Andy Slavitt can’t stop: How a health care wonk became a rabble-rouser

SIERRA VISTA, Ariz. — The sighting took place on a hot day in May, in the lobby of the Sierra Vista Public Library, not far from the rack where local kids can borrow donated bikes. A blond woman in white tennis shoes nudged her twin sister, nodding toward a man who had just walked past. “That’s him,” she whispered. It was the kind of gesture you might make if you saw Mick Jagger heading into the men’s room ahead of you in the hour before a Stones concert — a mix of admiration and disbelief at seeing in the flesh someone you’ve only ever encountered in print or on screen.

But the man looked like your average middle-aged dad — blue jacket, dark jeans, slip-on dress shoes, a salt-and-pepper beard neat enough to look professional — and he was here to talk about health policy.

It was Andy Slavitt. From 2015 to early 2017, he had been the head of the Centers for Medicare and Medicaid Services, the government agency that administers President Obama’s Affordable Care Act and that provides health insurance for children, the elderly, the disabled, those on low incomes. He describes the job as “looking after the programs that serve 130 million people or so.”

The 49-year-old twins hadn’t heard of Slavitt while he was on the job. They only discovered him about a month after he stepped down, when they’d gone to meet their congressional representative, Republican Martha McSally, at two town halls around Tucson. It was right around the time when President Trump was learning that health care was complicated, and the sisters wanted to know more about the Republican alternative to Obamacare. They didn’t find the information they’d been looking for, though, because they didn’t actually meet McSally at either event. “The first we were locked out, the second was an empty chair,” said Jan Stockwell. “She was invited and didn’t attend.”

To get their questions answered, they went online, and quickly found Slavitt’s Twitter feed. They weren’t the only ones. “When I left CMS I had 17,000 followers. My younger son said to me, ‘Well, that’s it, you’re not going to get any more followers, no one’s going to care what you say anymore,’” Slavitt told STAT. “And a week later I was like, ‘You’re wrong, I’ve got 23,000!’ And then I had 45,000, and then I had 60,000. I’m not really sure what happened.”

Now, the Stockwell sisters had driven over an hour to hear their new trusted source on health policy in person — and their reason for being there was remarkably similar to Slavitt’s. The week before, 217 congressional Republicans voted for the bill that would “repeal and replace” the Affordable Care Act. But, as Slavitt noted during the car ride to Sierra Vista, in the congressional recess that followed the vote, only a dozen or so of those lawmakers were holding town halls about the legislation.

Slavitt decided that if these members of Congress weren’t going to explain the legislation to their constituents, he would do it for them in a series of his own town halls. His explanations, though, came with an added message: Don’t let your senators pass this bill.

Slavitt, 50, insists that he is not an advocate or an activist — “If the Republicans came out with a good bill, I would be out here actually supporting it,” he said — but he has become one of the strongest voices in the fight against the dismantling of the Affordable Care Act. He’s also become a kind of amplifier, turned up high enough to create feedback: It can seem as though every story he hears on the town hall trail is broadcast back to a national audience through his daily barrage of tweets, which in turn generate the sharing of more stories, the asking of more questions.

While he was at CMS, Slavitt began every morning by reading and responding to emails from those whose health insurance he was administering — everything from “the battery in my wheelchair no longer work” to “my daughter is in an adult facility, she’s disabled, there’s a bad situation we need to change” — and he soon started sending messages straight to the American public on Twitter, with no intermediary.

“I drove the White House a little crazy,” he said. He didn’t stop then, and has only ramped it up since he left the government in January — a Trump-like strategy in form if not in content.

Some Republicans think of Slavitt as a carpetbagger; others suggest that his outreach is not as innocent as he says.

Those who have been CMS administrators before him, though, express nothing but respect for his recent work, even if they don’t agree with all of his policy decisions. As Thomas Scully, who had the CMS job from 2001 to 2003, under the George W. Bush administration, told STAT: “I’m not sure that’s been done before, but God bless him, he has the right to whatever he wants to do. … Most of us have had to go out and get full-time jobs. But I gave speeches to defend my work when I had time.”

Bruce Vladeck, who had the same role under Bill Clinton, considers the work he and others did to save Medicaid in the mid-’90s the high point of his career. “If Bush had come in in 2001 and gone after the Medicaid program, I’d be out there just like Andy, I would’ve had to,” he said. “How could you not? How could you give your life and blood for years to something and then have a bunch of assholes try to destroy it, and just sit there? How can you do that?”

Slavitt isn’t, by any means. He has seemingly boundless energy, and the cellphone numbers of a lot of CEOs. The question, though, is whether a wonk-turned-evangelist — who lives outside Minneapolis, no longer a fixture of Washington’s policymaking habitat — can whip up enough public furor to affect the Senate’s plans for health reform.

