Oregon’s New Health Authority Director to Face Uphill Battle, Promises to Bring Grit and Commitment

Dr. Sejal Hathi will take the reins at the Oregon Health Authority in January, becoming the agency’s fourth leader in about a year. 

A first generation American and primary care physician, she will lead one of Oregon’s biggest and most influential agencies, with a budget of more than $17 billion annually and nearly 5,000 employees. The role involves overseeing Medicaid, public health, health care systems, the Oregon State Hospital and making decisions that affect the lives of most Oregonians, especially the most vulnerable. 

Her appointment comes at a time when the state is grappling with widespread drug abuse and a lack of treatment options. It is reviewing the eligibility of the one in three Oregonians on Medicaid and preparing to expand the free health and dental insurance. At 33, she will follow in the footsteps of three middle-aged white men who’ve overseen the Oregon Health Authority within just over a year. She said in an online news conference she’s well-matched for the challenge. 

“This is a state and a team that embraces my values for equity, for evidence-based policy, for innovation and relentless improvement. I’ve had my eye on Oregon for quite a while, and I could not be more excited to make the state my home,” Hathi said. 

Hathi, who describes herself as a physician and public servant, acknowledged she might hit some resistance because of her age, which she said has come up before.  

“I harbor no illusions about the path ahead. I know it will be hard and long and full of challenges, but I’m committed to that journey,” she said. “I know, at the same time, that there is no age requirement for getting the job done. My job is to keep and fulfill the promises that the state has made, that the governor has made to the people of Oregon.” 

She has served in a number of high-profile positions in recent years – sometimes simultaneously, sometimes in rapid succession – after earning a master’s in business administration and a medical degree from Stanford University. She advised the U.N. Secretary-General Ban Ki-moon on health care policy, cared for patients at Massachusetts General Hospital, including during the pandemic, served on the faculties of Harvard and Johns Hopkins universities and was a senior adviser to the White House on public health. 

In July, she became deputy commissioner for public health services in New Jersey, about a month after Gov. Tina Kotek’s office posted the job opening. Kotek hired a Tigard firm to lead a nationwide search after her first hire, James Schroeder, a physician’s assistant and Medicaid specialist, unexpectedly quit after two months. Hathi indicated that Oregon officials approached her about the job.  

The role will mark a widening of responsibilities. In New Jersey, she said she has managed a $2 billion budget and staff of 1,000, five times fewer than at the health authority. She indicated her months in New Jersey and previously at the White House have given her experience in navigating bureaucracy, which in Oregon often means addressing problems by setting up task forces that commission studies and lead to meetings with advocates, lawmakers and community members. 

“I similarly had to wrangle a lot of difficult perspectives and bridge silos, entrenched silos to push the work forward,” she said. “That is that grit and commitment that I will bring to this role.”  

She said she hopes to stay for two gubernatorial terms. The previous long-term director, Patrick Allen, resigned in January to allow Kotek to appoint her own health care leader. 

Top priorities 

Hathi said she intends to hold the agency accountable while focusing on Kotek’s health care priorities. They include expanding Medicaid services to include housing and food at a time when the agency is reviewing the eligibility of its 1.4 million members. With the end of pandemic-related benefits, the federal government is requiring all states to review members’ income and other eligibility requirements. Oregon has one of the highest retention rates nationwide in this “great unwinding,” according to KFF health news, though there have been some glitches, including booting hundreds of eligible low-income individuals and children off Medicaid. 

The authority also aims to eliminate health inequities by 2030. The state needs more health care workers, especially in behavioral health and addiction services, and hospital services in areas have shrunk, are shrinking or consolidating. But perhaps the biggest problem is the state’s behavioral health system, which has been underfunded for years. Oregon has consistently ranked in nationwide analyses, including by Mental Health America, as having the highest incidence of mental illness and among the fewest options for treatment. 

“Paramount to that goal will be ensuring that we are investing adequately and responsibly, not only in treatment services, but in the wraparound navigation, social services, housing that we know underpin the success of our behavioral health programs and that in many ways precipitate poor behavioral health outcomes,” Hathi said. 

In 2021, the Legislature invested $1.3 billion in expanding residential facilities and recruiting and retaining behavioral health professionals. Earlier this year, the Legislature allocated about $80 million in residential treatment and addiction services, community health and for services related to the Oregon State Hospital, which mainly treats people accused of crimes who cannot aid in their defense without health care. The director is responsible for ensuring that that money is used well and reaches those who need it, something that’s not always happened in the past.  

State Sen. Elizabeth Steiner, D-Portland and a primary care doctor, welcomed Hathi’s appointment. 

“Dr. Hathi’s impressive experience on the frontlines and in public health policy will be essential as OHA takes on implementing the next generation of health care policy and programs,” Steiner said. 

In her role, Hathi will work with the state’s 15 regionally based coordinated care organizations, which serve as Medicaid insurers. The spokesperson of one of the largest, CareOregon, welcomed her appointment. 

“Having a new leader in place will help our team and countless others – from public health to health systems – continue to build out Oregon’s vision for a system of health that puts people first. We’re excited to hear that Dr. Hathi is aligned in this vision. We’re eager to continue this partnership and welcome the OHA director to her role,” Becca Thomsen, CareOregon spokesperson. 

‘Fixing what is broken’ 

Oregon’s approach to Medicaid and other innovations is partly why Hathi said she was attracted to the state. She indicated that she will bring to the job a new perspective. She grew up in the San Francisco Bay Area with parents of Indian descent. 

“My parents, both born and raised in Africa, arrived in this country with little more than a passport and burgeoning dreams – my dad, as a political refugee from Uganda and my mom as the youngest of eight in Tanzania, and as the fruit of their journeys, their quest to attain the American dream,” Hathi said.  

She said she embraces their desire for a better life. 

“Since my youngest years, I have been obsessed with fixing what is broken, finding, understanding, reforming those structures and institutions that entrench social inequities and compress the human potential,” she said. “This is a state and a team that embraces my values for equity, for evidence-based policy, for innovation and relentless improvement. I’ve had my eye on Oregon for quite a while, and I could not be more excited to make the state my home.” 

A year ago, she married Sheel Tyle, founder and CEO of a global venture capital firm, Amplo, according to his LinkedIn profile. Tyle is also a first generation American, with parents from India and is a Stanford and Harvard graduate with White House ties. Tyle was a member of former President Barack Obama’s delegation during his 2016 trip to Cuba. 

Hathi said she expects to spend her first weeks or even months meeting with doctors, nurses, social workers, peer specialists and community-based organizations to ask them what the agency should be doing that it’s not doing and what needs to be expanded to improve health care in the state. 

“While I may not have grown up here, that doesn’t mean that I don’t share a fierce desire for our families to be healthy and successful and safe,” Hathi said. “I want to serve my community and all Oregonians who rely on state programs with rigor, with urgency and with care. I want to accelerate and to center our quest for health equity. I want to wrest as much value out of every taxpayer dollar that we spend.” 

She starts Jan. 16 and will earn an annual salary of nearly $222,000.  

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By Lynne Terry of Oregon Capital Chronicle  

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