Featured FAN: A Conversation with Ruth Johnson

Vice President of Governmental Affairs at Woman’s Hospital, in Baton Rouge, La.,
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 Ruth Johnson, vice president of governmental affairs at Woman’s Hospital, in Baton Rouge, La., about the state’s obstetric outcomes, adapting to artificial intelligence (AI) and other health care trends, and navigating Louisiana’s legislature.
Woman’s Hospital opened in 1968 and specializes in care for women and infants. Could you tell us more about some of the services and care Woman’s provides that makes it both unique and essential in the community?
Woman’s is a special place in many ways. It is the largest single labor and delivery hospital in the state, with nearly 8,000 deliveries each year. We also have the largest neonatal intensive care unit (NICU) in the state, which means we get patients not only from our immediate area but [also] transfers from all over the state. We have the Woman’s Cancer Pavilion that provides the full continuum of care for the treatment of breast cancer, including clinical trials, as well as the Woman’s Mobile Mammography Coach that provides mammograms to patients in need across Louisiana. We offer many services, including gynecology, urogynecology, audiology, behavioral health, interventional radiology, laboratory, maternal-fetal medicine, respiratory care, sexual assault care, and sleep services. Last year, we saw women, infants, and children from 62 of 64 parishes in the state.
Additionally, we perform extensive work in our community and provide unreimbursed care to those in need of our services who do not have the ability to pay. We contribute to other areas in our community through back-to-school drives, menstrual period supply drives, fundraisers for pediatric cardiac care and public schools, and [collaborations] with local colleges and universities to train and hire in allied health care fields. Additionally, Woman’s Hospital hosts an OB-GYN residency program on our campus that has 16 residency slots.
Currently, what are Woman’s Hospital’s top state and federal legislative priorities?
Louisiana is facing a possible fiscal cliff due to the expiration of the temporary 45-cent sales tax in June 2025, which is not expected to be renewed. In our state, the two principal areas that are usually cut when there is a budget shortfall are health care and higher education. Therefore, the hospital’s priority in the upcoming legislative session is ensuring that the state Medicaid budget remains sufficient to cover the 1.7 million people who rely on it for their physical and behavioral health needs.
Secondly, the legislature passed a resolution requiring the Louisiana Department of Health to apply for the Centers for Medicare & Medicaid Services’ (CMS’) Transforming Maternal Health (TMaH) Model. Woman’s Hospital supports the implementation process, as we are the largest single delivery hospital in the state, with nearly 8,000 births a year, and can truly assess what it takes to help create positive outcomes for a large scale of the population.
Federally, the hospital’s primary focus will be addressing the maternal and infant health crisis. It is critical to fund essentials that are commonly acknowledged to help improve health outcomes. Those include doulas, community health workers, behavioral health providers, and funding for hospitals and OB-GYN doctors.
I want to take a moment here to acknowledge the work of two members of Louisiana’s congressional delegation: Sen. Bill Cassidy (R-La.) for his work on the unanimous passage of the bipartisan Maternal and Child Health Stillbirth Prevention Act, and Rep. Julia Letlow (R-La.) for proposing the Newborn Essentials Support Toolkit Act. These are examples of federal legislation that can directly impact the lives of mothers and infants in our country. We are a nation rich in resources and talent with some of the best health care professionals in the world. We can solve this crisis and improve general health, but it will take federal support.
How do you navigate the political climate in a state that is controlled by one political party at both levels, especially in an election year?
It is the same as when we had a bipartisan government. It is all about building relationships and being a reliable source of bipartisan information. We must also be clear about the issue, its impact, viable solutions, and the potential costs. The work remains the same. The only difficulty is that people may be harder to reach during an election year, so you must be flexible about when [and] where you can meet or conduct outreach. For example, we will schedule more visits at home in Louisiana rather than making trips to Washington, D.C.