Slavitt’s interest in health care was crystallized by a tragedy. In the late ’90s, he had finished his undergraduate studies at the University of Pennsylvania and done an MBA at Harvard. He had worked for Goldman Sachs and McKinsey. He’d had health care clients while working as a consultant, “but by no means was that my career path,” he said. Even after he left consulting, when he was running a company that set up health and worker’s comp insurance for agribusiness companies, he still wasn’t completely committed to working in the field.

But then, his college roommate Jeff Yurkofsky, who had just gotten married and had twins, was diagnosed with a brain tumor. Five months later he was dead. He had been a doctor, but, in Slavitt’s words, “was in that post-residency fellowship before … you earn real money.” Jeff hadn’t had any life insurance. So his widow and her kids moved from Baltimore to California, into the spare room in the house where Slavitt was living with his wife and their own newborn.

Slavitt was at that point dealing with insurers for his work at the agribusiness company, and he noticed something strange. “Jeff and Lynn had tens of thousands, maybe $60,000 in medical bills,” he recalled. “We were trying to help Lynn to pay those bills, and one of the things that I saw was that he was getting charged a dollar for things that this little company would be contracted and paid 40 cents for.”

That gave Slavitt the idea for his next company. Its aim was to help patients find the cheapest option for services that weren’t covered by their insurance.

“He came away realizing that the whole health care system was not very consumer-driven,” said Rob Keil, Slavitt’s senior-year roommate in college. “I think he became very passionate because he saw a huge problem.”

If a personal crisis pushed Slavitt definitively toward health care, it was a political one that propelled him to D.C. nearly 15 years later. It was October 2013. The Obama administration had launched healthcare.gov — the Affordable Care Act website — and it was immediately a technical disaster. Slavitt called D.C. on behalf of the company he was working for at the time, a subsidiary of the insurance giant UnitedHealthcare, to offer his firm’s expertise. The Department of Health and Human Services accepted. He first arrived at CMS on Oct. 24.

“I got to know him at a difficult time … we had made a commitment that by the first of December the website would be functional,” Kathleen Sebelius, the secretary of the Department of Health and Human Services at the time, told STAT.

Slavitt remembers being in the war room that he’d helped set up when the website rounded a corner. “All of a sudden it was popping,” Slavitt said, remembering how everyone stopped working and began staring at the enormous screen. “We were like, ‘People are getting insurance.’ There was this huge cheer.”

Yet even with the crisis under wraps, the agency that Slavitt would join was still in a precarious state. One of Slavitt’s former staffers said recently that it needed to be “healed.” Sebelius recalled that the Republican-controlled Senate’s refusal to give Slavitt a confirmation hearing when he was nominated to be administrator “left him in kind of a limbo position. Not that he was any less dedicated or enthusiastic, but it sends a message to other staff people that says, ‘Maybe he will be here, or maybe he won’t.’”

As Slavitt was trying to boost the morale at CMS and implement a change in the way that doctors got reimbursed for the care they provided, he was also relatively new to the workings of Washington. Senators would send him an email and put out a press release simultaneously: “Senator so-and-so tells Slavitt to fix this or else,” he recalled. “I would find out in Politico or Modern Healthcare. … And I was just trying to figure out, is this normal?”

A little over halfway to Sierra Vista, as reddish desert streamed by the car windows, Slavitt’s assistant handed him a schedule for the town hall. She had just written it up, on the back of a flyer for a Mexican restaurant that her Uber driver had given her that morning.

“Especially if people have come all this way, they’re going to want their questions answered, so I want to make sure we do as much of that as we can,” he said. “And everybody in the world, including me, maybe especially me, talks for longer than we think we talk for. So … we want to keep it brief, because we really want to hear from people.”

Stories are important to Slavitt. Growing up in Chicago, he dreamed of being a war reporter, partially under the influence of a melodrama called “The Year of Living Dangerously,” in which a young Mel Gibson is a foreign correspondent covering the political turmoil of 1960s Indonesia. “He plays a very swashbuckling Australian, hard-drinking journalist,” recalled Slavitt, who saw the film some 10 times.

“He sees what everybody else is reporting on, which is the sport of it all, and he gets exposed to the people in the villages … and he starts to tell that story.”

In Sierra Vista, the day was hot. A red-tailed hawk wheeled high over the parking lot as Slavitt paused for a photo op outside the library before heading inside.

Almost as soon as he got the mic, Slavitt jumped on the Republicans who had voted for the bill: To him, they seemed more interested in “the sport of it all” than in people’s lives.

“OK, Andy, why would you travel 1,624 miles to come talk about health care?” he began. “And unless she’s here”— he looked around the room with his finger out, picking through the crowd — “it’s in part because Representative McSally isn’t.”

There was laughter, then cheers and applause.

“I chose to come here as one of my first visits because, quite frankly, I found her comments to be representative of the fact that for some people this is a game, a sport to be won or lost.”

