Medicaid Policy and Advocacy (ft. Dr Felix Nuñez)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Hey everyone, it's Ed. Welcome to another edition of Digital Voices. So excited today because we're going back to the payer side, but we're gonna Go even further than that. It's going to be super interesting because I have a great guest. It's Dr. Felix Nunez. I know I'm saying it wrong. Tell us how to say it. Tell us, because you explained it really well and I blew it. Tell me. Tell me.

Absolutely. And so the, the last name is pronounced Nunez. And that middle N is, is I, is like the way Curly used to do that nyuh sound. It's Nunez. And it's, we actually in Spanish, we call it the, we actually call it the ñ. It's actually its own letter in Spanish. It's called an ñe.

Yeah. So what's your ethnic background?

I'm Mexican American. So, um, my family, family origins are from Mexico.

Very cool. Do you speak any other languages?

I'm fluent in both.

All right. That's awesome. Our daughter, one of our daughter-in-laws is from Mexico. And so, but I haven't been a very good father-in-law. I'm trying to learn the language, you know, so I can converse better with her family. And, uh, I need to do a little bit better job.

Well, yeah, that— and we're in the Southwest, so Spanish has always been part of the culture here in this part of the United States. So it's always been helpful for folks to know Spanish out here. And, but yeah, so I grew up speaking Spanish at home and then obviously in school and outside of home, English. And so right now my primary language is English. Both my parents have passed, so I don't get to speak Spanish on a daily basis as I used to when my parents were alive.

But I think a lot of the people that you serve, right, with Gold Coast Health Plan are bilingual.

Absolutely. Yes, that's absolutely true. That's true. And I still see patients as well. So when I go into clinic to see patients, I speak in Spanish most of the day when I'm with patients.

Yeah, I need to get on the ball. So hopefully next time you and I talk, maybe it'll be in Spanish. I'll do my first Spanish edition of Voices with you.

Let's do it.

And my daughter-in-law. I mean, cause you know. All right, so yeah, as I mentioned, you're the Chief Executive Officer of Gold Coast Health Plan. And we first met sort of virtually. So I know one of the individuals, other executives from Gold Coast Health Plan, and she was like, put us together. And I looked you up and I did some research and I thought, yes, this would be excellent guest. But before we get too far, Felix, we wanna talk about what songs are on your playlist. What's your favorite type of music?

So I have a very eclectic playlist. I love music. I just love music in general. So my favorite artist, I'd probably say it's probably a toss-up between, say, Jackson Browne, Bruce Springsteen, Buddy Guy. So it's, it's a pretty eclectic playlist. I love Jackson Browne. I grew up with Jackson Browne's music. Jackson Browne actually is from an adjoining neighborhood in Los Angeles. So he is, he's sort of a homeboy from from the area. He grew up in Northeast LA and I grew up in Northeast Los Angeles. So I love Jackson Browne's music, but I have a really eclectic playlist. I've been listening a lot to bands from Ireland. I listen to bands from Latin America. You know, to me, it's really not so much about the genre, but what really catches my ear. Is it rhythmic? I play guitar, so I love to listen to guitar music. So that's really important. To me, there's a band from Ireland that I love called Bell X One. It's a band that's not known well outside of Ireland, but Bell X One is actually a really popular band in Ireland. I discovered them and I love their music.

That's awesome. And people can't see, but I can as we're talking, and you've got all sorts of guitars in the background. So you, when you say you play guitar, you play guitar.

Yes.

Do you like Malangueno? What's that song, Malangueno?

Do you do any?

Balagangga? Yeah.

