Name: Theo Merkel
Hometown: Towamensing Township, Pa.
Position: Legislative assistant for healthcare for Sen. Pat Toomey, R-Pa.
Age: 29
Alma Mater: Johns Hopkins University
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Washington Examiner: What are some of your job responsibilities?
Merkel: I am the primary healthcare staffer for Sen. Pat Toomey. The primary responsibility there is to be somebody that is constantly learning because Pennsylvania is a relatively large state, you’ve got almost 13 million people, and healthcare and the scope of the federal government in healthcare is obviously very broad. We have a huge regulatory footprint. The federal government spends over $1 trillion each year in direct healthcare spending alone, so you need to be constantly learning about how that’s impacting people in Pennsylvania and how we can improve on its impact and be able to readily relay that information to the senator.
Washington Examiner: Did you always know you wanted to go into healthcare policy or to be in Washington? Merkel: No to both of those. It was circumstance that sort of brought me to healthcare in Washington. I, like a lot of other people, graduated from college without a clear sense of direction of what I wanted to do. I swung and missed at a couple of opportunities and I found myself living with my parents back in Pennsylvania, and there was an election back in November of 2010. I went to the Towamensing Township municipal building and cast my ballot for somebody by the name of Patrick J. Toomey. But it actually, interestingly enough, was my grandfather, who was a Democrat but also a profound judge of character, that sort of knew Pat from his background when he was a congressman in the Lehigh Valley at the end of the 1990s and early 2000s. He was the one who suggested that it might be worth applying to work in his office. I actually started as a constituent advocate, doing casework related to veterans navigating the bureaucracy of the VA, and then a job opened in Washington, and it happened to be healthcare. I applied for that, got that job, and sort of took off from there. I really got involved and fell in love with a lot of the nuances in healthcare.
Washington Examiner: What did you learn through the course of the healthcare vote’s debate and failure?
Merkel: I think I came out of it with a reinforcement of what you already knew about healthcare: Healthcare is deeply personal, and any changes to the way that the current system is are going to elicit a lot of very emotional reactions. Obviously the scope and size of healthcare makes change difficult because, while absolutely everyone will tell you that we spend around $3 trillion on healthcare and the National Academy of Medicine says that almost $1 trillion of that is waste, and even former President Barack Obama’s health economist, David Cutler, says that routinely, you realize that it’s not segmented in any way. It’s not as though there is $1 trillion of fraud that we can just attack and realign the system to change; it’s deeply embedded within the institutions and the practice of medicine today. So, that makes things challenging. That said, I’m still relatively — and I say relatively because obviously coming out of the vote at the end of July that was very disappointing — but I’m still relatively optimistic because there are still issues that need to be addressed, keeping in mind that the timeline was relatively condensed for such a challenging issue. When the Democrats confronted healthcare reform in 2009, they ended up passing two bills, one that passed Christmas Eve and the other that passed in March of the next year. So, we are not there by any means.
Washington Examiner: Can you talk about your work with members of the Trump administration?
Merkel: The people who have been hired over at [Health and Human Services] and in the White House are a lot of really great people that have been extremely helpful, especially when it comes to learning some of the nitty gritty details about Medicaid and how to improve the program. They are generally assets I rely on when it comes to getting a detailed perspective on a part of the program that I might not be as familiar with. Seema Verma [administrator for the Centers for Medicare & Medicaid Services] is incredible. She has a great understanding of the Medicaid program and she’s very willing to call staffers and explain provisions to them, which I have been very thankful for. Washington Examiner: Can you tell us about some of the other things in healthcare that you are looking to accomplish or have accomplished?
Merkel: I have been with Sen. Toomey in D.C. in two different stints. One started in 2011, when I was a more junior healthcare staffer. In 2013, we started working on something related to the opioid crisis, specifically trying to get at the problems of diversions of opioids from within the Medicare program. In 2013, we were just starting to craft legislation to get at that issue. I then left for almost two years, when I went back to Pennsylvania and was policy director of the campaign. In that time, the individual that took over the healthcare portfolio really did fantastic work in drilling down on the details of that issue, crafting the legislation down to the point where it was passable and getting it across the finish line as part of the Comprehensive Addiction and Recovery Act. Now, I’m back here in 2017, and I’m sort of overseeing its implementation in some ways, and I’m seeing results. The opioid epidemic is a huge issue, especially in a state like Pennsylvania. And that is something we are proud of and are going to continue to be working on. Washington Examiner: There has been a lot of talk recently about the impact of Obamacare’s Medicaid expansion on the opioid crisis. Are you looking at that at all?
Merkel: Yes. There are several different ways that folks have been looking at that. Certainly, Medicaid plays a large role in paying for some of the medication-assisted treatment. I think some of the things that have come out recently are that Medicaid prescribing patterns also tend to be higher than private insurance or Medicare. Now there could be a lot of different reasons that’s the case, but that’s obviously something we want to learn more about in identifying how we can improve upon that. We also have issues with regard to medication-assisted treatment when it comes to diversion in Pennsylvania of things like suboxone. In addition to getting people in treatment, we need to make sure the money that we are spending on treatment is not perpetuating another problem.
Washington Examiner: Can you share an interesting story about Sen. Toomey?
Merkel: Sen. Toomey has recently come out as a beekeeper, which is a really cool hobby. I got to see the bees and the hive at one point. I don’t think he’s harvested any honey yet, but we’re all eagerly anticipating it.
But also he gave a speech on the 150th anniversary of the Gettysburg Address that was just an extremely concise and moving tribute to Abraham Lincoln that I was able to contribute a couple of statistics and facts to.
Washington Examiner: What do you enjoy about D.C.?
Merkel: I am from a considerably less populous area than D.C. is, so I really enjoy the amount of choice that you have around here when it comes to going out and going to restaurants. I’m also a very big fan of the type of history that makes most people’s eyes glaze over. I find that D.C. and Pennsylvania are absolute treasure maps when it comes to places of historical significance. There’s just boatloads of opportunities.
