University of Iowa public health researcher has front-row seat to national health care debate

Since he first came to the University of Iowa in 2000, Brian Kaskie has been offering a truism to the students in his public health courses: “The best time to be in a policy-making environment is during a period of big transformation.”

And from his 1,000-mile-away perspective on Washington, D.C., Kaskie watched and analyzed the intense health policy transitions following the inaugurations of Republican George W. Bush in 2001 and Democratic Barack Obama in 2009.

But little did the public health professor know then that he would have a front-row seat to an even more intense policy transition following the presidential election of 2016.

“It’s kind of scary in some sense,” Kaskie said in a phone interview from Washington. “Now here we are with the transition from the Obama administration to the Trump administration, and once again we have all sorts of churn.”

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Kaskie has been in Washington since November as part of the American Political Science Association’s congressional fellow program. With his expertise in Medicare, Medicaid and caring for the elderly, he is assigned to the majority staff of the U.S. Senate Special Committee on Aging, which is chaired by Sen. Susan Collins, R-Maine.

His job is to make sure that when Collins — whom Kaskie refers to repeatedly as “my boss” — goes into a meeting, she has “a pretty good idea of what the potential changes might do in the long-term to Medicaid and Medicare.”

“One of the things I appreciate about Sen. Collins and her staff is really how well prepared they are,” he said. “I’m here to support the professional staff. … I try to add my expertise to what they are doing.”

Kaskie spends much of his days in Washington looking into the long-range consequences of proposed legislation, such as the recent Republican proposal for replacing the Affordable Care Act. Unlike with his own scholarship, however, he seldom gets to choose which questions to answer first.

“In a lot of ways, it’s sort of humbling,” he said. “I was cautioned about this: My role is not to lead; my role is to help. … My colleagues and I often are in our offices, working on our assigned tasks, not knowing exactly what others are doing.”

Kaskie describes the transition from “being more academic-minded to being more Hill-oriented” as a shift from a more “obsessive compulsive” approach to a more “attention deficit” approach.

“At the university, you really work over all the details of your scholarship and research,” he said. “Here on the Hill, you have to bounce quickly from one issue to the next.”

Kaskie couldn’t offer a definitive yes or no as whether his input has led to a specific policy decision — "What's a decision? It's sequential." — but he has learned more about various parts of the legislative process.

In a committee, for example, the job is to bring up an agenda item and, if it seems to reasonable with members of the committee, they will turn around and bring a bill forward.

“Once a bill gets introduced, then it's out of my hands,” he said.

The job responsibility he enjoys most, he said, has been helping to schedule hearings on topics ranging from Alzheimer's support, to military care-giving, to creating livable communities for older adults. Pulling on the contacts he's made over a quarter-century in the field, he helps identify potential expert witnesses that may not be on other staff members’ radars.

One of his most successful hearings, Kaskie said, involved the issue of how the opioid crisis impacts the relationship between grandparents and their grandchildren. With so many addicts being incarcerated — or otherwise being ineligible to serve as custodians for their children — grandparents are being called into service as primary guardians.

"It was our way of adding the aging perspective to what already had become a pretty extensive public health issue," he said.

Kaskie said he has developed a very different relationship with his younger colleagues on the Hill than with his students.

“As an academic — as someone who wants to learn — I’m just having a gas going to hearings and learning about new positions on issue or meeting people in D.C. who have been studying issues of aging for years,” he said.

He even has begun bringing his old textbooks to the office.

“I’m in an environment where people want to work on health policy,” he said. “When I’m teaching back in Iowa, I can’t say that the majority of students are really all that excited about what we’re studying. So to be surrounded by a lot of young people who love health policy as much as I do, well ... it’s been a lot of fun.”

Reach Jeff Charis-Carlson at jcharisc@press-citizen.com or 319-887-5435. Follow him on Twitter: @JeffCharis.