These Heller alumnae are making sure the Affordable Care Act is doing right by Massachusetts residents.
By Sarah C. Baldwin
In 2006, the Bay State became a model for the nation when then-Massachusetts Governor Mitt Romney signed into law comprehensive health care reform designed to make health insurance available to all state residents. As part of that reform, a health insurance marketplace, known as the Massachusetts Health Connector, was created to help people find health coverage and obtain subsidies. In its first two years, the Health Connector helped reduce the percentage of uninsured working-age adults from 13 percent to four percent. Over the next two decades, it helped the state achieve the highest rate of health insurance coverage in the country.
Now, 10 years after most of the provisions in the Affordable Care Act (ACA) went into effect, several graduates of the Heller School’s Master of Public Policy (MPP) and PhD in Social Policy programs are using their health policy expertise to ensure that the Health Connector’s 370,000 individual and small-employer members continue to get the health and dental coverage they need. (A fourth, Sarah Buonapane, MPP’15, is the Health Connector’s associate director of community assistance programs.)
Micro to Macro
When Marissa Woltmann, MPP’13, first started at the Health Connector, in 2008, she worked in administrative appeals, reviewing individual cases of people who felt they had been wrongly denied subsidies. After a few years of resolving cases one at a time, she wanted to find a way to make improvements on a much larger scale. “How can we adjust policies upstream, so people don’t have to appeal in the first place?” she wondered. She felt that Heller’s MPP would give her the system-level knowledge and skills she would need to help devise and implement those changes.
Scaling her work at the Health Connector back to part time, Woltmann enrolled in Heller’s MPP and pursued the concentration in health policy. She especially valued the program’s “diversity of lenses — qualitative, quantitative, political, research” — through which policy was explored. And she appreciated an approach that took into account the social determinants of health.
“Understanding social policy — how it’s been shaped around poverty, education, transportation, or homelessness — is helpful in putting together a vision of a whole person and how they are situated in our society, and how that can support or impede their pathway to health care,” she says.
Woltmann returned to full-time work at the Health Connector in 2013. Today, as the Health Connector’s chief of policy and plan management, she and her team of 10 are responsible for ensuring that Massachusetts continues to comply with the ACA as policies evolve, and for “making sure the trains are running” — in other words, seeing to it that members are getting what they need at a cost they can afford. At the same time, Woltmann is continuously seeking paths to improve members’ experience. Recently, she and her team have been working on ways to help members by reducing the administrative burden of obtaining ACA-related tax credits.
Continuing to guarantee affordable insurance despite rising costs is “a tough nut to crack,” Woltmann says, but it’s also a team sport. In addition to working with the state’s many insurance companies, she and colleagues collaborate with state agencies like the Health Policy Commission, which sets growth benchmarks and monitors spending, and the Division of Insurance, which regulates the insurance market. They also confer with the Health Connector’s board, whose 11 members — including a health economist, a health care actuary, a consumer advocate, a representative of organized labor, and an employee health benefits plan specialist, among others — provide a range of perspectives.
Woltmann’s team also gathers feedback from members themselves, to gain insights on “how they’re experiencing their coverage.” In mid-2024, such feedback had to do with a two-year pilot that expanded the state subsidy program to include people with income 500 percent above poverty level (up from 300 percent). According to Woltmann, the pilot is helping many middle-income households, who have struggled with out-of-pocket costs.
“It was really gratifying to be able to put that [pilot] into motion … and get feedback from members that they’re able to get care that they had deferred due to cost,” she says. “We heard from a lot of self-employed individuals, people who had retired early to take care of sick family members. It took a little of the load off their shoulders.”
As she thinks about enhancing the health insurance experience, Woltmann draws often on expertise she gained at Heller, including how to take a complicated problem, sort through it, figure out what’s important, and make a decision. Or how to make a spreadsheet to show cost implications. Or analyze data on membership trends.
“Whether you’re doing data analysis, putting it into a presentation, and sharing it at a really high level, or writing a memo using that data,” she says, “Heller’s interdisciplinary approach is a really crucial component to being successful in a policy role.”
Close to Home
When she was in high school, Kayle Scire, MPP/MBA’18, was aware that her parents and grandparents lacked health insurance, despite owning a deli in East Boston, a working-class neighborhood in which half the residents are foreign-born. Scire recalls hearing deli customers, especially other small business owners without coverage through their job, worry about being able to pay for insurance, and about being dropped. Her own grandfather died in his 60s of diabetes; unable to access preventive care, he didn’t get the treatment he needed until his chronic disease was quite advanced.
In 2006, when Massachusetts passed its landmark health care reform bill, Scire sensed a shift in those conversations as customers expressed excitement about accessing health insurance. “I think that’s what got me into health policy and health disparities,” she says.
As an undergraduate at Wellesley College, her interest persisted: she wrote her political science thesis on applying lessons from Massachusetts health care reform to the ACA. From there she went on to work as a senior aide to U.S. Senator Edward J. Markey (D-MA), fielding the health care-related requests and complaints of his constituents. But, she says, “I wasn’t doing policy work that could make a big difference. That job helped me understand that I wanted to be at the state level, doing policy analysis.”
After researching numerous MPP programs, Scire chose Heller’s, in part for its focus on social as well as health policy. For good measure, she coupled her MPP with a Master of Business Administration (MBA). “I thought having a better sense of [insurance carriers’] business motivations would help me with the larger policy questions about, for example, health care cost containment,” she says. She also became a 2017 Segal Fellow, working at the Joint Committee on Health Care Financing in the Massachusetts State House.
