in Health Policy from the Thomas Jefferson University College of Population Health and a BA in Public Policy from the State University of New York at Albany.TFAH's report is at: https://www.tfah.org/report-details/leveraging-evidence-based-policies/.Regarding economic mobility, listeners are encouraged to read the recent July 22 NEJM Perspective essay by Lucy Marcil, et al., titled, "Medical-Financial Partnerships - Beyond Traditional Boundaries." This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

In late May I interviewed John Kotcher regarding his survey that showed physicians worldwide had a limited understanding of the climate crisis and its health effects.  For example, 41% said they lacked sufficient knowledge to discuss the topic and less than half also believed the climate crisis is responsible for heat-related illnesses and increases in vector borne diseases.  Since the climate crisis will pose increasingly harmful human health consequences, especially for Medicare and Medicaid beneficiaries, health professionals would be well served by understanding the physics of climate change or what is causing planetary warming.  Concerning recent climate crisis-related events: North American just suffered its hottest June in recorded history; two recent studies recently concluded the climate crisis presently causes five million deaths annually and the earth’s energy imbalance approximately doubled between 2005 and 2019; and, a leaked UN Intergovernmental Panel on Climate Change report (the report is expected to be published later this year) warns a series of thresholds or tipping points may soon be crossed that will leave policy makers unable to control of limit global warming - meaning the earth will experience run away warming.  During this 34 minute conversation Dr. Krauss begins by noting climate change or the climate crisis, like evolution, is empirical fact.  Dr. Krauss goes on to discuss in detail how and why the planet has warmed by on average 1.3 degrees Fahrenheit moreover over the past 60 years due to human-caused emissions of greenhouse gases (moreover from the burning of fossil fuels) or approximately 10 billion tons annually.  His discussion includes noting emissions to date will largely persist in the atmosphere for the next 1,000 years, that the planet will continue to warm if and when human-caused emissions are eliminated largely due to continued ocean warming and he discusses a few nonlinear feedback loops, for example, the release of carbon via melting permafrost, that will exacerbate the climate crisis.  Dr. Krauss concludes by explaining why he wrote the work or how it may help policymakers address the issue.   Dr. Lawrence Krauss has recently retired as Director of The Origins Project at Arizona State University and was a professor at ASU’s School of Earth and Space Exploration and Department of Physics.  He now serves as President of The Origins Foundation and hosts The Origins Podcast.  Dr. Krauss 's work as a theoretical physicist included study of the interface between elementary particle physics and cosmology, focusing on the origin and evolution of the universe and the fundamental structure of matter.  He has written more than 300 scientific publications and ten popular books, including the international best-sellers, "The Physics of Star Trek," "A Universe from Nothing" and "The Greatest Story Ever Told--So Far."   He writes regularly for magazines and newspapers, including The New York Times and The New Yorker, and frequently discusses his work via radio and television programming.  He is the recipient of the highest awards from all three US physics societies and received the National Science Board's2012 Public Service Award.  Dr. Krauss earned his B.Sc. in math and physics with honors from Carleton University and his Ph.D. in physics from MIT.   Information on the book is at: https://posthillpress.com/book/the-physics-of-climate-change.   A video of a Dr. Krauss physics of climate change lecture is at: https://www.youtube.com/watch?v=lApLD5g1Nrs.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The US prison and jail population is the largest in the world at two million.  With 4.2% of the world’s population, the US accounts for roughly 25% of the world’s prisoners.  African Americans, at 13% of the general population, account for 34% of the prison population.  Much like the effect COVID-19 has had Skilled Nursing Facility (SNF) residents, prisons and jails have also constituted killing fields.  Beyond this, prisons and jails serve as infectious disease multipliers, or as epidemiological pumps, spreading disease far beyond their walls.  For example, prior to the beginning of last year’s school year prisons and jails accounted for 90 of the 100 worst COVID-19 cluster cites.  Those incarcerated in jails and prisons have suffered a 5.5 times greater risk of a COVID-19 infection, experienced three times the death rate of those not incarcerated and so-called jail cycling has significantly accounted for COVID-19 infection rates in the general population, moreover in minority communities.  The combination of high rates of arrest and incarceration have consequently become, as Dr. Reinhart recently stated, both the symptom and cause of poor public health, not a solution for it.   (To appreciate further the extent to which mass incarceration affects prisoners’ health, in December 2016 I discussed the behavioral/mental health effects via wide-spread use of solitary confinement with Solitary Watch’s Jean Cansella.)  During this 40 minute discussion Eric Reinhart begins by discussing why and how he chose Cook County Jail for his research and describes how he conducted his study.  In turn, he discusses and dismisses the possibility of reverse causality, details the magnitude of the jail cycling problem or the effect released inmates have on community or public health, discusses the use of decarceration in response to the pandemic and more generally as a solution for excessive punitivity/incarceration in context of carceral-community epidemiology. Eric Reinhart is lead health and justice systems researcher at Data and Evidence for Justice Reform (DE JURE), the World Bank.  He is a medical anthropologist, resident physician in the Physician Scientist Training Program at Northwestern University’s Department of Psychiatry and Behavioral Sciences, and an advanced candidate in adult psychoanalysis at the Chicago Center for Psychoanalysis.  His writing has appeared in the New York Times, Wall Street Journal, Jacobin, Boston Review, boundary 2, Journal of Legal Studies, Health Affairs, New England Journal of Medicine, British Medical Journal, The Lancet, and the Proceedings of the National Academy of Sciences.Reinhart's May Health Affairs blog post, "How Mass Incarceration Makes Us All Sick," is at: https://www.healthaffairs.org/do/10.1377/hblog20210526.678786/full/.Reinhart and Chen's May 2021 Proceedings from the National Academies (PNAS) article, "Carceral-Community Epidemiology, Structural Racism, and COVID-19 Disparities," is at:  https://www.pnas.org/content/118/21/e2026577118.short.Reinhart and Chen's June 2020 research article, "Incarceration and Its Disseminations: Covid-19 Pandemic Lessons From Chicago's Cook County Jail," is at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00652?utm_campaign=covid19fasttrack&utm_medium=press&utm_content=reinhart&utm_source=mediaadvisory.Reinhart's March "Medicine for the People" Boston Review essay is at: http://bostonreview.net/science-nature/eric-reinhart-medicine-people.Information on Paul Farmer's Pathologies of Power: Health, Human Rights and the New War on the Poor is at: https://www.ucpress.edu/book/9780520243262/pathologies-of-power. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

In The Hospital, Mr. Alexander provides an account of Bryan, Ohio's Community Hospitals and Wellness Centers (or CHWCs) hospital’s efforts to stay solvent between 2018 and 2020.  The work, in many ways is a companion to Nick Freudenberg's "At What Cost, Modern Capitalism and the Future of Health (I interviewed Prof. Freudenberg on May 20th), is particularly timely because rural hospitals, that serve roughly one in five Americans, are closing at a record rate.  For example, 136 have closed since 2010 and currently over 500 are at risk of closing.   The demise of rural hospitals is largely due to decades of poor-to-dire economic circumstances, largely zero wage growth for non-degreed workers, particularly in Ohio and the five other Rust Belt states.  The consequence thereof has been approximately 100,000 annual "deaths of despair."  (See Case and Deaton's 2020 volume by the same title.)  The demise of rural hospitals generally and the threat to CHWC is the health care marketplace that Mr. Alexander terms, "cut throat."  Not surprisingly therefore, in “The Hospital” Mr. Alexander also profiles the health status and economic circumstances of several CHWC patients and their peers and describes healthcare marketplace realities and their effects on CHWC.      During this 34 minute interview Mr. Alexander begins by explaining how and why he chose CHWC to profile.  He moves move on to discuss moreover the health status of CHWC patients' health and their economic circumstances (i.e., the role social determinants play), discusses CHWC's struggle to succeed in a health care market dominated by two large regional provider organizations, why the CHWC's CEO and board refused to merge with a large provider entity and discusses what he concludes from his two year study.     Brian Alexander is a contributing writer to The Atlantic.  His most previous work is the Glass House, The 1% Economy and the Shattering of the All American Town, winner of the Ohioana Book Awards.  He’s also written for The New York Times, Los Angeles  Times and Esquire, among others.  He’s presented at The Obama Foundation Summit and in Washington, D. C. to members of the Senate and House of Representatives.  Mr. Alexander lives in San Diego. Information on The Hospital is at: https://us.macmillan.com/books/9781250237361.Information on Glass House, The 1% Economy and the Shattering of the All American Town is at: https://us.macmillan.com/books/9781250085801. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Last October India and South Africa appealed to the World Trade Organization to temporarily waive patent or intellectual property (IP) rights such that COVID-19 production and distribution worldwide could be accelerated.   