You have spent more than three decades as a public servant in state agencies across the country, including as undersecretary of the Louisiana Department of Health (LDH) and Louisiana’s Medicaid director. Can you speak about your experience working in these various roles and how they affect the way you see your position and advocacy now?
I love working at Woman’s Hospital. The culture at this hospital is amazing. You can truly focus on helping women and infants in a meaningful and direct way.
The structure of state government often makes it slow to move, especially if legislation is necessary. Our legislature meets once a year, and depending on if it is a fiscal or general session, there is a limit on what can be addressed because lawmakers are only allowed to file a certain number of non-fiscal bills. You must have a clear strategy and do outreach early. My deep knowledge of the legislative process and the relationships I have built are invaluable to me in my current role and assist my advocacy at both the state and federal levels. Additionally, at Woman’s Hospital, there is a clear and simple decision-making process, which aids in the way of making the best policy decision.
As undersecretary, I managed the budget, accounting, training, human resources, information technology, rulemaking, policy, federal reporting, and Medicaid. I represented the agency on fiscal and Medicaid issues at the legislature, briefing the administration and provider groups. Our agency included public health, mental health hospitals, a forensic hospital, Aging and Adult Services, Citizens with Disabilities, and Human Services District. It was often a 24/7, 365-day job, especially during the COVID-19 pandemic. We had to transition our supplemental payments to new models under CMS requirements and manage severe weather impacts and water system failures.
During my time at LDH, I collaborated closely with a respected secretary, emphasizing teamwork and the importance of a business plan to drive innovation and direction. Seeking diverse opinions and prioritizing “do no harm” were crucial, as we were responsible for nearly 2 million people at the height of the pandemic.
These experiences were critical to my current role, where understanding multiple areas and their interactions aids advocacy. I must be aware of various perspectives and know when to concede or advocate for essential issues, reserving the most persuasive efforts for significant matters, like expanding Medicaid postpartum coverage.
I have learned to accept challenges while maintaining focus, while recognizing there are external forces at play. I have also learned the importance of balancing personal life, like spending time with my children and grandchildren, to keep me motivated and mentally healthy.
Louisiana faces some of the poorest obstetric outcomes in the nation. Doulas, midwives, and other specialty staff play critical roles in the health of a patient during pregnancy and postpartum. Can you speak about how Woman’s Hospital provides those services, and how Medicaid reimbursement for doulas has been a focus of your work?
Currently, we have two grants, one from the Donaghue Foundation for community health workers and one from the National Institutes of Health for doulas called the Well Mama Study. We support the use of these models in health care for expecting patients. I have worked with legislators and other advocates to provide them with the research showing the reduction in overall costs when doulas are involved in cases, whether that be from avoidance of cesarean sections, reduced emergency room visits, greater adherence to breastfeeding, fewer lower birth weight infants, or overall better health of the birthing patient and the infant.
I have also honestly expressed that there is no one solution to the problems we face, but we can and should start with the things that make good common sense that are supported by research, with a low cost of implementation, and evidence-based. Then, we can work our way through the tougher issues where we have less of a clinical effect and more of a social effect, which brings back weighing the political and policy [implications] and costs against the benefits. These are the issues you save for your passion and persuasion.
How is Woman’s Hospital adapting to trends in health care policy, such as telehealth, AI, and value-based care?
We are investigating the use of AI in a clinical setting. Our legislature recently set up a committee to study the use of AI in all areas, including health care, [and] we plan to be part of that discussion both to provide opinions from a provider’s standpoint and to define what is considered AI and what is not. We are currently using telehealth in maternal-fetal medicine to reach patients in remote areas of the state. Although we have six clinics statewide that are mostly in cities, we recognize the patients who need us most are in the rural areas of the state. We will continue working to expand the use of telehealth as CMS continues to evolve in its use. I believe the TMaH model will ultimately lead to a value-based care model for OB-GYN care, and Woman’s Hospital wants to be a part of that program design from the outset.