He then laid out some ground rules for his speech. He would try to keep it short, to leave time for questions. He would try to let the audience know when he was giving his opinion, he said, and when he was saying what he held to be facts.

“This is not political,” he said — and then he explained how exactly Trump had broken his three big promises on health care.

Slavitt said he couldn’t know exactly how many millions of Americans would lose care — estimates are inexact — but that millions would lose their coverage under the new bill. He said the new bill definitely made health insurance more expensive if you’re over 50, and even more expensive if you’re older and live in a rural part of the country. And, he said, “On the House GOP website appeared the words that nobody with a preexisting condition should be charged more than anybody else. After the House vote, that sentence was eliminated. That’s all you need to know. … I don’t know of any other three-letter word besides ‘lie’ for that.”

It’s hard to maintain that this is “not political” — and Republicans have sneered at the claim.

Congressman Mark Amodei, of Nevada, called it “incredible.” He was one of the Republican members of Congress in whose districts Slavitt held a town hall either in person or by phone. (STAT contacted the offices of seven; neither McSally of Arizona, nor Erik Paulsen of Minnesota, nor Evan Jenkins of West Virginia, nor Alex Mooney of West Virginia, nor Don Young of Alaska responded to requests for comment.)

Amodei, who was first elected in 2011, said Slavitt’s town hall project — and Slavitt’s very existence — was news to him.

“I have never heard of the guy before, which is probably an indication that we didn’t have a real customer-friendly relationship with CMS under the previous administration,” he said by phone. “Until you asked me the question, I was unaware that this former CMS administrator decided it was his civic duty to hold a telephone town hall after the AHCA vote.”

Amodei, who said he held his own town hall in April, before the Republican health care vote, also wondered who was organizing and paying for Slavitt’s. He said he was sure Slavitt does not have “an overriding concern about the issue; I’m sure someone asked him to come into Nevada to whip folks up.”

These suggestions don’t worry Slavitt. He finds them laughable. “I was at an event with Rupert Murdoch this week,” he said. “Someone made the comment to him, ‘People are really up in arms about this bill,’ and he said, ‘Don’t believe it for a second, people are getting bussed in.’ That’s what he said. And you know, we just had 3,300 people on a call from Alaska. Where do they get bussed in from?”

The idea for the town halls had, in fact, come from Slavitt. His team then turned to local chapters of progressive organizations like Organizing for Action, a nonprofit offshoot of Obama’s reelection campaign, to help set up the events. Slavitt’s team said that Save My Care — an initiative organized by a coalition of liberal groups — helped pay for his plane tickets, while he paid for his own hotels.

Slavitt may not have been called in to “whip folks up,” but pressing people into action was part of his goal in Sierra Vista. He knew that the Republicans only have a slim majority in the Senate. If constituents could get Senators John McCain or Jeff Flake to stand up against the bill now, that would change the landscape.

Afterward, Slavitt took questions, including some about government employees’ insurance, veterans’ insurance, and why he isn’t advocating for a single-payer system. After responding to more questions and stories one-on-one, he had to go. He would have liked to stop for lunch at the best Mexican restaurant in town, but there wasn’t time: He needed to be at a Tucson news station by 3, and at the airport around 4.

While he insists that he’s no politician, Slavitt’s schedule of town halls, skipped meals, and meetings all over the country make it sound like he’s on the campaign trail. “I’ve been getting a lot of ‘Andy, are you going to run for Congress?’ My answer to that is no,” he said. “My answer to that is, ‘I don’t want to run for one congressional seat, I want to run for 25 seats.’” Later that day, he added, “I’m more of an executive branch kind of person.”

Right now, though, he’s focused on what will happen in the Senate. “It’s not about a bunch of policy arguments,” he said, “it’s about getting out here in the real earthy world where people are going to have to place their votes, and it’s one senator at a time.”

On the way back to Tucson, Slavitt leaned his head onto his right shoulder, watching the desert roll by as he did a phone interview. He was still on a business call as he walked from the car into Tucson’s public broadcasting studio. Not long afterward, Slavitt emerged from the air conditioning into the mid-afternoon heat. As he walked back toward the car, he asked Julia Strange, a vice president at Tucson Medical Center, who had driven him to and from Sierra Vista, about the show he’d just been on.

Was it big?

It was big, she said. Its sound bites would be played on Arizona’s public radio stations all week.

“I laid it onto Flake,” Slavitt said. He’d been nice, he went on: He’d mentioned that both Flake and McCain cared deeply about their constituents. But he’d made sure to zero in on the fact that Flake was up for re-election in 2018, and that his action on the Republican health care bill wouldn’t go unnoticed.

“He’ll see it,” Strange said.

“Good,” Slavitt replied. Then they got in the car and headed toward the airport.