As of a month ago 80% of COVID-19 vaccines had gone to those in in high or upper middle income countries while only 0.2% had gone to those in low income countries - meaning it was projected to take until 2024 to inoculate developing world populations.  The Trump administration opposed a waiver.  In early May, the Biden administration announced it would support a so called TRIPS (Trade-Related Aspects of Intellectual Property Rights) waiver over the opposition the European Union (EU) and the pharmaceutical industry - though Moderna announce last fall it would not enforce its COVID vaccine-related patents).   Along with recent administration announcements to purchase and distribute over 500 million vaccines worldwide, the administration has evidently recognized the moral imperative and the fact COVAX, the WTO's initiative to pool vaccine resources, remains profoundly underfunded.      During this 26 minute conversation Ms. Krishtel moreover explains why the Biden administration was unprecedented, the definition of a waiver, its timing and the practical issue of tech transfer.  She goes on to address or refute the industry's objections to a temporary waiver and discusses more generally inherent problems with the market-driven US patent system.  Among other issues, it undermines the purpose of public investment, socializes risk while privatizing profits (or places profits over people) and slows the worldwide diffusion of pharmaceutical know how.         Ms. Priti Krishtel is the co-founder of Initiatives for Medicines Access and Knowledge (I-MAK),  a non-profit building a more just and equitable medicines system.  She has spent nearly two decades exposing structural inequities affecting access to medicines and vaccines moreover across the Global South.  Of late this work includes advocating for equitable access to COVID-19 vaccines across the globe and helping to ensure the Biden administration prioritizes equity the US Patent and Trademark Office's work.  I-MAK's work on the patent system has been cited repeatedly in Congressional testimony on prescription drug costs, most recently in hearings by the House Committee on Oversight and Reform.   To improve equity in the patent system, I-MAK recently developed a new tool called Participatory Changemaking that will provide an assessment of the patent system and bring together stakeholders from across the stakeholder spectrum, from patients to investors and policymakers, to drive sustainable, long-term change into what has long been an exclusionary process.  Ms. Krishtel and I-MAK have also put out a 10 point plan for the Biden administration to bring equity into the patent system.  She is a recent TED speaker, Presidential Leadership Scholar, and an Ashoka Fellow.For information on I-MAK go to: https://www.i-mak.org/.   Ms. Krishtel's recent British Medical Journal article noted during this discussion is at: https://www.bmj.com/content/bmj/373/bmj.n1344.full.pdf. The Ink interview noted during this interview is at: https://the.ink/p/doses-are-charity-knowledge-is-justice. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowPodcast listeners are aware US healthcare significantly underperforms.   Among numerous other statistics, despite spending approximately twice what comparative countries spend on healthcare, the US has highest rates of preventable deaths.  Even wealthy Americans are more likely to, for example, die during childbirth, from cancer and from heart attacks than those in 12 comparative countries.  This is substantially due to the fact primary care in the US, as the National Academy of Medicine report states in its opening, is “slowly dying.”  The report further notes despite the fact primary care's value is beyond dispute, approximately 25% of Americans do not have a primary care physician and 80 million Americans live, per  HRSA, in primary care health professions shortage areas.  In turn, this is largely due to the fact only 5% of healthcare spending goes to primary care despite such visits accounting for 40% of all medical office visits.  Translation: primary care physicians are substantially undercompensated that contributes to a growing shortage of primary care clinicians.During this 34 minute conversation, Dr. Phillips discusses several of the reports nearly 20 recommendations including recommending all Americans select a primary care provider or be assigned one and that there be created a HHS Secretary Council on Primary Care.  Among other subject covered in the report, Dr. Phillips discussed Primary Care Medical Homes (PCMHs), discusses measuring quality performance, value and risk adjusment particularly as it relates to adjusting for social risk or social need.      Robert L. Phillips, Jr., MD, MSPH, is the founding Executive Director of the Center for Professionalism and Value in Health Care.  Dr. Phillips also currently practices part-time in a community-based residency program in Virginia and is Professor of Family Medicine at Georgetown University and Virginia Commonwealth University.  Prior to, or from 2012 to 2018, he was Vice President for Research and Policy where he led the launch of a national primary care clinical registry and a Measures that Matter research and development program for primary care.  