When she joined the Health Connector in 2019, Scire not only felt confident, she felt at home: “The Health Connector is the perfect place for thinking about the ACA and federal regulations that impact us [in Massachusetts],” she says.
Now, as the Health Connector’s associate director of policy, much of Scire’s job entails analyzing state and federal bills and regulations, including new bills that come “fast and furious” from both levels. For example, in response to Massachusetts’ 2024 comprehensive maternal health legislation, she worked with the state’s Division of Insurance to ensure that the plans offered by carriers on the Health Connector marketplace cover the required postpartum depression home visits.
Another part of that legislation provides coverage for the provision of pasteurized human donor milk and human donor milk-derived products, which in turn requires certified human milk banks — something the state doesn’t yet have quality guidelines on, which Scire learned by attending a listening session at the Division of Insurance. The Department of Public Health is now working to establish such guidelines so that insurers can comply with the legislation and facilities have clear standards to follow for certification.
“It’s one thing to pass a bill and make a service required. It’s another thing for us to be able to make sure our carriers are doing it so that people can actually access the benefits,” Scire says. “Health insurance doesn’t help anyone if no one’s using it, or if you can’t afford it.”
Putting Policy into Practice
Director of Policy Signe Peterson Flieger, PhD’13, one of Woltmann’s direct reports at the Health Connector, shares her boss’s focus on improving people’s lives in concrete ways.
In the early 2000s, Flieger was working with children with emotional and behavioral needs who were living in residential treatment facilities. “I was really interested in the systems and policy issues that impeded their progress on a broader scale,” she says. She began working toward a master of social work from the Washington University in St. Louis School of Social Work, whose dean at the time was Edward Lawlor, PhD’84. A Heller graduate, Lawlor had studied with health economists Stuart Altman, the Sol C. Chaikin Professor of National Health Policy and former Heller dean, and Stanley Wallack, founding director of Heller’s Schneider Institutes for Health Policy and Research. Lawlor’s class on health policy combined with her practicum in the policy department at Paraquad, a Center for Independent Living got Flieger “hooked” on health policy, she says.
When she later took a position in the Boston office of the Division of Medicaid and Children’s Health at the Centers for Medicare and Medicaid Services, she discovered two colleagues, including her boss, were also Heller graduates. “Heller people are everywhere,” she says. “It was clear, as folks talked about it, that the Heller School was a unique place for social policy in terms of producing people who did applied work. That really mattered to me.”
In 2008, Flieger decided to pursue a Heller doctorate in social policy. She recalls that she and her fellow doctoral students “often heard Stuart and Stan talking about the 1970s and their work with government. Those real-world examples have always stuck with me.”
She also learned about organization theory and behavior, a focus of Wallack and of health care and management pioneer and Heller professor Jon Chilingerian, and studied policy implementation with Heller professor Jeff Prottas. Through them, she learned to think about how policies trickle down and are altered by people and cultures “on the ground” — much the way federal policy is shaped at the state level.
“Those are exactly the kind of decisions we’re making at the Health Connector on a daily basis,” Flieger says. “The federal rule says this is what we need to do. What does that mean in practice? How can we design that in a way that’s aligned with how our systems work and with our mission, while still complying? How can we put our stamp on it to fit our goals?”
Flieger discovered her love of teaching as she pursued her PhD. In addition to serving as a TA for various classes, she developed and taught a course with Professor Jody Hoffer Gittell, founder of the Relational Coordination Research Collaborative at Heller. Later, at Tufts University School of Medicine, she designed and taught courses on policy analysis, health care, and organization theory — all of them influenced by her Heller professors. (In 2022, she and Chilingerian both received Excellence in Teaching Awards from Tufts .)
But after a decade in academia, Flieger missed the feeling of making a difference in the health policy world. In 2023, she was hired as director of policy at the Health Connector, where she is responsible for analyzing policies and their implications for the people of Massachusetts. In doing so, she draws on what she learned from Wallack, Chilingerian, and Prottas, and on the qualitative and quantitative approaches she learned at Heller: “Without the context of what’s happening on the ground, you can’t tell the story about the numbers,” she says.
Currently she and her colleagues are thinking about the scheduled expiration, in 2025, of the enhanced premium subsidies introduced by the American Rescue Plan Act and the Inflation Reduction Act. Specifically, they’re analyzing impact at the congressional-district level. “What would it look like if those enhanced subsidies go away? What stories do the numbers tell us about what this means in people’s lives?” she says. “We’re in the process of providing those stories to our U.S. congressional representatives so they can understand, what does the impact mean in our neck of the woods?”
When it comes to navigating the ACA-related changes threatened by the next Trump administration, Flieger says, “at the Health Connector, we have a good understanding of what the various federal policy levers are. We’re monitoring and assessing and being as prepared as we can so that when things change, we can figure out what we need to do to protect Massachusetts residents.”
In Good Hands
When it comes to “providing the support people need to lead a healthy life,” as Woltmann describes her job, the Health Connector is making a difference. Scire’s parents are longtime satisfied members, for example; her father makes a point of calling his daughter to report, “I did open enrollment again and had a seamless experience!”
According to Scire, while they all share excellent training in health policy analysis, she and her fellow Heller MPP graduates share softer skills, too: “We all care deeply and take our work seriously,” she says. “As hard as implementation can be, especially when regulations are really technical, getting across the finish line and making things better for people is the best part about working here.”