Featured FAN: Jeff Cilek

Each quarter, we feature a Federal Action Network (FAN) member leading the charge on Capitol Hill to protect essential hospitals.

This quarter, we spoke with Jeff Cilek, vice president, external relations at association member St. Luke’s Health System, in Boise, Idaho, about his time working on the Senate Committee on Appropriations and how he communicates hospital needs to legislators.

Tell us about your time on the Hill working on the Senate Committee on Appropriations in the 80s. Do you have any unique thoughts about how the current appropriations will play out for 2025 and 2026? 

I started out on Senator McClure’s personal staff and ended up on the appropriations committee. I was there [10 years], half on his personal staff and the other half on the Senate Appropriations Committee.

My subcommittee was the Interior Subcommittee, and it was great. Interior is one of the smaller appropriations bills but has responsibility for some great federal agencies like the National Park Service, the Department of Interior except for Bureau of Reclamation, part of the Department of Energy, the Smithsonian Institution, the National Gallery of Art, the United States Forest Service, and National Endowment for the Arts.

It was a very eclectic group of things, to include the Kennedy Center, which has all of a sudden gotten popular out there. So, it was a lot of fun. Reagan was president, and he didn’t like the Department of Energy, so he didn’t fund it. So, we had to recreate it every year in the appropriations process. Earmarks were a big deal, which aren’t bad. We had to deal with a lot of earmarks from members.

Now everything seems to be tied into one big continuing resolution, which is unfortunate. When I was there last, I dropped in on the House Interior Appropriations Subcommittee on my way to see Congressman Mike Simpson (R-Idaho). It was a nice chat, and I decided I might swing by the Senate Subcommittee, but when I asked for the room number for the Senate, they looked at each other and said, “We don’t have any idea.” And it dawned on me that they don’t know each other.

They don’t do appropriations bills. The House passes them, but the Senate doesn’t. There’s no conference, which is too bad. They’re ceding a bunch of authority to the bureaucratic elements of the federal government.

What’s your top priority with St. Luke’s? What keeps you up at night right now and what advocacy work are you engaging in to address that? 

What keeps up at night at the federal level? Boy, it grows every day. The reconciliation process and the long list of things that they are considering cutting that would negatively impact health care. And to what end? What’s the replacement and why would you want to make those cuts? For what reason? Just to fund the tax cuts that are expiring. That’s pretty hard to swallow. For the deficit? I doubt it. But all of those stress me out. And the lack of desire of the legislative branch to stand up and say, “Hey, we have our own job to do. That’s why there are three branches of the government.”

Medicaid, Medicare, and the current Federal Medical Assistance Percentage (FMAP) rate are highly concerning topics to a lot of our members and to us right now. What are you pointing to at St. Luke’s to voice your need for these kinds of programs?

We want all the above. I think we feel like we need to be very careful with our communication to Senator Crapo. He’s the chair of Senate Finance Committee and he’s from Idaho, so we need to be respectful and make it very clear [on] our priorities and why they’re our priorities. Site-neutral, disproportionate share hospitals, FMAP tax credits, and the extenders. We have the only hospital-at-home Centers for Medicare & Medicaid Services–approved program in Idaho. We get a lot of pressure from a lot of folks who want our help getting separate meetings with Senator Crapo or his staff on a Senate Finance Committee issue that [aren’t] necessarily related to health care. We really can’t do that. We have to stick to our knitting. Idaho hasn’t lost a hospital. None have gone under or closed, but the smaller ones are on the brink. We want our friends in Washington, D.C. to be very conscious of the action that they are about to take. We are kind of using whatever’s happening in D.C. at the state level to mitigate expansion.

Has your messaging changed to be more effective as the state legislature in Idaho has become more conservative?

We are very aligned with the Idaho Hospital Association. They have an excellent staff, board and reputation. Idaho is a rural state and protecting critical access hospitals is important. If it helps a critical access hospital, it will probably help us.