Gary Cohen

At the Heart of Health Law, From the ACA to Blue Shield

When Gary M. Cohen accepted the job as Vice President of Government Affairs at Blue Shield of California in September of 2016, he was well prepared for what the giant nonprofit health insurer thought lay ahead: building on the Affordable Care Act and addressing the cost of health care. Cohen, JD ’79, was a battle-scarred veteran of the ACA’s original implementation, which he helped direct in several federal and state roles. Most notably, he spent two years as the federal government’s director of the Center for Consumer Information and Insurance Oversight (CCIIO). Over the four years he was at CCIIO, consumers received more than $1 billion in refunds from insurers, and in California alone the percentage of uninsured residents dropped from 16 percent to below seven percent.

But soon after the election of Donald Trump, the ACA itself was under attack.

Cohen says that put Blue Shield’s fundamental mission of “ensuring that every Californian has access to high-quality health care at an affordable price” in jeopardy. Blue Shield saw GOP alternative plans as unworkable. Cohen was frustrated that much of the health insurance industry stayed out of the early debate because they thought it was inevitable that the ACA would be repealed. “They kept saying, ‘We’re preserving our seat at the table by not opposing the repeal legislation.’ And I kept saying: ‘What exactly are you getting for that seat?’ Because the proposals kept getting worse,” Cohen recalls.

Gary Cohen
Gary Cohen, JD ’79, vice president of government affairs at Blue Shield of California

Soon, Blue Shield CEO Paul Markovich became the first CEO of a commercial health plan to take a public stand against repeal. Cohen emphasizes that Blue Shield’s position was not partisan: “Paul said it’s about what we stand for.” Markovich told the news site California Healthline the proposed alternatives “could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance.”

Fast-forward five years. The ACA mostly survived, and for Cohen it’s like September 2016 again—but with the added stresses of a pandemic. “We already had a huge crisis of affordability in this country,” Cohen says. “One thing COVID did was shine a really bright light on the disparities in health and in health care that exist in this country, based on race and economic status.”

And he’s helping Blue Shield tackle those challenges.

Health care policy was not on Cohen’s radar when he arrived at Stanford Law School in 1976. He grew up in Manhattan, where his attorney father was a theatrical agent and producer, and the young Cohen mingled with Broadway stars and other celebrities, like Johnny Cash. After Brown University, he and his high school sweetheart and by then wife, Liz Nichols (MA 79), both came to Stanford—she for a graduate degree in East Asian Studies and he to study law.

After taking former Professor Tony Amsterdam’s popular criminal law seminar, Cohen embraced public defense, and later he secured a Prettyman Fellowship from Georgetown Law School to work with indigent defendants in Washington, D.C. But after two years, he realized he wasn’t suited for that role. “I felt incredibly responsible for what was happening to my clients, which in most cases was not great. And I felt really burdened, in many cases, by what my clients had done.”

The couple lived for two years in Japan and then Cohen joined San Francisco firm Keker & Brockett (now Keker, Van Nest & Peters), where he spent 16 years as a partner. Later, he went in house as general counsel to the Public Utilities Commission (PUC). Twice, he successfully argued cases before the California Supreme Court—once as a Keker litigator in a case involving voting rights, and again as GC at the PUC defending its right to negotiate a settlement resulting from California’s 2000-2003 energy crisis.

Cohen then became deputy commissioner and GC at the California Department of Insurance, where he had a staff of 90. “I had the experience of being a manager. I found that I really loved that part of it.” Insurance Commissioner John Garamendi was impressed and asked Cohen to join him as chief of staff when Garamendi was elected to Congress. Not long after, Cohen entered the world of the newly passed ACA.

After an initial two-year stint running the ACA oversight group, Cohen and his wife returned to California. They were barely unpacked when he was recruited back to Washington as director of all of CCIIO.   

“One thing COVID did was shine a really bright light on the disparities in health and in health care that exist in this country, based on race and economic status.”

—Gary Cohen, JD ’79
Vice President of Government Affairs at Blue Shield of California

Over the next two years, Cohen was summoned 10 times to appear before often hostile committees in the Republican-controlled Congress. For a time, Cohen bunked in the spare room of his former SLS classmate Julie Saulnier, JD ’79, and her husband, who helped him decompress with canoe trips on the Potomac.  She says of Cohen, “I think it was quite stressful, but he’s not only brilliant; his emotional intelligence is fabulous.”

“Service to the federal government is far and away the highlight of my career,” Cohen reflects today. He notes that despite the infamous website flop when Obamacare went live, his team hit its April 2014 target of enrolling 7 million people on state exchanges. Overall, the ACA brought 20 million uninsured citizens coverage and eliminated insurance practices such as annual and lifetime dollar limits. In 2014, Cohen moved back to California and joined Blue Shield of California’s board of directors before agreeing to run its government affairs team.

Jonathan Schwartz, JD ’79, a classmate and longtime friend notes that “even as a student Gary was an extraordinarily quick study, deft at translating complex legal issues into practical ideas, which he has built upon to become an extraordinary manager of people as well.” Another close friend, Diane Redleaf, JD ’79, says Cohen’s friendly, fun personality belies his academic and legal seriousness. “He wasn’t bad at relaxing,” she laughs.

These days, Cohen’s preoccupation with affordability of care is affirmed monthly when he reviews his own medical bills. In 2020, he was diagnosed with multiple myeloma, a cancer of plasma cells, and was treated with a stem cell transplant. He says he feels well and is back at work, but is on a medication that will cost $21,000 per month for the foreseeable future. “I have good health insurance, obviously, and I have a $9,000 out-of-pocket limit. I can afford that but it would represent a huge financial burden for most Americans. It’s just intolerable the increases in price that have happened since the drug was introduced. There’s nothing stopping drug companies from charging whatever they want. So, I believe very strongly that we need to make some real changes in our healthcare system.”

COVID-19 holds the spotlight today, but Cohen says health care costs will soon again be a battleground. Health plans are not blameless, he concedes, but says, “The reason why health care is so expensive in America is because of the hospital prices, the medical procedure prices, the drug prices.” Blue Shield also advocates for more comprehensive policies to address other contributors to poor health, such as violence and environmental pollution. However, Cohen adds, “as long as we are paying for volume in a fee-for-service environment, for procedure upon procedure, we’re never going to provide the care that people ought to have at a price that we can afford.” And that’s a goal he’s still determined to fight for.  SL

Joan O’C. Hamilton, a freelance writer, is a former bureau chief for BusinessWeek magazine.