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As the RWJF Health Policy Fellows Program marks five decades, alumni and program directors reflect on the program’s impact

By Marisa Coulton

The Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program enables mid-career professionals to have a lasting impact on the health policy landscape.

David Keahey was a fellow from 2015-16. His most memorable fellowship experience took place during the passage of the Comprehensive Addiction Recovery Act, or CARA. A room full of bipartisan Hill staffers, including Keahey, were discussing whether nurse practitioners and physician assistants (PAs) should be allowed to prescribe buprenorphine for opioid use disorder, a highly effective treatment that was helping to mitigate the opioid crisis. Before CARA, only physicians were permitted to prescribe the drug. The staffers all seemed to be leaning towards an agreement that prescription privileges should be limited.

Keahey looked around and realized he was the only clinician in the room. It would be up to him to offer a front-line practitioner perspective. He pointed out that the United States has a physician shortage, especially in rural America. PAs and nurse practitioners are providers of care for a large proportion of patients that need these medications. Heads began to nod. When CARA was passed, PAs and nurse practitioners were allowed to prescribe these lifesaving drugs to treat opioid use disorder.

Thanks to the RWJF fellowship, Keahey had a seat at the table. For 50 years, the fellowship has given health professionals from a broad range of specialties and backgrounds the opportunity to work directly with policymakers.

The key to the program’s longevity? Adaptability, said Marie Michnich, former program director. “Part of the reason why the program has survived [for so many years] is that it adapted and evolved, developing into the socially conscious program that it is today.”

She added, “[The fellows] have to understand how policy is made in Washington, D.C., and that changes over time. So [the program] has to adapt… The lecture that people gave in the ’70s is not going to be the same lecture that people are giving today.”

The program was developed through a partnership between the Robert Wood Johnson Foundation (RWJF) and the 91������ (91������). Since its founding in the early 1970s, RWJF has been committed to improving health and health care in the United States. It seeks to build a national “culture of health” where health care is accessible to every American, regardless of who they are, where they live, or their socio-economic status. The program is conducted and administered by the 91������, which has the mission of advancing science, informing policy, and catalyzing action to achieve human health, equity, and well-being. The 91������ provides objective advice on health to address critical issues and inspire positive action.

The RWJF Health Policy Fellows program equips exceptional mid-career health care professionals with the knowledge they need to become health policymakers. It provides them with an insider perspective on the political process and allows them to develop an extensive professional network.

“I loved [my cohort],” said Marlon Priest, who was a fellow in the 1990s. “I loved my time at the National Academy, getting to meet some incredible scientists doing some phenomenal work.”

Priest is among the more than 300 RWJF Health Policy Fellows who have relocated to Washington, D.C., to work hand-in-hand with key players in federal health policy, such as Members of Congress and federal administrators.

The fellows bring a wealth of expertise to the policymaking process. They offer policymakers an informed perspective on the health challenges of the day, while those policymakers give them insider access to the complicated political process and inner workings of life on Capitol Hill.

The program begins with a three-and-a-half-month orientation, where fellows meet with ‘briefers,’ a who’s who of American health policymakers and organizations. Briefers include national leaders, think tanks, interest groups, key executive branch officials, and Members of Congress and their staff.

To give the fellows the best education possible, the orientation content evolves from year to year in line with the changing health policy landscape. Though the content is always different, the central pillars of the program have always remained the same.

The Program’s ‘Magic Sauce’

One of the most unique aspects of the RWJF Health Policy Fellows program is the way in which fellows are selected for the program, said Gregg Margolis, current program director and 2009-10 fellow. It’s geared toward experienced, mid-career professionals, unlike other health policy fellowships in Washington, which tend to be geared toward early-career and, therefore, less practically experienced professionals, he added.

This is truly one of the “hallmarks” of the program, he said; in a room full of policymakers, the RWJF Health Policy fellows are often the only people who have actually worked in the system and have seen firsthand how the American health care system operates on the ground.

“The pillar of this program is that it provides people with many years of experience the opportunity to step away from their specialty, and bring their expertise and perspective to Washington, D.C., to add context to health policy deliberations,” he said.

It takes a lot to incentivize an experienced professional to step away from their work for an entire year, he added, but it is absolutely worth it. The fellows bring a great deal of experience to Washington, offering insights that many offices on Capitol Hill lack.

“[They] bring their subject matter expertise and experience to the policy conversation,” said Margolis.

The fellows are disruptive—in a good way.

They bring a “different way of thinking” to the political process, said Michnich, which encourages Hill staffers to use science and information to inform policy.

