The nominee to be Montana’s subsequent well being director confronted an unwieldy illness outbreak and pushed Medicaid work necessities — two points looming in Montana — when he held the same job in Kentucky.
Montana senators will quickly resolve whether or not to substantiate Adam Meier, Republican Gov. Greg Gianforte’s decide for director of the state Division of Public Well being and Human Companies. He would earn $165,000 main Montana’s largest state company, which oversees 13 divisions and is a frontrunner within the state’s pandemic response.
Gianforte is assured Meier “will carry higher transparency, accountability, and effectivity to the division because it serves Montanans, particularly probably the most weak amongst us,” Brooke Stroyke, a governor’s workplace spokesperson, stated in an emailed assertion.
For a lot of Montana officers and well being care business gamers, the main target is on Montana’s future, not Kentucky’s previous. However it may be instructive to see how Meier dealt with comparable points in his prior function, which he held from Might 2018 by way of December 2019.
Some have praised the job he did in Kentucky, together with his spearheading of a program that might have created work necessities within the state’s Medicaid program. However others criticized these proposed adjustments in addition to his dealing with of a big hepatitis A outbreak that unfold by way of rural Appalachia beginning in 2017, in the end sickening greater than 5,000 Kentuckians and killing 62. The main points of the state’s response to the outbreak got here to mild after an investigation in The Courier Journal in 2019.
“The hep A response might be one of many darkest or most regarding issues he did when he was in Kentucky. He additionally didn’t carry out effectively in my eyes on different points,” stated Simon Haeder, an assistant professor at Pennsylvania State College who research politics, well being care and public coverage. “He didn’t achieve this effectively in Kentucky, so I don’t understand how effectively he’s going to do in Montana.”
Dr. Kevin Kavanagh, a retired Kentucky doctor who runs the nationwide watchdog group Well being Watch USA, is amongst those that stated Meier and his workforce wanted to do extra early on to curb the hepatitis outbreak because it made its manner into Appalachia. Kavanagh stated Meier’s dealing with of the outbreak supplies a window into how he would possibly deal with the covid disaster in Montana.
“However it may very well be a studying alternative if failed methods are corrected,” Kavanagh stated. “The most important query is: What did he be taught in Kentucky?”
Throughout Meier’s affirmation listening to earlier than Montana’s Senate Public Well being, Wellness and Security Committee, the nominee stated one lesson he discovered was to put money into public well being infrastructure. As a result of hepatitis A was spreading in rural Kentucky mountains, he stated, normal outreach to weak populations in settings like homeless shelters didn’t work. As a substitute, well being officers began vaccinating folks at comfort shops.
“One of many issues I’ve discovered there’s, it’s a must to be artistic about the way you attain of us,” Meier stated.
Kentucky’s outbreak first centered in Louisville, the place a greater than 200-person well being division was capable of administer tens of 1000’s of vaccines in opposition to the extremely contagious liver an infection brought on by a virus. The Facilities for Illness Management and Prevention referred to as the town’s response a “gold normal.”
However in spring 2018, the illness started to unfold in Appalachia, which had thinly staffed county well being departments.
Dr. Robert Brawley, then the state’s chief of infectious illnesses, sounded the alarm to his bosses. Brawley requested state officers to spend $10 million for vaccines and non permanent well being employees. As a substitute, the performing public well being commissioner, Dr. Jeffrey Howard, despatched $2.2 million in state funds to native well being departments. Brawley referred to as the response “too low and too gradual.”
Within the months that adopted, the outbreak metastasized into the nation’s largest.
Meier stood by Howard’s choices on the time and the company’s response. In Meier’s Feb. 10 Montana listening to, he stated Kentucky lacked the infrastructure to purchase $10 million price of vaccines, and they’d have gone unhealthy anyway as a result of the state didn’t have the required storage. Brawley’s proposal had referred to as for sending $6 million to well being departments to purchase vaccines, nonetheless, and $4 million for non permanent well being employees.
