Sejal Hathi recently took over as director of the Oregon Health Authority. An attending physician, Hathi previously served as New Jersey’s designated state health officer and deputy commissioner for public health services. She also advised the Biden-Harris administration on public health policy for two years and has held faculty positions in the schools of medicine and public health at Johns Hopkins University.
Hathi joins us to tell us more about her new role and her priorities for the OHA.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. We start today with the new director of the Oregon Health Authority (OHA). Dr. Sejal Hathi spent two years as a White House public health advisor and four months in the New Jersey Department of Health. She takes over at OHA at a challenging time. There are big questions about the best ways for the state to respond to its twin crises of substance use and mental illness, and there are the ongoing experiments with the Oregon Health Plan - that’s the state’s Medicaid program which provides health insurance right now for more than one in three Oregonians. Sejal Hathi joins me now. Welcome to the show.
Sejal Hathi: Thanks so much for having me.
Miller: Why did you want this job?
Hathi: Well, that’s a great question and I appreciate the opportunity to highlight the amazing things that the Oregon Health Authority is doing, which is really what inspired me and drew me to taking this job. And you know, Dave, Oregon has been, for decades, at the vanguard of bold progressive imaginative health policy. It was the first state to articulate and to center an ambitious goal of eliminating health inequities by 2030. It has some of the strongest reproductive health laws in the country. It has groundbreaking Medicaid programs from our first in the nation, 1115 Waiver, to address food and housing insecurity, to legislative achievements like Cover all Kids, Cover all People, and the new Basic Health Plan.
I was excited by that tradition. I wanted to be a part of, and to foster that legacy. And so when the state came knocking - especially from my vantage point of the federal government, where I had long admired, seen and sought to support the work that Oregon was doing - it was simply too compelling an opportunity to forgo.
And moreover, it presented an opportunity for me to return home. I grew up on the west coast, my entire family is still in Northern California, and I had been searching for a way to re-establish this region as home. And here, this role gives me the opportunity to do that.
Miller: What are your biggest goals for this sprawling agency?
Hathi: You pointed out in the introduction that we have a lot of challenges before us. But this is also an incredible opportunity with an administration and a governor - my boss - who is not only willing to tackle the hard problems, but hungry and ready to meet them with bold solutions. And so I’m truly excited about the work ahead.
I’m gonna be launching a regional listening tour, actually, at the end of this week, where I’m hopeful Oregonians themselves will tell me which challenges they want me to focus on most. But if I could name for you three priorities that I’d like to focus at this stage, it would be health equity, our behavioral health system, and access to care.
Specifically, around health equity, making sure that we can make our 2030 strategic goal real and set a roadmap with clear benchmarks for what it means to eliminate health inequities for all Oregonians across the state.
For a behavioral health crisis, both our country and our state are really engulfed by this unprecedented behavioral health pandemic, and we really need to make sure that we are investing in prevention, early intervention, treatment and rehabilitation over the next year.
And then finally, it’s important to me that we strengthen access to care and what that means is preserving and enhancing our coverage gains over the last few years, but also thinking about how we ensure the coverage folks do receive is comprehensive and affordable, and ensure that cost is not a barrier to obtaining necessary medical care. So I would say those three priorities rise to the front of my mind.
Miller: Let’s dig more deeply into some of them, including behavioral health, which is a kind of catch-all, but substance use disorder is included there. What do you think should happen with Measure 110 - maybe the most prominent issue that the Oregon Legislature is taking up right now?
Hathi: The governor has made clear that any change to Measure 110, including recriminalization, really will have to pass the balancing test of concrete, measurable, improved outcomes for individuals that are struggling with addiction, and accountability, which was her focus on the campaign trail, throughout tenure thus far as governor, and I can’t help but agree. I’d say that I see my role as really implementing the changes to the law that ultimately the legislators enact, and doing so with rigor, with transparency and with urgency. Whatever revisions our legislature chooses to make, my team and I will make sure that we implement them. But what I do want to note...
Miller: But that’s your job, right? You have to do that. But do you think they should change it? I mean, if you put on your hat as an internist, as a doctor, do you think that changes are warranted?
Hathi: I think the public has spoken, and where Oregonians are is that the roll out of Measure 110 over the last few years has been fraught. It’s met a lot of challenges. And I think for an unprecedented law, the first of its type in the country, that’s no surprise. What was happening before Measures 110 was not working. It’s clear that what is happening right now is not working.
