FAIR Health Board Access Interview with James W. Lytle, JD

November 18, 2021

As an award-winning healthcare attorney, James W. Lytle, JD, has had the opportunity to view the healthcare landscape from a variety of vantage points over the course of his career. An adjunct professor of health law at New York University School of Law, Mr. Lytle is the former Managing Partner of the Albany, New York, office of Manatt, Phelps & Phillips and is a senior counsel with Manatt Health, the firm’s healthcare law and consulting practice, affiliated with both its Boston and Albany offices. Mr. Lytle has tackled issues pertaining to, among others, insurance regulation, biomedical research, healthcare delivery and regulation, programs for persons with disabilities and higher education. From 1983 to 1986, Mr. Lytle served as the Assistant Counsel for Health and Human Services to the former New York Governor Mario Cuomo. In 2020-2021, he has been a fellow at the Advanced Leadership Initiative at Harvard University. A graduate of Princeton University and Harvard Law School, Mr. Lytle recently spoke with FAIR Health Access about the COVID-19 pandemic’s longer-lasting impact on the healthcare landscape and how FAIR Health’s role as a steward of objective healthcare data will continue to evolve in the coming years.

FAIR Health: What influenced your decision to pursue a career in healthcare law?

James W. Lytle: As my father was a physician and my mother was a nurse, I suppose it all makes sense that I am engaged in healthcare law, but that wasn’t the plan. I pursued a career in law primarily because of an interest in politics and policy, less so in the traditional practice of law. I imagined that I would be more involved on the government, policy making and political side of things—frankly, with the intention of running for public office.

After law school, I worked at the Manhattan District Attorney’s Office and then at a law firm in Rochester, where I’m from; the firm represented several area hospitals in malpractice matters. But what really brought me into the healthcare sector were two things. In the early 1980s, I joined a legal services organization that was formed to address cutbacks in legal services occurring at the national level. I represented clients who were either seeking Medicaid benefits or had issues with the Medicaid program. I became more involved in those issues at that time, and because of that experience, I was assigned to work on similar issues when I served as Assistant Counsel for Health and Human Services under Governor Mario Cuomo during his first term. Working under the Cuomo administration provided me with a tremendous graduate-level immersion in healthcare law and policy for the next four years that set me on the path to stay involved in the healthcare sector even after I left the governor’s office.

After working for the first Governor Cuomo, I concluded that playing a policy advisor role was more satisfying and fit my personality better than being the elected official, with one exception: I did serve seven years on my local school board—that’s as far as my political career advanced.

FH: You served as the Assistant Counsel for Health and Human Services to the former New York Governor Mario Cuomo just as the AIDS epidemic was taking hold. What were some of the challenges and opportunities in the 1980s that led to the state’s establishment of the AIDS Institute and New York State AIDS Advisory Council?

JWL: As the AIDS epidemic reached us in New York State, which was part of its epicenter, it became an important issue for Governor Cuomo and his administration. I recall some of our earliest meetings about our approach to the AIDS epidemic with the remarkable David Axelrod, who was then the Commissioner of Health. To his credit, State Senator Roy Goodman from Manhattan was among the first to insist that the administration give the issue the priority that it deserved; I recall meeting with him with other staff from the governor’s office, when he sounded the alarm on the AIDS issue. We became very involved initially in some of the public health interventions, one element of which involved addressing venues of transmission, and we soon pivoted to deal with issues like insurance discrimination. We were in the awkward predicament of having a test to determine HIV status before any treatment was available, so there was the opportunity for discrimination against individuals with that diagnosis. This was before New York State, and ultimately the national government, precluded discrimination based on preexisting conditions.

I would give all the credit to Dr. Axelrod and to the state’s Department of Health for the steps they took, including establishing various elements within that department to focus on AIDS, like the AIDS Institute. It was all intended to provide a unique focus on the condition and to make sure that the public realized that there was that level of attention. Prior to that time, the notion of focusing on a specific disease, and the idea of considering what steps New York might take on the research side, were a little more unusual than they are now, but they sparked focused attention at the state level on a particular disease.

FH: The public health and healthcare sectors have typically served as two sides of the same coin. With greater attention now being paid to the importance of preventive public health, what opportunities do you see for strengthening, or reimagining, a public health infrastructure at the local, state and federal levels?

JWL: I hope there will be additional attention paid to the importance of preventive public health, and I would hope that we would imagine creative ways to establish a strong public health infrastructure going forward. A number of issues need to be addressed. One is, to what extent should we continue to rely on state and local public health efforts as the frontline of defense? Or, to what extent should we begin to think about a more national approach to public health issues? There are arguments for going in either direction. At the end of the day, public health probably needs to be addressed at the local level because of unique characteristics that might be experienced by a unique community. Having a coherent, coordinated response to public health crises like this one [COVID-19] is overwhelmingly obvious, but whether we have the public will to invest in it remains to be seen. The fact that there has been so much resistance to COVID-19 public health initiatives and even threats to public health officials across the country does not bode well.

