‘Not a health care guy:’ Johnson likely to lean on leaders and aides for policy smarts

November 29, 2023 | By Megan Wilson


Health care lobbyists and advocates expect the House leadership shakeup that gave Louisiana Republican Mike Johnson the gavel and the staff exits that followed to shift more power to committee leaders and high-level staffers, a half-dozen lobbyists told POLITICO.

Some of the change is driven by Johnson’s relative inexperience with health policy and his never having been in the ranks of GOP leadership, said the lobbyists, five of whom were granted anonymity to discuss the dynamic on Capitol Hill.

Johnson, who is in his fourth term, opposes abortion and gender-affirming care and supports cutting government health care programs such as Medicare and Medicaid, but has an otherwise scant record to signal where he falls on other health care policies being discussed in Congress.

Health care isn’t “his favorite subject,” said Joel White, a health care lobbyist and former House Ways and Means Committee staffer who founded Horizon Government Affairs. But White pointed out that Johnson led the roughly 175-member Republican Study Committee when it released a 50-page health care policy blueprint crafted in the wake of failed Republican efforts to repeal and replace Obamacare.

Lobbyists said the recent departures of top health policy aides for Kevin McCarthy (R-Calif.) and House Majority Leader Steve Scalise (R-La.) is another reason they expect committee leaders, staff and other offices in leadership to play an expanded role.

“Speaker Johnson is thankful to have such capable health care leaders at the Energy and Commerce, Ways and Means, and Education and Workforce Committees and within the House Republican leadership helping to drive a health care agenda that helps deliver lower costs and better outcomes,” said a spokesperson for Johnson.

Ryan Long, who left McCarthy’s office to rejoin BGR Group, and Alye Mlinar from Scalise’s office joined Mehlman Consulting, were both steeped in health policy and institutional knowledge having worked for leadership and health committees — making them a go-to for lobbyists, members and other staff to move legislation.

“With Ryan and Alye leaving, you can’t just go to one person anymore, so the power will be more diffuse by definition. Ultimately the decision-making is made from the top, but it will require input from a more diverse network of staff and policymakers,” said one Republican health care lobbyist.

Johnson hired Drew Keyes, from Paragon Health Institute, a conservative think tank founded by a former Trump administration official, to take the slot Long held under McCarthy. Keyes worked under Johnson at the RSC and served as the staff lead for its Health Care Task Force that wrote legislation and analyzed health care legislation.

Lobbyists described Keyes as smart and said he knows how to ask the right questions, but it’s unclear how much he will influence policy — with one lobbyist and former GOP leadership aide saying that working for the RSC is different from negotiating among the three House committees with jurisdiction over health policy and wrangling an entire conference.

At the RSC, “you’re trying to get people to move to the right, get leadership to move to the right, rather than getting people to work together,” the person said.

Keyes didn’t respond to a request for comment.

During his time at Paragon, Keyes weighed in on one of the biggest industry battles on the Hill this year — pharmaceuticals versus pharmacy benefit managers — writing an op-ed in June titled, “Congress should not do the bidding of a dying trade association,” referring to PhRMA, a lobbying group for large drugmakers.

There are some lobbyists who hope this is a harbinger for how the speaker’s office will come down on the debates between the two, but Johnson also has Dan Ziegler, who directs the entire policy portfolio, on staff. He lobbied for PhRMA and some of its member companies at Williams and Jensen before taking the new gig.


There are other key GOP health policy slots open, including filling Mlinar’s job in Scalise’s office and the lead for Medicare policy on the House Energy and Commerce Committee. Alec Aramanda, who held the role, joined lobbying firm Williams and Jensen this month.

Should Scalise hire a more “seasoned” health care staffer, it could allow his office “to assert more authority and have more say over the agenda and committees than we’ve seen in the past,” said the former Republican leadership staffer. “That’s the big dynamic shift that I see.”

Johnson may lean on Scalise — a fellow member of the Louisiana delegation with a longer tenure on Capitol Hill and within leadership — for advice on direction and strategy.

Several of the lobbyists said Nolan Ahern in Majority Whip Tom Emmer’s (R-Minn.) office is an ascending health policy aide. He’s worked on the House Energy and Commerce and House Ways and Means committees, knows health policy and was in meetings while Republicans developed their policy recommendations for Republicans’ Health Futures task force released earlier this year.

Scalise and Emmer’s offices didn’t respond to a request for comment.


The Republican goal of giving committee chairs more power to steer and develop policy — rather than concentrating power among the leaders — is likely to be exaggerated under Johnson, said White and four other lobbyists.

“Johnson is not a health care guy,” said one of those lobbyists. “Committees see this as an opportunity to exert more power because they have existing staff and agendas — so, what are they able to do?” one of those lobbyists said.

Johnson is also close with Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-Wash.), said White, which bodes well for the Lower Costs, More Transparency health care package. Her panel — along with the House Ways and Means and Education and the Workforce committees — crafted the bipartisan measure. She has pushed for a floor vote even as hospitals and PBMs — which would be subject to increased transparency requirements and a decrease in payments — have lobbied against the wide-ranging package. The measure, which would also reauthorize expiring programs, was supposed to receive a vote in September but was removed from the calendar amid the tumult around funding the government and mixed support from Republicans and Democrats.