I have not played balagangga. That's so funny. I learned it when I was in college from a roommate, and I don't think I've really played it since college. I, I, so I'm 55. I played guitar since I was 14. So I've played guitar for about 40 years. I didn't take lessons. I was self-taught. And I have, I have picked up lessons here and there a few times, but later on in life, not when I was younger. And it's, it's interesting because by the time I started taking some lessons, I had already gotten into my bad habits and the lessons were really more focused on things that I wanted to learn. So I'm really interested in the blues. I really like blues music. I love going to listen to live music and live blues music. So I wanted to understand sort of the blues music, where it comes from, sort of the progressions and sort of how the lead parts of the lead guitar parts of the blues, how those are constructed and how they develop the lead portion. So yeah, I took time to take, to learn how to do that with some folks. So, but I had already learned all the bad habits and it's really hard to unlearn bad habits if you've taught yourself how to do it. So my kids know this. They hate it when I'm learning a song because what I'll do is I'll just play the song over and over and over again. And then I'll just listen to it and then I'll just pick it out. And once I figure it out, I'll just keep practicing it over. I don't actually read music. I will try to memorize a song.

Did your kids pick up on your musical interests? Are they musical themselves?

No, they're not. Both of them learned an instrument. It was kind of obligatory in our household. My father-in-law was a professional jazz trumpeter. So my son picked up trumpet and played that through high school. And then my daughter did viola all the way through high school as well. But, but after that, I think they just kind of went off and did their thing. But I still encouraged them. I don't play in a band, so I mostly play for my own relaxation and de-stressing. I find that playing guitar really helps me to de-stress and really takes me to a different place and gets my mind out of the hustle and bustle of what's going on in life. So I really enjoy doing that. So I encourage them to do it for that reason.

Yeah, I like that. We had the same philosophy with our kids and my parents, which I got from my parents, and they insisted on the same thing. Everyone, we sort of had to play an instrument. Only maybe one of the 7 of us went on and still is active, but, but it's good. It's good training. It's good exposure to the arts. You know, it's good classical education to know a little bit about constructive music. So that's cool.

Yes, I agree. Uh, I think, I think people that play instruments are working different brain cells. Yeah. So it's, it's really good for kids to play instruments. I think music really helps to develop that brain and really helps them be much more creative, not just from the musical side of it, artistic side, but also from the problem-solving side of things.

Yeah, no, I love it. And it's a great philosophy. If our listeners have learned nothing yet, it's definitely get into music for your kids and for yourself. It's good for multiple reasons. So let's jump into your career. So you've had a career, a very distinguished career. You've been a huge public health advocate and leader for and provider throughout your career. So what inspired you towards public health?

I kind of tell people I became a doctor because I flunked out of becoming a Catholic priest. So this was the next best option, I guess. So in truth, I think I've always been called to a life of service. So at a very early age, I did look and think about becoming a Catholic priest. I actually finished what we call a minor seminary, which is a high school seminary training. In Roman Catholicism, a high school seminary is sort of the first step in your trajectory towards becoming a priest. So I finished a minor seminary training as a high school seminarian, and I was thinking about the priesthood, and I think I was drawn to that, that idea of a life of service, committing yourself to something bigger in life, of service as something to aspire to. And I think that comes from the priests that were probably our parish priests in our community. I came from a very lower working-class community, And the priests were really leaders in that community. They were people that served that community. They were people that we turned to for advice, for counsel, for leadership, spiritual leadership. So I think I was drawn to that, right? That sense of these, these were men that were educated. These were men that, that were thoughtful, that were compassionate. Yeah. And I wanted to be that kind of person, right? I wanted to be a leader. I wanted to serve people because that's what leaders do. So I think that was the common thread that kind of got me going. And if you look through my, Career trajectory—that's the common thread. I don't have a script. I can't tell you that I went from one position to another position because I had a script and I was following that script on a trajectory towards becoming something. Yeah, I had a common thread that connected things, and it's it's more about that common thread that I that commitment towards a life of service and looking for opportunities that allow me to fulfill that that vision. That mission in life of service. I love that.

That's a great answer that, you know, a lot of people, they're always, they'll never find, they never find fulfillment because they're always like grasping for things, but you've known for a long time, look, I'm, I'm created. You've had this mission of service and how it manifests itself, you know, is up to whatever happens. And so you became a clinician and you still see patients and you serve other people and you serve at scale. as a CEO of, you know, a payer-type organization. So let's talk about Medicaid policy and advocacy. So we're recording in July 2025. So I wanna put that out there. Share your perspectives on the current Medicaid policy and where we're headed. I know this is really important to you and your constituents.