FH: In 2020, you enrolled as a fellow at Harvard University’s Advanced Leadership Initiative, an innovative, multidisciplinary academic program designed for executive-level professionals committed to solving society’s most pressing challenges. How has this fellowship, undertaken during such a pivotal time in public health, influenced your legal practice and perspectives?

JWL: It has been a great experience to participate in the fellowship at this stage of my career, and to give some thought as to how I might be useful in this next chapter to address issues of social change. That’s the goal of the program. As a fellow, I have a wonderful opportunity to sample any number of interesting courses throughout Harvard University—including undergraduate and graduate programs at the various schools—and at the same time focus on some broader policy issues of interest. The experience has changed my thinking about some issues.

One particular project that I’ve been focused on concerns organ donation and transplantation, which I’ve been dealing with over the last nine years, representing Donate Life New York, the leading organ donation and transplant advocacy organization in New York and the operator of the state’s donor registry. It’s been interesting to draw upon the experts here at Harvard to inform what might be the best policy steps to address issues in the organ transplantation arena. Together with a colleague in the program, I’ve also been examining potential legal and policy approaches to childhood obesity relating to consumption of sugar-sweetened beverages.

FH: Your work has focused on individuals with disabilities, a group that faced a significantly higher risk of mortality due to COVID-19; this increased risk was documented in a FAIR Health report and in other research. What policy actions can be taken to address the vulnerabilities of these individuals?

JWL: When I was in the governor’s office, part of my responsibility involved issues pertaining to persons with intellectual and developmental disabilities. It seems like a lifetime ago, but this was during the Willowbrook era1 when there still were large institutions in New York that were doing a poor job of providing care to individuals with these disabilities. I was very proud of the efforts we took to close those facilities and to make unprecedented investments in community services to those individuals. In many respects, New York State has been a leader in this arena, although the field continues to struggle mightily to provide services, particularly during the pandemic.

Statewide associations that represent providers in the field have an extraordinary workforce challenge that has been compounded by—but that predated—the COVID-19 pandemic. Not surprisingly, finding people prepared to work at minimum wage to undertake a challenging role in this field is nearly impossible. To add to that, issues of concern among those workers about their safety in the context of the pandemic and now a vaccination mandate, which some are resisting, have put providers and their clients at grave risk.

The pandemic underscored key issues for clients within this service system. One was access to necessary interventions, including various personal protective equipment (PPE) for employees and clients within these programs. PPE was distributed to hospital staff, and to a secondary extent, nursing home staff. However, a whole service system in desperate need of that basic protective equipment was left out.

There are incredibly challenging bioethical issues with respect to allocation of scarce resources that inevitably seem to affect individuals with disabilities. Knowing that we may experience another pandemic, probably within my lifetime, we need to be better prepared. Advocates for persons with disabilities, I believe, have been appropriately concerned about whether these policies going forward intentionally or unintentionally discriminate against individuals with disabilities. And FAIR Health’s monitoring of the pandemic’s unique impact on people with intellectual and developmental disabilities provided a very useful focus on these issues.

FH: FAIR Health has continued to lead as a source of independent and objective price and utilization information. Looking to the future, how do you predict FAIR Health’s role in the healthcare sector will evolve?

JWL: I witnessed FAIR Health’s creation in 2009 when I was representing one or more of the health plans that were subject to the Attorney General’s investigation. As relevant as it was then, FAIR Health’s role has become even more critical now as we enter a more focused conversation on transparency and value.

What is clear even during the short period of time I’ve served on the Board is that FAIR Health’s role is expanding exponentially. State after state has enlisted FAIR Health to help it deal with healthcare transparency or a reporting issue. FAIR Health plays a critical role in helping us get a better fix on what we’re paying for and how much we’re actually paying. All the work that FAIR Health is now doing puts it very much at the forefront of the national healthcare debate. The national emphasis on identifying value in healthcare—meaning, some combination of both price transparency and outcomes information—is overwhelmingly evident in areas ranging from autism services to dental health, and a range of other elements within the healthcare system, such as worker’s compensation. This makes clear that having an independent, objective resource for healthcare cost information is a critical element to future policies.

FAIR Health Board interviews reflect the views of the Board member in his or her individual capacity and not necessarily those of FAIR Health or other organizations with which the Board member is affiliated.


1 Founded in 1947, the Willowbrook State School was a New York State-supported institution for children with intellectual disabilities located in the Willowbrook neighborhood of Staten Island. Pursuant to journalistic investigations that uncovered deplorable conditions at the institution, including overcrowding, unsanitary living conditions and physical and sexual abuse by staff members, the Willowbrook State School was closed in 1987.