What happens when health coverage becomes unaffordable, and who’s stepping up to lead in moments like this? This episode connects two powerful public health stories.

First, we break down the ACA enhanced premium tax credits: what they were, who they helped, and what’s at stake now that they’ve expired. Catherine Jones, Senior Analyst Government Affairs at ASTHO will explain how these pandemic-era subsidies dramatically expanded access to marketplace coverage, helping middle-income families, older adults not yet eligible for Medicare, rural residents, gig workers, and others without employer-based insurance. With premiums now rising sharply, millions may lose coverage, leading to delayed care, skipped medications, more emergency room use, rising uncompensated care costs, and even potential hospital closures, especially in rural communities. We explore how insurance coverage isn’t just a healthcare issue, but a population health issue tied to chronic disease management, maternal health, mental health services, vaccinations, and overall mortality. Then, we shift to leadership. James Bell III, Chief of Staff/Director of the Michigan Department of Health and Human Services and a Doctor of Social Work, reflects on his experience in the DELPH Leadership Program and how it reshaped how he shows up as a public health leader. From finding his voice in high-stakes rooms to practicing servant leadership, advocating for equity, and building authentic national networks, Bell describes how leadership development strengthens not just individuals, but the systems and communities they serve.

ACA Enhanced Premium Tax Credits: Legislative Developments in 2025 and 2026 | ASTHO

Developing Executive Leaders in Public Health | ASTHO

Reducing Hypertension Through Self-Measured Blood Pressure Monitoring Programs | ASTHO

Addressing Hypertension During Pregnancy Improves Maternal and Infant Health | ASTHO

1073: Coverage, Consequences, and the Leaders Shaping Public Health’s Future