“The ‘too low and too gradual’ response to the hepatitis A outbreak in Kentucky, reported in The Courier Journal, could also be an albatross round his neck for a very long time,” Brawley, who resigned in June 2018, stated of Meier in an e-mail.
Montana’s Democratic Social gathering cited the hepatitis A outbreak when Meier was nominated for the Treasure State job in January, slamming him as unsuitable.
The well being division declined KHN’s request for an interview with Meier however offered letters from native Kentucky officers written in 2019. Allison Adams, public well being director of Buffalo Hint District Well being Division in Kentucky, defended the state’s actions in a single February 2019 letter, arguing Kentucky’s management “made sound choices concerning the help and identified assets obtainable.”
Meier has pitched himself as somebody who works effectively with others, bolstered Kentucky’s household companies and reduce by way of the state’s forms.
Meier, an legal professional, lived in Fort Thomas, Kentucky, close to Cincinnati, together with his spouse and three youngsters, the place he served on the Metropolis Council simply earlier than being named deputy chief of workers for former Gov. Matt Bevin in 2015. After leaving Kentucky’s well being Cupboard, he labored as a coverage advisor with Connecting the Dots Coverage Options LLC.
Throughout Meier’s affirmation listening to earlier than Montana lawmakers, Erica Johnston, operations companies department supervisor for the well being division, stated she was already impressed by his information of the company’s packages and concepts for adjustments. Previous colleagues stated he listened to these he oversaw. John Tilley, a former Democratic Kentucky consultant who served because the state’s former head of Kentucky’s Justice and Public Security Cupboard, referred to as Meier a problem-solver.
“What I obtained in Adam was this refreshing tackle authorities, this lower than bureaucratic take,” Tilley testified.
Whereas deputy chief of workers for Bevin, Meier oversaw the event of a Medicaid overhaul plan referred to as Kentucky HEALTH, which might have required recipients who had been ages 19-64 and with out disabilities to work or do “engagement” actions resembling job coaching or neighborhood service.
Bevin, a Republican who, like Gianforte, joined politics after making a fortune in enterprise, described the trouble as a manner to make sure the long-term monetary stability of Medicaid and put together enrollees to transition to non-public insurance coverage. In Meier’s Montana listening to, he stated the objective was for Medicaid recipients to be linked to employment and coaching. Kentucky opponents stated this system would have brought about folks to lose protection and improve the state’s administrative burden.
That debate is acquainted in Montana, the place lawmakers permitted work necessities for individuals who joined Medicaid beneath its enlargement. The work guidelines are awaiting federal approval.
Kentucky’s necessities by no means took impact. They had been licensed by a federal waiver however had been tied up in authorized challenges till the state’s present Democratic Gov. Andy Beshear rescinded the foundations.
Nonetheless, Meier has stated Medicaid’s enrollment dropped throughout his management and advantages remained regular for individuals who stayed on the rolls. That drop paralleled an general nationwide decline in Medicaid enrollment that lasted by way of 2019.
Penn State’s Haeder, who noticed Meier’s tenure, criticized Meier’s help for Medicaid work necessities, saying “extreme quantities of information present how detrimental they’re to public well being” as a result of weak folks lose protection.
Mary Windecker, government director for the Behavioral Well being Alliance of Montana, stated work restrictions aren’t a great mannequin for Medicaid. However she stated it isn’t stunning Meier has been in favor of these steps, given Montana’s current efforts.
Even so, Windecker is optimistic when she talks about Meier’s affirmation. She stated she’s thrilled he has expertise with one other state well being company.
“These are very difficult programs to run,” Windecker stated. “When you perceive well being care, you stand a greater shot at getting this.”
The Montana Senate has to take up Meier’s affirmation, which moved out of a committee Feb. 17.
Whereas Meier awaits affirmation, he’s already engaged within the state’s covid vaccine efforts and is engaged on the company’s day by day duties, division spokesperson Jon Ebelt stated in a press release. Meier is “centered on the job at hand,” Ebelt stated.
Houghton, Montana correspondent, reported from Missoula. Ungar, Midwest editor and correspondent, reported from Louisville and previously labored for The Courier Journal.