How Dr. Andy Bindman Helped Reform Medicaid, Thanks to the Robert Wood Johnson Foundation Health Policy Fellows Program

The program is “a phenomenal opportunity to grow,” says Bindman

By Marisa Coulton

Dr. Andy Bindman, an internal medicine specialist and executive vice president and chief medical officer of Kaiser Permanente, first became interested in health policy years ago.

At the time, he was teaching University of California San Francisco students and residents in his capacity as Chief of the Division of General Internal Medicine at San Francisco General Hospital.

He noticed a concerning trend: patients with certain manageable chronic illnesses, such as high blood pressure, were returning to the hospital repeatedly despite the availability of effective medications and treatments.

“I wanted to understand what that was about,” Bindman said. “So I started performing research to get insights into the role that access to primary care played in avoidable hospitalizations.”

San Francisco General serves many community members who rely on Medicaid, he said. His research revealed that housing instability, food insecurity, lack of financial resources, and other social factors made it harder for his patients to keep up with their medications and support their health.

In some instances, patients would go to the pharmacy to pick up their blood pressure medication only to learn that their Medicaid coverage had been disrupted, and they would need to pay out of pocket. The patients would stop taking their medication, instead putting the money toward food and other necessities.

The patients would generally feel okay at first. “Everything’s fine,” said Bindman. “Until it’s not.”

The patients would inevitably come into the hospital feeling much worse than before, having suffered a heart attack or stroke. Their hospitalization would then trigger a whole host of other coverage issues, Bindman said.

In other instances, patients in unstable housing situations would forget to fill out important forms when moving from one location to another, causing their coverage to lapse.

Bindman studied the Medicaid program and its policies in depth, as well as the various reasons a patient might lose coverage. He realized the program was flawed; he wanted to reform it.

At the time, Barack Obama had just become president and discussions about the Affordable Care Act (ACA) were beginning to pop up in scientific and health policy circles alike.

Bindman saw the ACA as an opportunity for real change. He wanted to have a say in the new legislation. So he applied to the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, was accepted, and joined the 2009-2010 class.

It wasn’t his first time as a fellow; Bindman is what one might call a RWJF “lifer.” He completed not one, but three separate Robert Wood Johnson Foundation programs: The RWJF Clinical Scholar Program, the General Physician Scholar Program, and the RWJF Health Policy Fellows program.

The networking, concentrated mentoring, and emphasis on research with impact kept him coming back, time and time again, he said.

After the three-and-a-half-month policy orientation, Bindman, along with the nine other members of the RWJF Health Policy Fellows cohort, took part in the placement interview process, which exposed them to a range of agencies and offices on Capitol Hill. Bindman had one-on-one interviews with the offices he was most interested in, including the Senate Finance Committee and the Office of the Speaker of the House, but ultimately accepted a placement on the committee that oversaw the Medicaid program, the House Committee on Energy and Commerce.

The experience was “phenomenal,” he said. “I had a front-row seat to the ACA,” he said. “I was in daily meetings with the speaker’s office, working with Senate leaders around different components of the ACA. So it was an incredibly powerful and exciting time; we were part of something quite substantial.”

He helped write some of the components of the ACA and helped reform Medicaid, removing its ability to exclude people with pre-existing conditions, which meant it could now benefit more people.

Bindman wasn’t a spectator. As a physician on the Hill, he was regularly consulted and relied on for his expertise. “There weren’t a lot of physicians at the table,” he said. “So I felt like I had a lot to contribute from my direct experience of taking care of the uninsured individuals the bill was targeting.”

The work was challenging but fulfilling, he said. There were a lot of early mornings, late nights, and pizza eaten on the run. He recalls standing in the Capitol Rotunda at 1 a.m., looking around at the statues, reflecting on this unique opportunity to bring about real, constructive change.

Overall, the placement was “very satisfying.” Bindman came away with the knowledge that he had helped change the lives of millions of people. He couldn’t have done it without the RWJF Health Policy Fellows Program, he said.

The thing he appreciates most about this program—and the RWJF programs more broadly—is the opportunity to engage in shared peer learning alongside other health care professionals.

