Featured FAN: Rachel Osterloh

A Conversation with Rachel Osterloh

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 Rachel Osterloh, MPAff, director of legislative affairs at The University of Texas Medical Branch at Galveston (UTMB), in Galveston, Texas, about maternal health advocacy, the unique role UTMB nursing students play in advocacy, and the health system’s specialty care services.

UTMB opened in 1891 as the nation’s first public medical school and hospital under unified leadership. In what ways has it stayed true to its roots as a leader in the health treatment and education spaces both in Texas and in the United States?

I started at UTMB in my current role about a year and a half ago, and I learn something new about the institution nearly every week. UTMB has been around for more than 130 years, which has allowed for an impressive breadth of programming. This ranges from educating the flight surgeons who keep astronauts safe in space to more specialized, local needs back on Earth, such as ensuring rare pediatric kidney disease is detected and properly cared for in Texas kids.

UTMB is a special place, with its tandem emphasis on Texas history and forward-thinking clinical care. Our infrastructure tells this story: the Galveston campus is home to the only structure in the country that once housed a complete medical school in the 1900s. [We] also recently unveiled a remodeled, patient-centered Women’s and Children’s wing with cutting-edge technologies and spacious rooms in the John Sealy Hospital. This institutional balance makes me proud to be at UTMB, and contributing to the mission for a safety net hospital in Texas brings a great deal of professional satisfaction.

In fact, it feels full circle for me, as a member of my immediate family received emergency care from UTMB physicians when I was much younger. Centered in UTMB’s culture are stories like my own, illustrating the deep and true connection to the Galveston community and the broader state. As the institution grows, particularly under the energetic leadership of the new president and CEO of the health system, Jochen Reiser MD, PhD, I imagine increased innovation, coupled with tradition, will move us into an even stronger place.

The close relationship between providing care and teaching the next generation of health care workers is a unique aspect of the essential hospital experience. Can you describe the working relationship between your role in health policy advocacy, and the educational aspect of the institution?

Bridging the gap between the hospital and the policy sphere ensures students and providers are aware of what is happening in the fast-paced state and federal spaces, particularly as it impacts the ability to serve patient populations. Given the rapid pace of the Texas legislative session — coupled with an increased federal focus on hospital policy — there is a power in distilling the needed information from the frivolous, which is the approach we take for providing external and internal stakeholder updates.

What types of specialized care can you speak to that UTMB provides its patients?

UTMB has several specialized care programs, including cardiology, nephrology, infectious disease, and emergency medicine. I would like to highlight UTMB’s prominent and hardworking neonatology team, who are deeply compassionate and excellent providers of care for Texas families during periods of extreme stress. The UTMB Galveston campus has a level IV neonatal intensive care unit (NICU) — one of two with the designation in the Houston/Galveston area — which holds 43 beds for moderately and critically ill newborns. In addition, UTMB sees around 6,000 births a year. Often for legislative tours, we will walk through UTMB’s NICU, and everyone comments on how they can feel the team’s deep dedication to their important work and warmth of spirit. I certainly always can!

Looking at your background, you were heavily involved in the student senate during your time at UT Austin. Did that involvement grow out of an early interest in the political process or was that the spark?

I would be lying if I didn’t say that I had memorized the School House Rock lyrics to “I’m Just a Bill” very early on, but I knew I wanted to stay around politics after undergrad. A close friend from high school jokes that, in 2015, I was essentially the mayor of a burnt-orange town, and the experience of handling the daily minutiae of governance is not easily forgotten. One of the greatest functions of an undergraduate program is the ability to experiment in terms of who you are and how you lead — and I learned my strengths surrounded by fellow Longhorns who wanted to leave the university a little better than we found it. I think every class builds on the work of the previous, resulting in greater storytellers and stronger graduates with each passing year. Having now worked in several professional roles, I know that I learned this truth in the student senate, which is to focus on doing the most good you can for as many people as possible. Leaving your ego at the door is a perennially valuable lesson, particularly for a 20-year-old. UT also taught me the reality of the need to collaborate with peers who you do not necessarily see eye-to-eye with, as you might still have a common goal. Finding a way in is a skill which transcends the student arena and neatly transitions into the day-to-day activity working in legislative affairs.

What work are you most proud of in the health advocacy space?