Yeah, thank you. It is incredibly important. So just for transparency, I'm one of those crazy people that believe that everyone should have access to healthcare services regardless of who they are, where they are in this world, that nobody has to show their worthiness of access to healthcare. If you're a human being alive on this planet, you should have access to quality healthcare services, period.

Yeah.

And there is absolutely no excuse that the wealthiest nation on earth by multiple factors cannot provide that for every resident of this nation. Regardless of who they are and where they are in this nation, we should be able to do that. It's shameful that, frankly, that we don't consider that a fundamental right in this country, that we still argue and fight about the worthiness, the people needing to show their worth to be able to access healthcare, to be able to access food, safe drinking water, housing. That's shameful. We're an over $30 trillion economy in the United States. The next highest economy is China. China is like $12 trillion. They're not even half the way there to where we are. It is absolutely shameful. And what's happening right now in Congress is taking us 2, 3 steps back instead of moving us forward. We still weren't there. I mean, we still weren't there in the last, the Biden administration. We still weren't there in terms of making sure that we were giving everyone access to healthcare services. But now we're going backwards. And it's a retreat and it's a defeat for those of us that really believe that healthcare is a right and not a privilege. And that no one on this planet, no one in this country should have to demonstrate some kind of worthiness to be able to access that. So setting up barriers like work requirements as a measure of your worth to be able to access healthcare services, that's an artificial barrier. That's you saying, That, Ed, you're not worthy of healthcare unless you do this.

Yeah.

That doesn't, that doesn't play in my book. That's phony. The reality is that this country right now is, is in a state of decline in regards to where we are in advancing universal access for all human beings in this country. We are taking monumental steps backwards. We are doing it, we're doing this on the backs of the working class, the middle class. Frankly, I think we're giving to— it's the opposite of the Robin Hood story.

Yeah.

We're giving to the rich on the backs of the poor, the working class. And I fear for this country. I don't think people fully understand the ramifications of this. I think a lot of people who currently are receiving Medicaid actually do not know that they are getting Medicaid. Here in California, we call it Medi-Cal. We don't call it Medicaid.

Right.

In other states, in Tennessee, they call it TennCare. They have different names for it. Each state brands it differently. They don't even realize that what Congress is talking about when they say Medicaid is actually healthcare that they're getting right now. And it's critically important that people realize this because there's still time for folks to act and engage in this. There's actually still time. We're at the 11th hour, I know, but there's still time for people to do that. And I'm really concerned about this, that people aren't aware And they're not going to understand until it's too late that what Congress is doing is taking away vital access to healthcare services. And it's going to happen in a way that is insidious. By the time they realize that it's happened, it's too late. It's gone. It's been taken away. And the consequences of that, the ramifications, it's going to be a cascade because it's not just going to touch Medicaid services. You, Ed, don't have healthcare, don't have health insurance. You neglect your diabetes, you neglect your hypertension, you don't go to your doctor 'cause you can't afford the copay, you can't afford the office fees, you can't afford the medications, you can't afford the lab tests. So your diabetes goes uncontrolled, your hypertension goes uncontrolled. You end up with diabetic ketoacidosis, which is a very serious condition. You end up in the emergency room, uncompensated care. The burden falls on the public health system. The burden falls on the emergency room. Emergency rooms are clogged with people now who don't have serious conditions that could have been addressed in the clinic are now being addressed in emergency rooms. Hospitals are flooded with people who now have very serious advanced illnesses. That undermines the entire healthcare infrastructure, not just for the Medicaid people, but for everybody else in that community. They're at risk because now those systems are now inundated with people who, through no fault of their own, have had to neglect care because of the cost.

Yes. Well, it's super interesting because a friend of mine is Honorable Tony Clement. He's Canadian. He's the equivalent of the Health and Human Services Secretary, you know, in the cabinet of the Prime Minister. And we were talking about this, you know, and you know how Canada has sort of this universal healthcare. How, what would be the ideal state for a country like United States, which It's sort of this public and private. Um, is there a way to marry the two together, uh, to get the both— the best of both?