“Bring[ing] that knowledge and expertise and understanding into the political process [is]… to my mind, a contribution to the country,” she said. “I hope we’re always able to do that. We need to bring that outside voice in.”

Through the RWJF Health Policy Fellows program, fellows have the opportunity to be a part of history.

The 1980s

Jay Noren

Internal medicine specialist Jay Noren was a member of the 1981-82 fellowship cohort, during Ronald Reagan’s presidency.

Noren remembers it like it was yesterday: the members of Congress were proposing their budgets for the annual House Budget Vote. As a fellow, Noren had the opportunity to assist Congressman Dave Obey, chair of the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, in drafting his budget proposal. Though none of the proposals passed, Noren’s received the most votes.

“It was an amazing learning experience,” he said. The fact that the proposal he helped draft had the most votes, even more than the one proposed by President Reagan, was “overwhelmingly exciting.”

After the fellowship, Noren returned to the University of Wisconsin to resume his roles as senior staff associate for federal legislative actions at the Center for Health Sciences and associate professor of preventive medicine at the School of Medicine.

“[The fellowship] was a very significant experience for me,” Noren said. “It impacted the rest of my career.”

Noren’s colleagues and university leaders knew the value of the RWJF Health Policy fellowship experience. “[They] were aware of what I had done,” he said, “and began to immediately include me in policymaking and interactions with Congress and the state legislature.” His knowledge of health care and Congress made him a resource for lobbyists, he said.

With hands-on policymaking experience under his belt, his career took off. He took on leadership positions and presidential roles at numerous universities, including vice chancellor for health sciences at the University of Wisconsin-Madison, president of Wayne State University, provost of the University of Nebraska and Dean School of Public Health, president of Texas A&M Health Science Center, and chancellor of Minnesota State Colleges and Universities.

“I know that the fellowship facilitated my career evolution,” he said. “Might I have taken a similar course? Maybe. But it probably would have gone a lot slower.”

In all his roles, his knowledge of the state legislature, which he learned during the fellowship, has been “very valuable,” Noren said. Having such a well-rounded understanding of the inside workings of the policy process is difficult to accomplish, unless you’ve been there and have seen it operate, he said.

The fellowship not only gave him an understanding of the health policy world in the 1980s, but also prepared him for the changing health policy landscape in the decades ahead, he said.

Marie Michnich

Marie Michnich was a fellow in 1984-85, just a few years after Noren. It was an experience she’ll never forget.

“Pretty much anybody will tell you it’s transformative,” she said. “It opens up a way of thinking, and an understanding of the way the world works that you didn’t have before.” Those who complete the program will never read the news the same way again, she said.

As a fellow, Michnich got to be a part of many hallmark bills, which she said was “such a privilege.” She worked on the funding of academic medical centers, physician payment reform, and helped pass Continuation of Health Coverage, or COBRA, a program that allows workers to maintain their health care coverage when they leave their jobs.

Fellows leave the RWJF program with a greater connection and understanding of federal policymaking, as well as an enhanced desire to participate in the political process, Michnich said. After the fellowship, “what happens at the federal level is not so distant,” she said. “It becomes more personal.”

Michnich continued to work with the RWJF Health Policy fellows program long after her fellowship year was over. She would go on to serve as program director from 2002 to 2017.

Michnich implemented a few changes while she was director. First, she instituted two state site visits, where fellows would visit states to witness policymaking at the state level.

For two to three days, the fellows would meet with a series of “essential visitors,” she said, which would include academic leaders, a representative from the state Medicaid office, and representatives from major companies delivering health care.

The fellows also had the opportunity to visit Canada to see how the Canadian system functioned.

In addition to the state visits, Michnich also introduced media training, a facet of the program that is still in place today. “We brought in coaches and managers to teach them how to manage press interactions,” she said.

In her previous role as head of policy for the American College of Cardiology, Michnich saw firsthand how valuable media training can be for leaders. “If anybody needs any training, it’s the fellows. They’re working to develop statements for the members to go out in the press,” she said. There is an art, she said, to conveying a message.

The Evolution of the Program

When the program was first founded, the selection committee admitted mainly academic clinicians—doctors, nurses, and other health care professionals who were affiliated with a university—like Michnich and Noren.

“It was a very specific niche,” said Michnich. The program was, after all, housed at the Academy of Medicine (formerly known as the Institute of Medicine), so it was fitting that the fellows should be academics, she added.

“It was very prestigious in Washington, D.C., to have these academic medicine fellows,” said Michnich. “Everyone wanted to have one in their office.”

