Kentucky State Rep. Kimberly Moser’s Pragmatic Approach to Improving Health in Her State

Finding broad consensus on addressing maternal mortality or keeping a public health system focused on its mission isn’t all that difficult. Yet translating conceptual agreement into nuts-and-bolts legislation, with buy-in across the political spectrum and from assorted state agencies and outside stakeholders, is a far more complex task. 

In Kentucky, state Rep. Kimberly Moser, a neonatal intensive care and flight nurse turned policymaker, managed to get sweeping legislation passed on both those issues after just a few terms in the legislature. 

Her leadership formula, she said, is simple.   

Gather data.  

Know your stuff. 

Bring people together, first in small groups to build relationships, and then in larger gatherings of diverse stakeholders.  

And listen, listen, listen. 

“When you pull groups of stakeholders together, people do a lot more listening to one another. They hear things that they wouldn’t ordinarily hear in those one-on-one meetings,” said Moser, who is a current Milbank Fellow. “You can hear the whole story.” 

From Medicine to Politics 

It’s not that surprising that Moser, the chair of the Kentucky General Assembly House Health Services Committee, has made health both her vocation and her avocation, in and out of public office. 

Her dad was a doctor, her mom a nurse. She became a nurse, and married a doctor who also had a physician dad and a nurse mom. The extended family tree has multiple physicians on its branches, including one of Moser’s sons and a daughter-in-law. 

It was not so predictable that Moser would end up in politics, running for her fifth two-year term this November. Or that Moser, a traditional conservative on issues like taxes, abortion and gun rights, would become a deft coalition builder on public health challenges including tobacco, maternal mortality, cancer screening, and addiction and overdose. 

It turned out that nursing, parenting, and extensive volunteer work in health- and medicine-related fields had honed her listening skills and taught her a lot about policy. And as the mother of five boys, she certainly knew how to get things done.   

And that includes major legislative achievements such as a maternal mortality “Momnibus” law and the Kentucky public health overhaul.

Building Coalitions to Improve Population Health 

Moser believes leaders don’t just score points; they solve problems. The “Momnibus” law passed this year takes a multipronged approach to saving lives of moms and babies. It requires health plans to treat pregnancy as a qualifying life event, meaning that an uninsured person who becomes pregnant can get coverage outside of the usual enrollment season. That means that prenatal care is covered — along with conditions such as diabetes to opioid abuse, both drivers of maternal death. The Momnibus also established a suite of other services, including telemedicine, help getting started with breastfeeding, and a mental health hotline, Kentucky Lifeline for Moms. It passed the House unanimously, but after an amendment garnered controversy in the Senate, Moser opted to include the Momnibus within another piece of legislation that was still moving, choosing to advance the legislation without regard for who received credit. 

The Kentucky Public Health Transformation was another complicated initiative — this one designed to better meet community health needs in a fiscally responsible way. In addition to legislators, Moser had to bring in state and local public health officers and countless advocacy groups and other stakeholders. Moser saw herself primarily as the facilitator, finding the common ground that eventually led to broadly supported legislation that passed in 2020. 

The basic issue, as Moser described it, was that the state’s local public health departments had taken on missions outside their core responsibilities, creating fiscal pressures and a general drift. It wasn’t that these activities were necessarily bad things to do, but something like home health wasn’t really in their purview. The outcome of the stakeholder meetings was agreement on what was and what was not part of departments’ mission — and acceptance that when a local public department wanted to add on, it was fine if they had clarity, transparency, and the means to pay for it. 

“It brought [the health departments] back to their core and foundational function,” she said. “We were watching the cost go out of control. And we had to rein it back in and say, ‘What is the best service that you provide for your constituents that’s not already provided by someone else in the community?’ And then ‘How do you create partnerships if you want to continue those services, and do it at a reduced cost to the state?’” 