“The peer group was very important,” he said. “Those relationships have continued to this day.” He still calls peers on the phone whenever he has questions or reflections on particular challenges, he added.

Prior to the beginning of his placement, Bindman got to know the other fellows over the course of the three-month orientation, during which the group had the opportunity to meet with over 200 American health organizations and policymakers, or ‘briefers,’ which include think tanks, national leaders, key executive branch officials, Members of Congress, and their staff.

The orientation is ever-changing, evolving every year to suit the changing health policy landscape. The content the briefers shared was “extremely powerful,” Bindman said.

The orientation led him to a profound realization: though medicine and health policy had a common goal—advancing trust to build toward change—the “language” and pathways to success were slightly different, he said. In medicine, you arrived at the truth through the scientific method; whereas in health policy, you arrived at the truth through the “eyes of different constituency groups,” he added.

He also noticed how the constituency groups interacted with one another. In his medical and research work, he had known about the individual organizations, but he had not seen them as a collective, and did not know what their relationships with one another were. “They were an ecosystem,” he said.

These lessons were “particularly instructive” to his health policy work after the fellowship, he said.

Upon his return to California, he resumed his post as a professor of medicine, health policy, epidemiology, and biostatistics at the University of California San Francisco, and embedded more deeply into the health policy world.

For one, he was involved in several state committees related to expanding health insurance reform and expansion of universal coverage in California. He was also contracted by the California legislature to lead several task forces related to expanding health insurance coverage in the state.

“During the fellowship I formed relationships with key Congressional and Executive Branch staff with expertise on (Medicaid-related provisions within the ACA),” he said. “Following the fellowship I was asked if I would continue to share expertise in the role of the Chief Medical Officer of the Medicaid and CHIP Payment and Access Commission which was created as a part of the ACA.”

Then, he spent time as a senior advisor at the US Department of Health and Human Services. It was an extension of the work he began as a fellow. In this role, he worked closely with the Centers for Medicare and Medicaid Services to establish the first payment codes in Medicare relating to non face-to-face management of patients to ensure safe, timely, and effective care following hospitalizations and ongoing care of chronic conditions.

Bindman then took on the role of director at the Agency for Healthcare Research and Quality (AHRQ).

The fellowship program played an important part in his getting the AHRQ job, he said. “I felt more prepared to be in such a role because I now had a lot more relationships with some of the key people, both in Congress,” he said.

Being Director required him to go to Congress multiple times to speak about AHRQ’s work, to inform budget decisions about the agency. That was easy for him, because the fellowship had taught him how to communicate with members of Congress and their staff. Without the fellowship, he “would not have had the confidence and the skills to know how to go about doing that,” he said.

After AHRQ, he was invited to take on his current role: executive vice president and chief medical officer of Kaiser Permanente, a leading health care provider and not-for-profit health plan. Its overarching goal is to provide high-quality, affordable health care services and to improve the health of its members and the communities it serves.

The fellowship taught him “a different way to perceive problems and solutions in ways that have opened up doors,” he said. When the Kaiser Permanente job presented itself, he was able to “see the opportunity in it” because the fellowship had given him new “insights into ways of making impact,” he added.

Today, Bindman works tirelessly to improve care quality and outcomes for the organization’s 12.6 million members by integrating quality innovation, care delivery, and research.

“The knowledge I gained as a fellow has helped me understand the role different governmental entities play in shaping those policies,” he said. It also showed him how his organization could use learnings and insights from the “front lines of care” to shape and support future policies.

He wouldn’t have gotten to where he is today without the Robert Wood Johnson Health Policy Fellows Program. “I think it was a phenomenal opportunity to grow,” he said. You will grow and change in surprising ways, he said. “It will allow you to discover yourself.”

Discover yourself. The application period for the 2026-2027 class of RWJF Health Policy Fellows is open from August 1 to November 3, 2025. Learn more at HealthPolicyFellows.org

Follow the RWJF Health Policy Fellows program on LinkedIn or email info@healthpolicyfellows.org to get in touch.

About the author: Marisa Coulton is a journalist based in Toronto, Canada. She holds a Master of Journalism and a Master of International Affairs from Columbia University.