Welcome to another episode of Relocalizing Health, where we dive into the critical and often complicated world of healthcare reform at the local and state level. In this episode, host Dave Chase sits down with two trailblazing leaders in public sector health: Marilyn Bartlett, renowned for her transformative work on Montana’s state health plan and a member of Fortune’s 50 World Greatest Leaders, and Chris Deacon, an experienced former Deputy Attorney General of New Jersey with firsthand knowledge of negotiating healthcare on behalf of state employees.
Together, they unpack the real-life impact of skyrocketing healthcare costs on state budgets, infrastructure, and, most importantly, the everyday lives of public employees. The conversation moves beyond numbers, exploring how unions became unexpected allies in the fight for health plan reform- and why educating and engaging stakeholders is the cornerstone of lasting change. From the power of transparent data to the importance of local advocacy and creative legislative wins, Marilyn and Chris share practical, actionable lessons for mayors, school boards, and anyone interested in bending the cost curve without cutting benefits.
Tune in as we shine a light on how shifting the status quo can restore trust, save millions, and lead to better care for all - plus, get a preview of their hands-on workshops at Rosetta Fest, where they’ll pull back the curtain on hospital finances, contract red flags, and more. If you care about healthier communities and smarter spending, this episode is for you.
Timestamps:
00:00 Genius Thrives in Adversity
03:50 State Employee Health Plan Challenges
08:46 Economic Development 3.0 Podcast Insights
10:55 Unified Approach to Health Benefits
14:21 Effective Data Use in Decision-Making
18:55 Federal Health Policy Movement Signals
22:18 Montana Pharmacists' Legislative Victory
23:25 Surprise Policy Gains for Advocates
29:14 Touching Union Meeting Reflections
30:41 Praising Marilyn and Chris's Impact
33:04 Grateful for Fun Contract Work
How Public Sector Leaders Can Tackle Healthcare Costs: Insights from Trailblazers Marilyn Bartlett and Chris Deacon
If you want to understand the complex world of public sector healthcare and how leaders can successfully rein in rising costs while protecting workers, look no further than the recent podcast episode featuring Marilyn Bartlett and Chris Deacon. These two change-makers have a proven track record of transforming state health plans, making them more affordable and sustainable, and their insights are packed with actionable guidance.
The Toll of Healthcare Hyperinflation on Public Budgets
Both Bartlett and Deacon have witnessed firsthand how ballooning healthcare costs threaten everything from teacher pay and infrastructure projects to basic services that communities rely on. For example, Chris Deacon, who managed New Jersey’s state health plan, notes that when a state spends billions a year on healthcare, “every 0.01% matters. That’s a teacher. That’s fixing the AC in a school. That’s removing lead from pipes.” Costs that spiral out of control can mean pay freezes for employees and critical cuts elsewhere.
Marilyn Bartlett recounts a similar story from Montana, where the employee health plan was hemorrhaging millions before new strategies were implemented. There, ever-growing healthcare costs directly impacted take-home pay and employee raises. By aggressively managing healthcare spending, these leaders showed it’s possible to stabilize benefits and even restore pay increases.
Forging Unlikely Alliances with Unions
A key theme from the episode is the vital role labor unions can play in healthcare reform. Traditionally, union negotiations with management are seen as adversarial, especially regarding benefits. But both guests emphasized that unions, representing hard-working members, are natural allies in the fight for better, more sustainable healthcare.
Bartlett shared how public employee unions in Montana became powerful advocates once they understood the state’s data-driven approach, even employing picket lines and mass communications to sway hospital negotiations. Deacon, working with 37 public sector unions in New Jersey, found education was crucial: “You have to communicate that you’re actually on the same side. With health benefits, we’re fighting the same boogeymen: bloated prices, misaligned financial incentives, opaque PBM contracts.”
Where Should Local Leaders Start?
If you’re a mayor, school superintendent, or local official, the best place to begin is with your healthcare data and contracts. Both Bartlett and Deacon advocate for bringing together cross-functional teams, not just Human Resources, but also finance, procurement, and administration, to really “follow the money.”
Ask tough questions: Who is your benefits consultant? Are there hidden incentives or commissions driving unnecessary costs? Use data, such as comparing local hospital prices to Medicare rates, to challenge assumptions and demand transparency.
The Power of Transparency and Legislative Change
On the policy front, the podcast highlighted promising developments at both the state and federal levels. Recent legislation in states like Indiana and North Carolina has advanced hospital price transparency and curbed PBM (pharmacy benefit manager) abuses. Federal executive orders are signaling greater oversight of healthcare intermediaries.
Moreover, advocacy groups and patient stories can make a real difference. Bartlett shared a case where small independent pharmacists in Montana won significant legislative victories against large PBMs by spotlighting their experiences. Deacon points to the impact of compelling patient stories in legislative debates, reminding leaders that the real goal is improving outcomes for families, workers, and retirees.
What’s at Stake? Better Lives for Public Employees
Ultimately, what does success look like? As Deacon puts it: “When you get a cancer diagnosis, your health plan shouldn’t even be in your top worries. You should focus on getting well.” Both guests emphasize that with the right strategies, it’s possible not just to cut waste, but to improve benefits and give workers peace of mind, with stories of pay raises, enhanced coverage, and better financial security.
Learn More:
RosettaFest 2025 - https://rosettafest.org/
Health Rosetta - http://healthrosetta.org/
Nautilus - https://www.nautilushealth.org/
Kynexions - https://kynexions.com/
Dave Chase - https://www.linkedin.com/in/chasedave/
Podcast Website - https://relocalizinghealth.com/