But what I do want to highlight, Dave, is that for all of its challenges, Measure 110 did provide more than $300 million in desperately needed funding for a range of vital services, from treatment, to housing, to harm reduction. Funding that has resulted already in a more than 100% increase in people receiving substance use disorder treatment, and nearly 300% increase in housing and supported employment services. So as my colleagues in the legislature do debate these reforms, it’s critical, from my view as a new Oregonian and as a doctor and as a public servant, that this funding and these programs, which expand and fill gaps in our continuum of care be preserved.
Miller: And speaking of that funding, we heard just recently on the show from House Minority Leader Jeff Helfrich that OHA should not be overseeing the review committee that oversees the disbursement of those grants - that instead, that should go to Oregon’s Alcohol and Drug Policy Commission. Do you think that OHA should continue to be in charge of overseeing those grants?
Hathi: I would slightly amend your statement by noting that we work closely with the OAC - the Oversight and Accountability Council - in overseeing those grants. It’s not a job that we take alone. But I don’t want to really debate the nuances that my Legislature colleagues are currently still navigating. I’m gonna leave that to them to discuss over the coming days. What I will say is that, as the agency principally responsible for strengthening health and well-being for all Oregonians, we certainly should have a central role in determining, and more importantly, holding accountable how these funds are spent. The particulars of that I will leave to the Oregon Legislature, but I know my team is working closely with the teams there to make sure that our viewpoints are incorporated.
Miller: If there’s one thing that you could go back and change about the public health community’s consensus responses to COVID-19, what would it be, with the benefit of hindsight? What’s one thing you think that we could have done better?
Hathi: I think that there are a lot of lessons learned from the last few years across the country, here in Oregon as well as in New Jersey, where I came from. I will say, Dave, that for all of those lessons, we did have, in Oregon, one of the lowest COVID-19 death and hospitalization rates nationwide. And amid striking disparities across the country, we did have, additionally, the highest vaccination rate among Black Americans. And so I think that the team at the Oregon Health Authority and across the state that mobilized to respond to the pandemic, did so with tremendous grit and persistence and mission orientation to get the job done. And I’m really proud of our public health division for leading a lot of that work.
Where I think that a lot of public health agencies might refocus or otherwise approach things differently, should another pandemic come around, is looking more closely at how some of our public health guidance is communicated, and making sure that it’s easy to understand, it’s not confusing, it’s pragmatic, it meets people where they are. And that we don’t wait for perfect information to begin to get out helpful information to front line workers, schools, small businesses that are otherwise struggling to make sense of a rapidly evolving situation.
Communication or the lack thereof, is often the bane of public health response. And so if I were to approach things differently or my teams were in any such future crisis, I would say it’s about how we transparently, clearly, consistently communicate in a rapidly changing situation.
Miller: The Oregon Health Authority has the largest budget of any state agency. Its two-year total funds budget is over $34 billion. What’s the largest budget you have directly overseen before this job?
Hathi: In my prior role in New Jersey, I oversaw roughly a $2 billion budget, so this is certainly a step up from that, Dave, to your point. I will say prior to that, when I was in the federal government, while I was at the White House and we did not directly oversee agencies, we still worked in partnership with them to formulate, execute and monitor the implementation of the president’s budget for health and human services programs - which of course was manyfold what I’m dealing with now. But I’m lucky to have a team that has been here for a while – my deputy of policy and programs, Dave Baden, whom you must know well, was our prior chief financial officer at the agency and has great fluency with the budget. My other members of the executive team similarly have been here for quite some time. So I’m thankful to have a team that I can rely on and work with closely to manage a sprawling budget.
Miller: We just have about a minute left. I mentioned you’ve had a couple of jobs in just the last couple of years. Two years at the White House, just four months at the New Jersey Department of Health. How long do you plan to stay in this job?
Hathi: I’m here for the long haul. And I recognize that to do the type of work that we need to, to address the challenges that lie before us, I’m gonna need to be here, not for two years, but for two terms, or as long as Oregonians will have me. My husband and I bought a home, we’re here to build a family and to lay down roots. And so, I’m here for the long haul and what I will say is that I’m here.
I was in New Jersey for four months because I was attracted by the work that Oregon was doing. And so I think that I recognize that there’s a lot of work to do. I’m eager to roll up my sleeves and I hope to do so over many years.
Miller: Sejal Hathi, then we will talk again. Thanks very much.
Hathi: Thank you.
Miller: Dr. Sejal Hathi is the new director of the Oregon Health Authority.
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