While I worked in the health space at the Women’s Health Caucus (WHC) and am now fully immersed at UTMB, most of my legislative experience is in higher education. I’ve organized both Austin- and D.C.-based advocacy days to ensure alumni and students can connect with legislators and members about policy issues. These formative experiences translated well to UTMB, where we engaged in efforts to encourage students to share their experiences in health education to legislators and members. While there are specific amendments I could point to from my time at WHC, I am extremely proud of an interaction that took place between a handful of UTMB nursing students and a legislator during one of these events. She remarked how visiting with the students filled her with renewed energy, like a shot of espresso, and reminded her of why she ran for office in the first place. The interaction also empowered the students, who were proud to have shared their thoughts on the current nursing workforce shortage. Students can be powerful messengers of the need for increased hospital, research, or health-related institution investment, as I have seen consistently in my career.

How did your time as the executive director of the Women’s Health Caucus in the Texas House prepare you to speak to a wide variety of health policy issues?

If I didn’t already have the proverbial bug for legislative affairs from my time at UT Austin, I knew I wanted to stay in or around the Texas legislature after working for WHC, which focuses on promoting women’s health in the state. Working in a caucus allowed me to interact with and learn from external health-focused stakeholder groups, myriad tenured staffers throughout the building, and a bipartisan group of state legislators. While I had interned for legislators in both chambers previously, I had never run to a random extension room to write down all the bill numbers rapidly listed out by the Calendars Committee, nor had I written an amendment to share with a legislator on the floor during a live debate. As this sink-or-swim scenario was happening, I also was charged with listening to the stories of Texas women and their families regarding health care access, particularly as it related to the state’s maternal mortality crisis. I carry those stories with me as I do this work, and always will. Women opened up to me with concerns running the full gauntlet of the health policy spectrum, from breastfeeding advocacy to contraceptive care to postpartum Medicaid coverage gaps. I remember feeling struck by the sincerity and vulnerability required by advocates in the evergreen quest for policy change, especially within a state legislature. Acting as their voice to policymakers was a privilege I was not fully prepared for, but one that has certainly shaped the rest of my professional career.

Your experience advocating for maternal health care is impressive. America’s Essential Hospitals is keenly attuned to this issue, having endorsed several pieces of legislation to cut back on maternal mortality and provide necessary support for birthing people at our member hospitals. What strides would you say are being made at the state and federal levels in this space? Or where do we need to focus our advocacy looking ahead?

We have a bright update regarding maternal health policy in the state, which is the passage of HB 12 in this past session. This bill expands legislation from previous sessions to provide 12 months of postpartum Medicaid coverage. This expansion will actively aid in the prevention of maternal deaths by managing potential complications or issues, including hemorrhage or postpartum depression, for a full year after pregnancy.

On the federal front, we must think about the intersection of artificial intelligence and maternal health, given it is a largely unregulated space. Being in the conversation, communicating how hospitals are currently balancing artificial and human intelligence in clinical care, will help build trust for aiming artificial intelligence at optimizing obstetric and infant health outcomes (i.e., predicting preeclampsia or other pregnancy complications). Ensuring the provider/company can speak to the diversity of dataset is critical in building transparency in care. It is most beneficial for federal leadership on this to avoid a checkerboard of patternless regulations across the states, potentially stymieing the health innovation economy.
Further, I was very excited to see the Biden administration provide 12 weeks of paid family leave for almost all federal employees, with a stated desire to build out this existing policy for more families. The first movement toward paid family leave since the Clinton administration’s Family and Medical Leave Act is a step forward in fostering healthy families. Research is telling that the first several months post-birth are critical for mother-baby bonding and facilitating healthy breastfeeding. Since women are the sole, primary, or co-breadwinner in 60 percent of Texas families, [paid family leave] would actively enhance quality of life.

We all know that Texas is unique; is there anything specific at the state level that has been beneficial to your advocacy or a hurdle that must be overcome?

I am from Texas, and, as such, my perception of civic advocacy and the path for safety net hospitals is shaped by my deep commitment to my home, which is not without increasingly alarming health statistics. The state’s patient population has the highest number of uninsured people in the country, including a quarter of Texas women of childbearing age. Texas also consistently has very high rates of repeat births for teens from age 15 to 19, compared to the national average. In the internal medicine space, Texas has one of the highest state rates of progression from chronic kidney disease to end stage renal disease (ESRD), with 10 percent of the nation’s ESRD patients living in Texas. With all this context, I believe Texas has incredible strength in its dedicated state health-related institutions, which look toward education to create greater continuity of care across the state. At UTMB this past year, 61 percent of graduates matched to residencies within the state. Retaining our talent is a critical part of the equation moving forward, if not one of the most tangible solutions.