Mild-mannered, well-spoken and cerebral, Alan Weil looks and sounds like the natural product of the tweedy milieu he grew up in. The quintessential public-policy wonk, he not only has the perfect credentials-degrees from Harvard Law School, Harvard's Kennedy School of Government and University of California at Berkeley-but the ability to influence the lives of thousands of people, all at the age of 32.
Weil is executive director of the Colorado Department of Health Care Policy and Financing. In a nutshell, he runs Medicaid and the medically indigent programs in the Rocky Mountain State. He oversees a $1.6 billion budget that serves 280,000 people.
He also advises Gov. Roy Romer, a Democrat, on healthcare issues. The governor, Weil said, "has a personal dedication to this issue. He believes in everyone having opportunities to succeed and not being held back by lack of healthcare. He believes strongly in universal coverage.
"I don't think I could have been working for him for 41/2 years if we did not have similar attitudes on this issue."
His boss returns the compliment. "Alan Weil is one of the most brilliant people that I know in the field of health policy," Romer said. "He's not only very knowledgeable in terms of the subject matter, he also has a very good feel for the political alignments in healthcare.
"He is an exceedingly able and wise individual. Let me underscore `wise.' He is young but he has a wisdom about his decisions that is outstanding."
Weil's position also gives him considerable influence on the national stage. He was the key staffer for Democratic governors in drafting the National Governors' Association policy on Medicaid reform earlier this year. In 1993 he played a similar role in drafting the association's policy in support of universal health insurance. He also served on the White House healthcare task force in 1994.
Before that he was legal counsel to the Massachusetts Department of Medical Security, created by then-Gov. Michael Dukakis to handle the state's attempt to mandate universal coverage. "We did a lot of interesting things," Weil said, but implementation kept getting postponed. Finally the law was repealed.
Weil spends a lot of time thinking about who gets health insurance coverage and how. Employer-based health coverage is shrinking, yet Americans are unwilling to let government pick up the slack.
"We're caught in a framework that we can neither make work nor are willing to get rid of," Weil said. "We need to decide whether universal coverage is an important enough goal that we get off this high center, where we can't move."
The Medicaid debate wasn't encouraging in that regard. "What's happened is we've masked the decline in private coverage by increasing public coverage through Medicaid," he said. "If you look at the coverage of children, you basically see that kids covered by employer-based coverage are declining, while Medicaid is increasing. The number of uninsured kids is stable."
But now the political establishment wants to reduce the government's reimbursements for Medicaid. "You have private coverage declining, and public coverage declining. That is not a sustainable trend," Weil said.
And don't pop the champagne just because Congress finally required health insurance portability. The Kassebaum-Kennedy law "is a baby step, and that may be generous," Weil said. "The actual number of people to be assisted by the legislation is small, but it's extremely important legislation for those people."
In Colorado, Weil is trying to keep a lid on Medicaid costs by providing alternatives that allow beneficiaries to avoid going into nursing homes. One pilot program lets individuals with disabilities hire people to take care of them in their homes. As a result, he said the number of Medicaid clients in nursing homes has held steady at 10,000 for three years, even as the state's population ages.
Government mandates are one way to enhance access but not the only way. "If I can make a difference in making the healthcare system work better, then that is also making progress," Weil concluded.