Yeah, I, I absolutely think that there is. Actually, the Affordable Care Act, Obamacare, did do that. Um, there, there is no— so there is no scenario where we build a national health system like in— like England did, like Great Britain. Uh, we don't— there is no tearing the temple down and rebuilding it in 3 days. We can't do it. We have what we have. We have to work within the parameters of what we have built as a nation. So first off, I tell this to students when I lecture. So the idea that the American health— or the statement that the American healthcare system is broken is actually a fallacy on 2 different levels. Number one, we don't have an American healthcare system. And number two, it's not broken. We in the United States, we have a healthcare industry. It is not a system. It's an industry. And I'm not saying that to be like flippant or anything. It actually is an industry. It's about dollars and cents if you really get down to how this works and, and how things get moving and what's the secret sauce in all of this. So it's an industry. So you need to understand that that's what we built in this country, and it actually reflects our values as a country. We are a capitalist nation. We have built a healthcare industry, not a system, that reflects who we are as a nation. And it's not broken. It actually does what it's supposed to do because it's designed to make money. It's an industry like every industry in this country. It's a multi-trillion-dollar industry. So we have to keep that perspective. So if you, if you believe that and you understand that, then you work within that parameter and say, okay, so I accept that. So how do we work with that and find a way to get everybody access to that?

Yeah.

I think President Obama took that very pragmatic approach and said, this is what we have. Let's work with that and let's find a way to get everybody, to get nearly or mostly everybody access to that industry, access to healthcare through that industry model that we've built. And I think he was successful in doing that. It's messy. It's not as neat as saying that there's one national health system.

Yeah.

And you have one national health system card. And with that card, you can go anywhere within the national health system network all throughout Great Britain. So it's it's messy. It's not neat. There's a lot of money changing hands, and there's a lot of people in between making money all all along the way. But that's what we have, and we can make it work. I think Obamacare, the Affordable Care Act, the foundation is still there. So regardless of what Congress does in this next day or two in terms of scaling back funding, that foundation is still there. I I am hopeful. That once we have a change of leadership that has a change of heart and greater compassion for their fellow Americans, we will see a revitalization of that of that system or that industry and bring people back back into that in terms of getting access to care. So that's my hope that we haven't broken things so much that we're not able to to rebuild it and get people access to care through that through that.

Yeah. And I suspect that there's a way to meet all of these aspirations within the current cost structure of the industry. Because I think there is a lot of dollars in it, right? And if they were used differently, I think we would have what you're describing, right? Everyone would have access to care, affordable care, and the industry would become more service-oriented. Yeah, I agree with you. You know, it's very much an industry. And we've sort of lost this heart of service in all of it. And again, I think there's enough money probably in there, right? It's 19% of GDP or, you know, some outrageous amount. There's enough money in there probably to put in different ways to achieve what, you know, what everyone would probably like is sort of this hybrid that you were describing. You know, I call it public-private partnerships, which we've seen work in different Yeah. So, I think I can see where you're coming from for sure. Let me shift a little bit into tech. Let me ask you a question about tech. So, where does tech come into all of this? Do you all leverage a lot of digital sort of tech for your constituents, or can it be a helper in all of this to make healthcare more accessible?