Source: Kentucky Public Health and Kentucky Rural Health Association. Public Health Transformation in Kentucky. November 2021. https://kyrha.org/resources/Documents/Public%20Health%20Transformation%20in%20Kentucky.pdf 

Walking Through the Open Doors 

Being a public office holder and state leader on health wasn’t something a younger Kim Moser had planned on or envisioned. She put in 18 years as a neonatal intensive care nurse and as a flight nurse for the University of Kentucky neonatal transport team. But as her quadruple-boarded physician husband Neal Moser moved around for training and jobs, her work-life balance got harder. After the birth of son number four — and before the birth of son number five — she stepped away from nursing to tend to her family. 

But as she witnessed changes to the practice of medicine in the late 1980s and 90s, some wrought by industry and others by government regulation, she began doing volunteer advocacy work. “I saw how policy really affected patient care and the practice of medicine. It really changed. It was interesting to watch — interesting and maybe a little disconcerting.” 

With each step in her advocacy years, she deepened her understanding of health policy and politics in her home state. She would eventually become the first non-physician in the country to chair a doctors’ political action committee, the Kentucky Physicians PAC, in 2013.   

As Kentucky’s heroin and opioid crisis deepened, her focus broadened to encompass not just the practice of medicine but also prevention and public health.  

“I looked around…. and I saw how unhealthy Kentucky was.” Her husband engaged as well; he had been part of a group of medical residents who got smoking banned from the University of Kentucky Hospital — not an easy task back then in a state where the economy was so tied to tobacco. 

Her advocacy work became a launch pad for a second career in policy and politics, even if that hadn’t been her initial intention. 

“A lot of times people see things in you that you don’t see in yourself. I just kept working and doors would open, and I would walk through and take on new leadership roles,” Moser recalled. 

“I always had that kind of scary feeling about change, and then you step into the role, and you realize, ‘Oh! I got this.’” 

Still, when people suggested she run for office herself, she brushed it off. “I absolutely did not plan on running for office.” 

Then, in 2015, Kentucky’s long-time Sen. Mitch McConnell became Senate Majority Leader. They had a talk. McConnell broached the idea of her coming to work for him; having a nurse in a senior staff position in a Senate leadership office was not unprecedented, and she was intrigued by the opportunity to work on drug policy at a national level.  

But then their conversation took an unexpected turn. “You need a political career of your own,” she recalled him telling her. This time, since the suggestion was coming from Mitch McConnell, she didn’t brush it off. 

The timing was serendipitous. Her youngest son was finishing high school, The long-time state representative in her own northeastern Kentucky district was retiring. She ran in 2016 and won easily. 

Her new colleagues swiftly recognized her expertise and put it to use. She led a Medicaid committee, and then switched to chair the House Health Committee. It’s kept her busy. 

A Pragmatic Approach to Improving Health 

Moser is a self-described fiscal conservative. But she’s also a pragmatist. And her goal is improving the health of the people of Kentucky.  

To do that, she sometimes finds herself coaxing fellow Republicans to think differently about public health. Other times, she’s seeking out common ground with the Democrats. It helps that from her volunteer past, she already knew Dr. Steven Stack, who is now Beshear’s Commissioner for Public Health. 

Looking back, she sees that the roots of her political and policy career were planted early, influenced by her father’s role as a family physician in their community. 

“I would go on house calls with my dad, back in the day when the doctors actually made house calls. And I just saw him in action. I saw the compassion and care and respect that he gave his patients. I saw how gratifying it was for him, but also for the patients to have somebody who cares so much.” 

Becoming a nurse “just felt kind of natural,” she said. “I’m the oldest of six kids so maybe that was part of it. I was always kind of a caretaker.” 

Today, the three threads of her adult life — nursing, motherhood, and politics — form her political persona. 

“I work within reality. I assess the situation as a nurse would. And then I look at the different options…I guess that would be a care plan.” 

She counsels younger lawmakers to have more patience, and some older ones to have more openness. Her inner mom — now her inner grandmother — sometimes kicks in. “I joke that a lot of what we deal with in the legislature we could have solved in kindergarten. Like be nice to each other! Don’t pull hair. Share your toys!” 

She leads. And she gets things done. 

“If you can’t get things done,” she asked. “Why waste your time?”