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Profile: Former NJ Health Official Has National Impact on ACA Implementation

Heather Howard finds ‘right balance’ by serving as Princeton instructor, municipal councilwoman

heather howard
Heather Howard, former state health commissioner

Who she is: Heather Howard, 47, a former New Jersey commissioner of health and senior services in Gov. Jon S. Corzine’s administration, has served as the director of two Princeton University programs assisting states with implementing the Affordable Care Act and healthcare-delivery reform. She’s also a lecturer at the university, where she teaches classes on both the ACA and state and local health policy.

Why she continues to make a mark: Officials in other states have cited research by the Robert Wood Johnson Foundation-backed State Health Reform Assistance Network, led by Howard, in describing why they decided to expand Medicaid.

Why she remains passionate about healthcare: “It’s a civil rights issue,” she said: A lack of healthcare access can prevent people from achieving their full potential. She added that healthcare remains the top cause of personal bankruptcies, and healthcare spending can crowd out other government priorities, from the environment and education to transportation funding.

“If you care about domestic policy and politics you need to care about healthcare,”, she said.

A personal issue: Howard also has experienced the healthcare system firsthand, when her son Nate Howard, then 2, had a cancerous tumor in a bone. While he was successfully treated and is now 12, the experience caused her to reflect on differences in access to care.

“If the ACA were not the law he could have been denied health insurance throughout his life, because he had a pre-existing condition as a cancer survivor,” said Howard. She acknowledged that New Jersey had a state law barring insurers from denying coverage based on pre-existing conditions, but added that many other states didn’t have that protection.

A longtime health policy wonk: Howard, a native of Westchester County, New York, worked for her local congresswoman, U.S. Rep. Nita Lowey, after graduating from Duke University. That gave Howard her first exposure to national health policy, since Congress was then debating President Bill Clinton’s health-reform proposal.

Many angles to health law: Howard has seen healthcare laws from many perspectives. After working for Lowey, she attended New York University’s School of Law and was a judicial clerk, then a trial attorney for the U.S. Department of Justice Antitrust Division’s healthcare task force.

Her thoughts on a former boss: Between working for the Justice Department and Corzine, Howard served on the White House domestic policy council, including as a senior policy advisor to then-first lady Hillary Clinton.

Howard said she’s excited about Clinton’s campaign announcement on health policy, including recently unveiled plans to address autism and Alzheimer’s research, as well as what she says are “sensible changes and improvements to the ACA.”

Legacy in the state Department of Health: Howard said the top challenge as commissioner was managing the Department of Health and Senior Services in a time of “serious fiscal constraint,” in which she relied on what she calls “an amazing staff” in “trying to do more with less.”

But Howard also helped reshape the state’s approach to hospitals facing potential closures due to financial distress. Building on the work of a commission led by her current Princeton colleague, Professor Uwe Reinhardt, the state began to do more planning to shape how much financial assistance hospitals should receive. The state “really did move away from crisis management” toward strategic planning, she said.

Other areas of long-term change: The department also expanded services in maternal and child health, as well as in autism services, which Howard sees continuing to grow under her successors as commissioner. The state also expanded access to New Jersey FamilyCare, which continued to grow under the ACA.

The grind of Medicaid expansion: Howard sees the expansion of Medicaid -- which has reached 30 states and is under discussion in four others -- following a similar path to the original Medicaid program. It took 17 years from when Medicaid was enacted in 1965 until the last state -- Arizona -- adopted it.

“I think we’ll get there on the Medicaid expansion, hopefully in less than 17 years, but it will take time,” Howard said.

Howard said the research done by the Princeton-based network she leads spells out why -- states save money in their budgets, as money they currently spend on charity care for hospitals is replaced by Medicaid.

No turning back on ACA: “It may be slow, but inexorably social programs like the ACA become entrenched, become a part of the fabric” of society, Howard said. She predicts that despite criticism of the ACA by some Republican presidential candidates, the next president will find it difficult to take away benefits that millions of people have begun to rely on.

Christie and Medicaid: Howard said Gov. Chris Christie and other Republican governors who chose to expand Medicaid were “brave.” But she contrasts Christie’s position with those of other Republicans who weren’t governors.

“Governors see the reality of their budgets,” Howard noted. “I think at the national level, the political discussion is a little bit removed from that reality.”

Potential for state-level reforms: While Obamacare has consumed much of the national debate, Howard sees broad, bipartisan interest in state governments in addressing further healthcare reform. That includes a shift toward paying healthcare providers for the value they provide patients -- by keeping them healthy while keeping costs down -- instead of the volume of services they provide.

“Because so much of state budgets go to healthcare, there’s a lot of opportunity,” she said.

Borough council: In addition to being immersed in state and national health policy, Howard is familiar with local policy as a Princeton Borough councilwoman. She said she decided to run in 2012 because she loves living in what she says is a “a wonderful community” with “really engaged, smart, committed residents . I wanted my son to grow with seeing the value of civic engagement” and “what it means to be a progressive in government at the local level.”

That’s led to her supporting local health laws like banning smoking in public parks and raising the age to buy tobacco to 21. She was sworn in to her second term on Monday. But she hasn’t looked to run for higher office, saying that the part-time council work fits in well with her academic and policy jobs.

“For me, this is really the right mix,” she said.

Family life: In addition to her son, Howard’s family includes her husband Hunter Labovitz, a lawyer in the Federal Community Defender Office in Philadelphia.

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