In the late 1990s and early 2000s, the selection committee broadened its scope beyond academic clinicians. These years saw a shift from ‘health care professionals’ to ‘health’ more broadly.

“There was a growing interest in influencing care at the direct delivery level,” said Michnich. “Not just how it takes place in academic health care settings, but in the community.” The RWJF Health Policy Fellows program began to recruit community leaders.

In the years that followed, recruitment broadened to include other professions, such as social work, economics, law, physician assistants, nursing, dentistry, and more.

The diversity of professions makes for a richer learning experience. “We spend a lot of time in the selection process thinking about how to create exceptional cohorts that are going to learn from each other,” Margolis said.

The selection process is rigorous, admitting the nation’s foremost experts. “You needed to be able to pick up on random health-related subjects and run with the ball,” said Michnich. To thrive on the Hill, fellows need to be adaptable and flexible, capable of learning about a particular issue on a very tight timeline.

The program’s commitment to peer learning has never wavered, and will never waver, Margolis said. However, other facets of the program, like the orientation, remain flexible in order to adjust to the changing policy landscape.

“The orientation is constantly evolving,” he said. It is tailored, each year, to suit the current historical moment.

The fellowship board is committed to making the program a little bit better every year, Michnich said, “taking a close look at the way things are” and considering new ways of executing the fellow program.

“The orientation program needs to reflect the reality of it at the time that it’s set within,” she said. She expects that the program will continue to remain recognizable over time, shifting subtly to meet the health policy challenges of the day.

Today, the program takes a more holistic view on health. Health encompasses more than just medicine; it includes non-medical drivers, such as income, education, food insecurity, social inclusion, working conditions, and more.

The 1990s

Marlon Priest

Marlon Priest, professor of emergency medicine at the University of Alabama, was a fellow from 1997-98, during Clinton’s presidency.

It was an interesting time to be a fellow, Priest said. He loved the fellowship, and it put him in the “heart of democracy.” During his placement with Senator Orrin Hatch, Priest was treated like a real senior staff member and given a great deal of freedom. He had the opportunity to work on a landmark piece of legislation called the Radiation Exposure Compensation Act, or RECA, aimed at compensating those exposed to nuclear radiation. It was “passed to compensate those Americans exposed to radiation as they mined and transported uranium, exposed to the downwind of the mushroom clouds,” he added.

The program was “one of the most remarkable experiences” he had in his life, Priest said. It’s right up there next to his marriage to his wife, the birth of his children, and practicing medicine, he added. “There was nothing like it in the world.”

The fellowship launched his career. Without it, he might have been reasonably successful clinically and academically, but the fellowship was “game-changing,” he said. His policy work spanned value-based care, health equity, and incorporating policy work into mentoring and care development coaching. He served as assistant vice president, associate dean, and professor of emergency medicine and surgery at the University of Alabama at Birmingham. He also served on the boards of nine large, multi-state health systems. The experience emboldened him; today, he is comfortable picking up the phone and calling leaders—presidents of banks and other organizations—for advice.

“The experience took a mid-career physician… to a place where he could envision how to create change on a large scale,” Priest said. He sought to create health care equality across the nation, through a three-step approach. “First, get agreement on the policy. Second, address the resource allocation… Third, build a nationwide team for the long game.”

Now, Priest is retired and spends most of his time with his grandchildren. As he reflects on his life and career, the RWJF Health Policy Fellows program is front of mind. “The fellowship played a huge role in the little bit of good I’ve done in the world, in my life,” he said.

Linda Degutis

Linda Degutis was also a fellow from 1996-97, around the same time as Priest. Before the program, she was working in the department of surgery at the Yale School of Medicine as the coordinator of their trauma program, where she taught surgery residents and medical students and practiced patient care.

Degutis learned about the fellowship from a former fellow and was intrigued. She had done some previous policy work and felt it would add a “different dimension” to her existing experience, she said.

She enjoyed the orientation, which she thought was extremely valuable. The briefers who came to speak to the fellows “always had a stake” in the health policy landscape, she said, which meant that the quality of the briefings was very high. She appreciated the opportunity to learn more about the interplay between politics and policy—the potential for working across the aisle to improve the health of the public.

During her fellowship, she served as the primary health policy person for Senator Paul D. Wellstone’s office and worked on a range of issues that were the focus of the Health, Education, Labor and Pensions (HELP) Committee, met with constituents, developed talking points for the senator, and responded to inquiries about issues like the implementation of the mental health parity provisions that were passed during the previous session of Congress.