Yeah, I think that's it. So from the accessible side of things, so that's a component of where tech can be really helpful for us is really understanding the populations that we serve and how we can target our efforts and our resources to really help that population achieve better care. So accessibility is part of it. Also efficiency and trying to minimize waste, especially now with what's happening in Congress, we may see our revenue streams start to dry up in some ways. Congress is cutting funding to Medicaid, regardless of what you're hearing from the president or from the Speaker of the House. They are cutting Medicaid by $1 trillion. That is what they are doing. No question about it. Anything else that they say is gaslighting. They're cutting Medicaid. So because of that, we're going to have to lean on technology to become a much more efficient industry. We cannot throw bodies at problems, for example. We're going to have to find a way to leverage technology to be more efficient in our use of the resources that we have. So that's going to be part of how we make sure that our members, our health plan members, continue to have access to the services that they need. So that's part of how we leverage technology. From an access standpoint, from a population standpoint, technology is really helpful for us to really get sort of an air traffic controller view of our world. Like what's happening out there with our membership? You know, where are people, where the needs are in that membership? Where are people not getting care? Because there's areas in our membership where they don't have cardiologists or they don't have a hospital readily available, or there's no obstetrical unit in this part of the county because all the obstetrical units have closed. Like having understanding of where our population is and what their needs are, Technology really can help us do that, to develop that view of the world like an air traffic controller view of the landscape. So like there's no cardiologist here. Well, can we start a grant program to help recruit cardiologists into that community? Right? Or can we can we start to help the county hospital system, for example, help fund a clinic out in this community so that they can help meet the the obstetrical care needs of that population? So that information. Gives us insight into where we can step in as an organization, right, and help meet the care needs of our population. So that's critically important. You know, where do we have a lot of folks, you know, suffering from complications of diabetes? We need to get more diabetic health educators out there, or we need to work with our doctors out there and give them more support, right, and develop a diabetic chronic disease management program and get them support out there. So That kind of technology is the only way we can get that information. There's no other way for us to really get that, that view of our population. So technology, I guess, on just on those 2 points are important. So internally, from an administrative standpoint, I believe we're going to be forced to look for technology solutions to continue to meet the needs of our membership because we're going to have less resources from an administrative standpoint.

Yeah.

So we're going to have to be much more efficient in the use of every dollar. And technology can help us do that. And then from a population standpoint, we're going to need to really understand who our members are. And the only way to do that is really getting that data, all that data source, that's the sources that are coming in, consolidating that data and then analyzing it and getting a real air traffic controller view of the world.

I love, I, yeah, I love that. I agree with you. There definitely will be, you know, more opportunities and more pressure in a sense. This has been so fascinating. I, I've really enjoyed hearing your perspective and I wish we had time to dig a little bit deeper on it. I'll just ask you one question on sort of leadership. So you gained all this great perspective from your parents and from your parish and life. What is one or two things that you might share with an emerging leader? Maybe they're younger in their journey and They look to someone like you. What are one or two, like, leadership things that you would encourage that person to pursue and understand?

Uh, I think to recognize that we lead, that we lead from 3 domains, right? In my world. So we lead from our head, our heart, and our gut is the way I think of it. Our head is all that knowledge, all that time in school, studying and reading and learning. Our heart is all that compassion, right? That love of humanity, that humanism. And then our gut is all the years of experience. And all that energy that you know just that going out there making mistakes, right? And learning from those mistakes and building on that. Those three domains don't discount any of them. They're all important. Yeah. You know, don't discount the knowledge that you need to learn to get there. Don't discount the compassion and the heart in this especially in this world where we live in healthcare. That's critically important. And the gut get out there and build that experience. Learn, make mistakes and learn from those mistakes. Don't discount mistakes. That's critically important. So learn from all of those domains.

Yeah, no, that's, if you had to choose one though, you were forced to choose one, obviously you'd want to blend, but I'm just going to put you on the spot. What's the most important one of those 3?

My heart. Always the heart. Compassion.

You're good. Uh, you know, we've only known each other a short time. I really appreciate you and admire your leadership.

Thank you.

Yeah, you're very bold and you're, but you're, and at the same time, you're a very loving, caring person. Someone, you know, I'd want to hang out with and want to be, you know, around and be a leader in my community. So I think what you're doing is great and your advocacy is super. We talked about so much just to give you the last word. Is there anything else that we didn't touch on or something you want to double down on?

Um, I just, I want to encourage people just, just to I said it just to always have compassion. Don't give up on folks. Always have compassion for their fellow man. Don't lose your humanity in the midst of everything that we're going through as a nation right now. Keep your humanity. Don't lose that compassion. That's absolutely vital for us as a nation. Thank you for listening to Digital Voices Podcast with Ed Martin. If you enjoyed this episode, subscribe on your preferred streaming And leave a rating and review. And most importantly, thanks again for listening.