by Kushal Kadakia, Public Policy Major

I heard former U.S. Surgeon General Regina Benjamin forcefully proclaim those words at a Sanford Diversity event during the first few weeks of freshman year. She had spent her entire life advocating for the poor, from starting a rural health clinic in the Louisiana Bayou to serving as America’s “Top Doctor” during the Obama administration. Dr. Benjamin’s declaration impressed upon me how the moral mission of medicine is underpinned by a network of local, state, and national policies – all of which influence our ability to get access to high quality health care at a low cost. That evening affirmed my interest in the politics and policies of the American health care system, and the Sanford School of Public Policy has been my home on campus ever since.

Over the past two years, I have taken courses on health law, undertaken independent studies on biomedical innovation policy, and conducted research on accountable care as part of the Duke-Margolis Center for Health Policy. This year, I was excited to join the Duke-Margolis Center’s Bass Connections Team on North Carolina Medicaid Reform, led by Professors Don Taylor (Sanford) and Barak Richman (Law). Today, 1 in every 5 North Carolinians is covered under Medicaid; a means-tested program that is jointly funded the state and federal government to provide health care to those who cannot afford it. State policymakers face conflicting proposals to overhaul North Carolina Medicaid, with the outgoing McCrory administration submitting a Section 1115 Waiver to convert the program to managed care, and the incoming Cooper administration countering with a notice to expand under the Affordable Care Act that has since been suspended by a federal judge. The goal of our team is to combine empirical analysis, stakeholder interviews, and policy innovation into a new Medicaid reform package which we will present to the North Carolina General Assembly in April.

This team draws from all corners of Duke – students of all years (undergraduate, graduate, and professional) and faculty of all disciplines (medicine, law, business, and nursing). Together, we are working to bridge academia and the public sphere, modeling Sanford’s mission of pursuing innovative policy solutions to create positive change. Over the course of this year, my research has put me on the frontlines of health policy in North Carolina. I have had the opportunity to speak with senior officials in state government about state reforms, to learn about delivery and payment models from private sector leaders, and to hear from advocacy groups about the needs and struggles of patients across the state. Seeing how the intricate details of claims data, eligibility rules, and health outcomes connect as a part of the broader shift from volume to value-based care has been an incredible experience; one made possible thanks to the analytical tools that my classes in Sanford have equipped me with.

Yet this experience is only the beginning. As a part of this team, I have been exposed me to the incremental nature of reform, the importance of building consensus, and the need for greater evidence and innovation in policy design and execution. Those lessons will remain with me as I embark on my own career in health policy, putting Sanford’s motto of “Outrageous Ambition” into practice as I work to secure access to affordable and quality care for all.