Previously still, Dr. Phillips served as Director and Assistant Director of the Robert Graham Center in Washington DC.   He has also served on the American Medical Association’s Council on Medical Education and as President of the National Residency Matching Program.   Dr. Phillips was elected to the National Academy of Medicine (NAM) in 2010.  He currently serves NAM's Membership Committee and the Action Collaborative on Clinician Well-Being and Resilience.  He is a graduate of the Missouri University of Science and Technology and the University of Florida College of Medicine where he graduated with honors for special distinction.  He completed his family medicine training at the University of Missouri that was followed by a two-year fellowship in health services research and in public health. Information regarding the report is at: https://www.nationalacademies.org/news/2021/05/high-quality-primary-care-should-be-available-to-every-individual-in-the-u-s-says-new-report-payment-reform-telehealth-expansion-state-and-federal-policy-changes-recommended. The report is summarized in a May 4 JAMA Viewpoint essay, at: https://jamanetwork.com/journals/jama/fullarticle/2779749. Information on the report's webinar series, noted during the interview, is at: https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowDespite a long history of engagement in various political and social and issues, for example, from the nuclear test ban treaty to the global AIDS epidemic, healthcare professionals have been largely absent in addressing the climate crisis.  This helps explain why the health care industry has been, in sum, absent from addressing what the World Health Organization has defined as the greatest threat to human health in the 21st century or what Nobel Price economist William Nordhaus (noted for his work on the carbon tax) has termed the "colossus that threatens our world."  As listeners of this podcast may recall the US healthcare industry’s own greenhouse gas (GHG) emissions account for 10% of total US GHG emissions, 25% of global healthcare GHG emissions and 4.5% of total global GHG emission.  Recently, however, a letter drafted by U. of Washington's Dr. Howard Frumkin and APHA’s Dr. Georges Benjamin addressed to DHHS Secretary Xavier Becerra, outlining in detail regulatory policy measures the Secretary should take to address the climate crisis, was co-signed by 65 medical professional associations including, for example, the Alliance for Nurses for Healthy Environments, Medical Students for a Sustainable Future and Mason's Center for Climate Change Communication.     Professor Kotcher begins the 30 minute conversation by briefly describing his Center's work.  He moreover describes the survey's methodology and the survey's findings including respondents understanding of the climate crisis and more specifically health risks associated with the crisis, respondents understanding of their responsibility as healthcare professionals to address the crisis, what barriers prevent or inhibit them from addressing the crisis and what products or tools would help healthcare professionals more successfully or productively engage in advocating/lobbying for solutions. Dr. John Kotcher is a Research Assistant Professor at George Mason University’s Center for Climate Change Communication where he conducts research on science, environmental, and risk communication.  His work focuses on how people respond to public engagement by scientists, how to effectively communicate about the public health implications of climate change and air pollution, and how civic organizations can most effectively recruit, organize, and mobilize citizens—especially political conservatives—to demand action on climate change.  Professor Kotcher also works on the Climate Change in the American Mind project, a series of national public opinion surveys carried out in partnership with the Yale Program on Climate Change Communication to investigate and track public attitudes toward climate change and support for climate policies in the United States.Professor Kotcher and colleagues' article, "Views of Health Professionals on Climate Change and Health: a Multinational Survey Study," was published in the May issue of Lancet Planetary Health and is at: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00053-X/fulltext.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAs the book's dust jacket notes, At What Cost, Modern Capitalism and the Future of Health [ recently published by Oxford University Press] confronts how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith.  As corporations manipulate demand through skillful marketing and veto the choices that undermine their bottom line, free consumer choice has all but disappeared, and with it, the personal protections guarding our collective health.  At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from climate change to opioid addiction.  This 32-minute interview opens with Professor Freudenberg commenting on the relationship between our economic model and public health in context of the current pandemic.   