The fellowship program kicked Degutis’ career into high gear. She ran for the Executive Board of the American Public Health Association and later for president-elect in 2006 and won. She also served as director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention in Atlanta, and as founding executive director of Defense Health Horizons, a program that focused on recommending solutions to issues faced by the military health system.

The 2000s

Gregg Margolis

Gregg Margolis, paramedic, joined the 2009-10 fellowship cohort, during Barack Obama’s presidency.

“It was an exciting year, and it was amazing to be there to watch the procedural elements of the passage of the Affordable Care Act [ACA],” he said. “I was in the Senate and House chambers when that passed.”

It was an experience he knew he would never forget. “You’re watching history being made. It was pretty amazing.”

As always, the structure of the RWJF Health Policy Fellows program had evolved to suit the historical moment. The passage of the ACA dominated the policy conversation for the entire year, Margolis said.

It was a polarizing time, Margolis said. There were many things that the political parties agreed on and many things they didn’t agree on, he said, but he was “pleasantly surprised” by the level of cooperation among the members of Congress. It reaffirmed his belief that politics is truly the “art of the possible,” rather than “dwelling on the impossible.”

Around this time, RWJF fellows were hard at work on other landmark legislation, such as the Medicare Sustainable Growth Rate, a method used by the Centers for Medicare and Medicaid Services to control the growth in Medicare spending for physician services; the Children’s Health Insurance Program Reauthorization Act (CHIPRA), a program which provides health care coverage to low-income, uninsured children; and the Medicare Access and CHIP Reauthorization Act (MACRA), a policy aimed at transitioning Medicare away from fee-for-service care to value-based care.

Margolis enjoyed the program so much that he became director in 2017, succeeding Marie Michnich.

“When I was a fellow, I had enormous admiration for then-director of the program, Marie Michnich,” Margolis said. “She had a big influence in my career and I remember telling my wife, ‘Marie’s got a really cool job.’ The opportunity to follow in her footsteps and build on the program that she and others created is a real honor.”

Berlina Wallace-Berube

Berlina Wallace-Berube, health administrator, applied to the fellowship because she thought it would be the perfect opportunity to learn, grow, and give back.

She left her post as director of the U.S. Virgin Islands Primary Care Office to join the 2022-23 cohort during Joseph Biden’s presidency.

Wallace-Berube became the first fellow from a territory. “I was excited about that and hope I will not be the last,” she said. She was also part of the first all-female cohort—a historic moment for the RWJF Health Policy Fellows program.

The time was a historic moment, too, for the country more broadly. The United States was still feeling the effects of the COVID-19 pandemic and the January 6th riots. RWJF fellows had worked on landmark legislation such as the COVID-19 Stimulus Package, which provided Americans with economic relief during the global pandemic; as well as the Bipartisan Safer Communities Act, which implemented changes to school safety programs, the mental health system, and gun control laws.

“I think it was a unique time for us, because there was a lot of healing that needed to take place,” Wallace-Berube said. “A lot of what we discussed during orientation was relevant to what was happening currently… We gained a broader understanding of [the evolution] of health policy over time.”

She added, “[The] orientation is not just a week, or two weeks, it’s three-and-a-half months, and it provides you with an opportunity to meet so many different people in health policy and health care who impact the health of the nation.”

Fellows meet with over 200 briefers—renowned experts in health, health care, and health policy—during orientation. Briefings have included individuals from AcademyHealth, the American Public Health Association, American Enterprise Institute, as well as the legislative and executive branches, including the White House. “That was an eye opener for me and really helped to give me a better understanding of the health policy ecosystem,” said Wallace-Berube.

Lifelong Bonds

Though the fellows come from all different health backgrounds and walks of life, they can bond over the shared experience of the orientation, said Marie Michnich, former program director.

The fellows become each other’s support system. “Everybody’s new to town,” she said. “Everybody’s going through a transition.”

The relationships the fellows make in the program are lifelong. “You spend a year of your life with people that you probably never would have known otherwise,” she added.

Michnich saw this firsthand when she was program director. “I watched these groups go through [the fellowship] and saw the relationships solidify,” she said. “Decades later, they’re still treating each other like brothers and sisters. It’s just wonderful to see.”

She added, “I think the Robert Wood Johnson Foundation is to be applauded for the investment that they’ve made in this amazing program, and their ability to make people’s lives better.”

The program has thrived for 50 years thanks to its capacity to grow, shift, and change. Michnich believes the fellowship will continue for decades to come. “I can’t tell you how grateful I am to the foundation,” she said. “It’s just amazing.”

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