Hi, I’m Christen Linke Young. I’m a fellow with the USC-Brookings Schaeffer Initiative for Health Policy. My research at Brookings focuses on health insurance coverage with a particular focus on the Affordable Care Act and how that’s shaped our current health policy landscape.
Q: Where did you grow up?
I grew up in Columbus, Ohio as the child of two molecular biologists. There was a lot of science in my home, and it wasn’t until middle school that I realized not everyone’s family referred to raw egg whites as “uncoagulated albumin.” But my upbringing inspired a lifelong interest in health and science policy. I didn’t exactly want to be a scientist like my parents, but I was really interested in the ideas of the life sciences and how they shaped our society.
Q: What inspired you to become a scholar?
I recently came to Brookings after almost a decade in government service. I served for eight years in the Obama administration, working to pass and then implement the Affordable Care Act, and then another two years working in state government in North Carolina. A lot of my government career was about putting out fires and making things work on the ground. An issue would come up and it would stay on my desk until there was a solution to the problem. Sometimes it was an elegant solution, sometimes it was held together with metaphorical duct tape and toothpicks, but it was about making things work in constrained environments.
Now that I’m at Brookings, I get to step back and think about problems without them being my problem, and I think that’s really important. It’s incredibly valuable to turn an issue around and imagine what the world could look like, and that kind of thinking is essential to solving the problems of our health care system.
Q: What do you think is the most important issue we’re facing today?
There are a lot of challenges in health care: the Affordable Care Act was a big step forward, but tens of millions of people remain uninsured, tens of millions more have coverage but are exposed to high health care costs, and health care prices are simply too high today. But I think one of the biggest challenges we face is that our political system may not be able to have a good faith conversation about how to address these issues. It’s true in a lot of sectors, but it’s especially true in health care.
Ultimately, the passage of the Affordable Care Act represented the victory of a certain point of view—the government should do more to make health care affordable for low- and middle-income people, especially those with significant health care needs, and we pay for that by reducing payments to the health care industry and by healthier and higher-income people paying a bit more.
Among those who opposed that vision at the time, today there’s still a belief that those were not desirable goals for the federal government and they need to be undone. There’s also this acknowledgment that it happened, the country has internalized those gains and moved on. As a result, we spend a lot of energy on bad faith conversations about preexisting conditions or on litigation targeting the ACA that doesn’t make sense. All that said, there is some hope that the dynamic is changing and evolving to a more productive place, which is why I guess I’m in this world in the first place.
Q: What are you working on now?
In the current environment, I spend my time tracking issues related to the implementation of the Affordable Care Act, as well as developing ideas for what should come next in health reform. For example, I recently published two pieces. One of them evaluates a recent regulation from the Trump administration, which changes some of the rules around how employers can finance account-based health benefits for their workers. My co-authors and I concluded that the rule is likely to increase premiums and is not consistent with the agency’s statutory authority.
In a completely different vein, I also published a piece that thinks hard about how to get more people into health care coverage using automatic methods of enrollment. What can we do to make the system easier for people to enroll into their eligible coverage? It is a hard problem and worth thinking about what it would take for that system to work.
Q: If you could recommend any book to our listeners what would it be?
I have two book recommendations to share. First is a piece of nonfiction: “Dreamland” by journalist Sam Quinones. It’s a deeply researched story of the rise of the opioid epidemic. It’s based in doctor’s offices, on the streets of the American communities that were hardest hit in the early days of the opioid epidemic, as well as in rural Mexico, where new forms of heroin were being developed and manufactured. The book provides an incredible window to understanding one of the major public health crises of our time.
The second book I would recommend is a work of fiction that’s had a tremendous impact on me over the years: “Infinite Jest” by David Foster Wallace. For me, good fiction shares a similar quality—it helps you understand what it feels like to be somebody different than who you are. “Infinite Jest” is this beautiful, complex story that provides a window into how addiction and depression are experienced by people. Immersing myself in that novel expanded my capacity for empathy, and I think that’s one of the most important things in policymaking.