Insurance Business sent him a few questions through email to pick the brains that helped shape Obamacare, and the answers reveal a professional with a vision, someone able to chart his own path wherever the tides take him.
IBA: What was the pivotal life experience that made you decide to focus on health policy?
JA: A friend of mine became Oregon Insurance Commissioner and hired me to work with stakeholders to develop a health insurance reform plan for the new Governor, John Kitzhaber, in 1994. I did not know much about insurance at the time but was totally captivated by the challenge and have been engaged in insurance reform issues ever since.
IBA: What is the greatest reward of working in the public sector?
JA: There is nothing quite like being in the arena, trying to weave together clashing interests in pursuit of the public good. The process can be messy, even ugly, but government service is a noble enterprise.
IBA: How are you acclimatizing at Manatt?
JA: I love my colleagues, many of whom came from public service, and enjoy working for a wide range of clients who collectively offer a 360 degree view of the health marketplace.
IBA: Experts say that the current brouhaha surrounding the ACA exchanges are birthing pains. What do you have to say about that? How do you envision them evolving over the long term?
JA: The path forward has been long and tortuous, but I still hold to the vision that the ACA exchanges are the model for how all public and commercial health insurance will be delivered in the future. Whether we are talking about public programs or employer-based insurance, the approaches are converging on the same basic model: consumers come to a website with a subsidy or employer contribution and have choices, with state of the art consumer tools to make the process consumer friendly.
IBA: What is the one thing you would change about these exchanges?
JA: I would make better use of the entrepreneurs who want to partner with the public exchanges to offer consumers a continuously improving shopping experience. Choice is a great thing, but it does not work if you don’t have world class tools to simplify the process, including apps that spoon feed you one or two best choices if that is what you want.
IBA: Managing the exchanges must have been stressful. How do you decompress?
JA: I wasn’t very good at that, which is why I only lasted a year at HHS. And I only had to manage the development of regulations, I was long gone when the more intense IT challenges emerged.
IBA: What is the thing you will remember the most working with President Obama? How would you rate him as chief of state, given that you had the opportunity to work with him up close on a project close to his heart?
JA: I was in the trenches, far removed from the President. But I know that we would not have Obamacare without Obama’s perseverance and I think history will look kindly on the President who took some real political hits to put us on the path to universal coverage. We are not going back.
IBA: What is the advice you would give to the ordinary American who is getting cold feet about getting into Obamacare?
JA: Remember what it was like when Americans with pre-existing conditions had to plan their career moves around keeping their health care. My middle son needs an expensive specialty drug and I am so thankful that he no longer has to fear being uninsurable.
IBA: What words of wisdom do you have for insurance companies on the exchanges?
JA: I am a fan of the provider-sponsored regional plans that integrate insurance and delivery systems for many reasons; an important one is that they tend to serve the whole community – from the Medicaid safety net to the commercial market to Medicare. In spite of what is happening this year, I see the national brands retooling to do the same and I hope they continue down that path so that we end up with a truly unique American model where the government sets the rules of competition – calibrated to the differing needs of Medicaid, Medicare and commercial populations -- and then lets insurers compete and innovate in ways that are not feasible for the government by itself.
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