The discussion moves on Professor Freudenberg describing attributes associated with, or the problems related to, neoliberalism, the negative effects neoliberalism/American capitalism has had on what he terms the five pillars of well being, specifically food and healthcare, the health care industry's role and responsibility in addressing capitalism's negative effects and concludes with an overview of Part III of his work, or solutions he identifies to temper modern American capitalism.  Nicholas Freudenberg is Distinguished Professor of Public Health at City University of New York School of Public Health and Director of the CUNY Urban Food Policy Institute.  Professor Freudenberg is also founder and director of Healthy CUNY, a university-wide initiative to improve the health of CUNY’s 274,000 students in order to support their academic success.  Professor Freudenberg was also founder and first director of the CUNY School of Public Health’s Doctor of Public Health program.  For the past 35 years, he has worked in sum to plan, implement and evaluate health policies and programs to improve living conditions and reduce health inequalities in low income communities in New York City and elsewhere.  Among numerous other publications, he is also the author of Lethal But Legal Corporations, Consumption and Protecting Public Health (Oxford, 2014 and 2016).    Professor Freudenberger earned his BS from CUNY and his MPH and DPH from Columbia University.  Information on At What Cost is at: https://global.oup.com/academic/product/at-what-cost-9780190078621?cc=us&lang=en&. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowOver the past several weeks the Biden administration has incrementally released proposed infrastructure policies under the title, "Build Back Better."  The White House defines infrastructure to include human capital that under grid the functioning of the economy.   (As Bryce Covert noted in yesterdays The New York Times, Lanham Act funds, initially used to fund infrastructure deemed critical to the war effort, eventually became used to build child care centers when it was learned children were being locked in cars because working mothers had no other options.  Infrastructure policies that address the "care economy" are outlined in the administration's April 21 American Jobs Plan and their April 28 American Families Plan.  The Jobs Plan includes proposals to expand Home and Community Based Services (HCBS) waivers, extend the Money Follows the Person program and policies to expand and improve elder care jobs.  Beyond paid family and medical leave and child related tax cuts, the American Families Plan proposes universal pre-school, free community college and related higher education supports expanded nutritional program policies.  Among other realities, the absence of universal day care, along with no long term care and paid leave policies, largely explains why compared to similar counties women are significantly under-represented in the US workforce at a significant cost to overall economic performance.   A recent AARP survey found one in five Americans, moreover women, served as a caregiver for an adult or child with health or functional needs in ’20.  Concerning elder care workforce, this labor market is expected to grow by approximately two million jobs over the next decade plus in caring for a significant percent of the 25% of Americans who will be 65 or older in 2040.   This 30 minute interview begins with a brief explanation of The Arc's work.  Ms. Jorwic goes on to moreover outline/explain provisions of the American Families Plan and the American Jobs Plan, discuses how the cost of these policies will be offset and the chances for Congressional approval.   Ms. Nicole Jorwic is the Senior Director of Public Policy at The Arc, a national community-based organization advocating for and serving people with intellectual and developmental disabilities and their families.  Prior to joining The Arc Ms. Jorwic served as Senior Policy Advisor for the state of Illinois.   Prior to that appointment, she served as the CEO/President of the Institute on Public Policy for People with Disabilities where she continued the Institute’s mission to improve the lives of people with disabilities and assisted the leadership of the state of Illinois in developing public policy driven best practices in serving individuals with disabilities.  Ms. Jorwic i a special education attorney and an advocate for students with disabilities, with a focus on transition-aged youth.  Nicole received her JD and Child and Family Law Certificate, from Loyola University Chicago and received her BS from the University of Illinois.  Nicole's sibling, her brother Chris, has been diagnosed with autism.For information on The Arc go to: https://thearc.org/. The administration's 15-page American Families Plan outline is at: https://mail.google.com/mail/u/0/#inbox/WhctKJWQntDXPWTSKGmSvRdkQDZZGdFbkBMKMblcGFztpZqKwNkjXHzTzrTdkqczLNTNGgq?projector=1&messagePartId=0.1.The administration's five-page American Jobs Plan outline is at:  https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/21/fact-sheet-the-american-jobs-plan-will-support-womens-employment/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com