The magazine of the UW School of Public Health

Close Up With Doug Conrad

Doug Conrad, Professor of Health Services in the UW SPH, talks about health care reform in Washington State.

Doug Conrad is a professor in the Department of Health Services in the UW School of Public Health. From November 2012 to January 2014, he served on the Board of the Washington Health Benefit Exchange. 

Remind us why the Affordable Care Act (ACA) is so important.

The root problem we’re trying to address is that 15 percent of the US population does not have health insurance. In Washington State, that’s roughly one million people. We do need to toss resources at health care reform. It’s not something to be done by eliminating waste—or solely by tackling disintegrated or uncoordinated care. Those that say we can make these changes within existing resources are wrong about that.

What’s the overall mission of the Washington Health Benefit Exchange?

Affordability of health insurance is absolutely a key goal. Equity is another key principle. When I was on the board, we looked at everything through the lens of whether the choices and recommendations made would reduce disparities in health insurance and disparities in health care.

What do you hope will ultimately be achieved with the ACA?

I’m hoping the ACA in Washington State will improve both the risk protection and the affordability in the individual and small group health insurance markets. And that’s a challenge because we have to get the carriers to compete on price and on the quality of the benefits they offer and the services they provide. I think it will work, particularly over three or four years.

What is your assessment of how well the Washington Exchange did when stacked up against other state exchanges?

I think they’ve done quite well with respect to enrollment. Michael Marchand, the Director of Marketing and Communications for the Exchange, used every technology possible to reach the “Young Invincibles” and those in the general population who are underinsured or uninsured.

The numbers after the March 31 deadline are good. In the early days of enrollment, there were issues with the call center and with bugs on the web portal. Those were disappointing, but the Exchange handled them honestly.

We need to remember that this is a massive undertaking that hasn’t been done before. By 2019, we are aiming to have 34 million new people signed up for insurance in the United States. 

In the years ahead, what do you think some of the primary challenges will be for the Exchange in Washington State?

In year one, the first year of implementation, the key emphasis was getting health insurance carriers to participate in large numbers along with plans that were reasonably protective against consumer financial risk and affordable. For year two, I think the challenge will be to see the plans being efficient and competitive. We need to get to a place where the total of the premium and out-of-pocket costs are not such a large share of family income.

When we set the exchange up, we were anticipating lower deductibles. It will be interesting to see if relatively high deductibles will keep people from signing up for health insurance and from getting necessary health care.

What the Exchange and the ACA are trying to do will require patience and compromise. If we can keep our eye on the ball and say what this is really about is improving access to good health care and access to improved health through population health and health investment, then I think compromises can be negotiated.
What are your hopes for ACA implementation in our region with regard to population health?

My hopes would be that the ACA as implemented in Washington State would give people improved access to primary care and prevention services.

The research shows that having insurance really does help the health of vulnerable populations. To the extent that the ACA improves access for vulnerable populations, it will improve population health.

You’ve worked a lot with Public Health - Seattle & King County to develop methods to evaluate the impact of the ACA. In what areas would you like to see public health and health care delivery coming together to improve population health?

To the extent that the ACA sends resources to health care delivery, health care has a responsibility to work with public health, particularly on population health. Explicit collaboration is needed to figure out new ways to move the needle to improve health with immunizations, prenatal care, and the integration of behavioral health and physical health.

It will take time to build relationships between different parts of the system. They are different types of work. We need consciously to commit to working together.

I don’t believe that the ACA will be repealed in the future. Instead, it will be improved, and I predict that the ACA will end up being a huge benefit for Americans.