Nielsens Contributions to the Affordable Care Act Recognized as Documented in Oral History of Obama’s Presidency

Image courtesy of the American Medical Association

BUFFALO, NY – Growing up in Elkins, West Virginia (current population 6,800), Nancy H. Nielsen, MD, PhD, could not have imagined that one day she would not only meet the President of the United States but work for with its administration. to completely transform healthcare in America.

Now, his work, and that of many others, on the Affordable Care Act, from advocacy to implementation, has been documented for posterity in the Oral History of the Obama Presidency .

Nielsen, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences, is one of the “extraordinary people from all walks of life” invited to participate in the oral history project of Obama’s presidency. Produced by Columbia University, the story is based on more than a thousand hours of interviews with hundreds of people.

Just being invited to do the interview was an incredible honor, Nielsen said. It also gave him a chance to review how he came to be involved in one of the most important health care reforms America has ever seen. She explains some of the highlights in this video (link to come).

“Non-Traditional” MD student.

In 1973, with a doctorate in microbiology and a teaching position at the Jacobs School, Nielsen was accepted into the UB medical school. She was a “non-traditional” student, as she already had a teaching position and was also raising five small children. She was one of 30 women in her class of 135.

After graduating and serving as the first female chief internal medicine resident at Buffalo General, Nielsen became board certified as an internist. In addition to running a busy private practice, she was drawn to the political side of medicine. She served as president of the Erie County Medical Society, became involved with the state medical society and began working nationally.

She served four consecutive terms as speaker of the American Medical Association’s House of Delegates and was elected president of the AMA in 2008, a term that coincided with the intense national health debate.

While Nielsen was president-elect, the AMA launched its Voice for the Uninsured campaign, advocating for health care reforms that would expand health insurance coverage to Americans who did not have it.

In preparing for the campaign, the AMA’s media relations staff asked if Nielsen had uninsured patients.

‘The cause of my life’

That’s when Nielsen revealed that she, too, had been without insurance. “During graduate school, I gave birth to two babies when I was uninsured,” she said, “and that became my life’s cause: making sure all Americans had health insurance “.

He recalled that at the time the Affordable Care Act was passed, 19% of the US population did not have health insurance.

“It was really a national scandal, to tell you the truth, and there were places where it was even worse than that,” he said. “There’s nothing good about being uninsured. That was the goal of the Voice for the Uninsured. They didn’t have a voice. So we became that voice.”

Once implemented, the Affordable Care Act reduced the uninsured rate in the US from 19% to 9%. He would have cut it even more, Nielsen explained, but the Supreme Court stepped in and said the Medicaid expansion, which was supposed to insure millions, was a state’s rights issue.

Since then, more states have joined. Nielsen said it’s now down to about 10 states that haven’t expanded Medicaid, about half of which are considering or are close to expanding.

A call from the White House

A few months after Nielsen ended her term as immediate past president of the AMA, she received a call from the White House. He was asked to come work at the newly established Center for Innovation at the Department of Health and Human Services’ Center for Medicare and Medicaid Services.

“It was a brand new part of HHS and they said they needed me to come and bring the voice of the physician as they were implementing this new part of the government,” Nielsen said.

As a senior adviser on the participation of interest groups, she would be “on loan” from the UB to the federal government, a period that would last two years. Their role was to interact and share the concerns of doctors across the healthcare system.

“The Innovation Center is unique in government,” Nielsen explained. “It was included in the ACA law so that instead of making a big policy change and then having unintended consequences, the Innovation Center would do pilots and really evaluate if care was improved and if there were savings . That was the purpose. There was nowhere else in government where there was the flexibility to try something to see if it worked.”

He took on additional responsibilities working with HHS Secretary Kathleen Sebelius, advising on policy and sometimes attending events when the secretary was unable to.

“It was an extraordinarily exciting time and I loved it,” Nielsen recalled.

He admitted that working in Washington was “alluring,” but he always intended to return to UB.

“I owe my career to UB,” he said simply. “I always wanted to be a doctor. I had no money. After my fifth child was born, I finally applied. I was 29 when I started medical school and my fifth child was 2 months old.

‘UB gave me a chance’

“So the UB gave me a chance. I was lucky that the admissions committee let me in, and I’ll never forget that. My whole career has been here and I’ve been very lucky. I owe everything to the UB”.

Now he is passing on his passion for politics to the next generation of doctors. Recently, Nielsen was asked to serve as a faculty advisor to a group of Jacobs School students who want to develop an elective policy.

“Why is politics important?” she asked. “Politics is the road map we use to get to the society we want. For me, it meant getting affordable health insurance for all Americans. I tell students, “Your cause will be different.” My role here is to help students change the world, whatever that means for them.”