Heller Profiles

The Heller School for Social Policy and Management at Brandeis University

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Anya Rader Wallack

USA • President, Arrowhead Health Analytics

PhD '07

Managing Health Care Reform, State by State

State officials increasingly are turning to people such as Anya Rader Wallack, PhD '07, to administer the U.S. health care plan.

Fall 2010

For more than a year, President Obama and the U.S. Congress engaged in an epic political battle to overhaul the nation's health care system by extending medical coverage to tens of millions of uninsured Americans.

With the far-reaching bill -- all 1,017 pages of it -- now on the books, the difficult work of administering the legislation falls to the individual states. To assist in this monumental task, state officials increasingly are turning to people such as Anya Rader Wallack, PhD '07, whose expertise in health care delivery has never been in higher demand.

Wallack recently started her own consulting business, Arrowhead Health Analytics, after serving for two years as executive director of the Massachusetts Medicaid Policy Institute (MMPI) and as interim president of the Blue Cross Blue Shield of Massachusetts Foundation for part of last year.

Implementing health care reform will be an "enormous burden" on the individual states, Wallack says, especially given the current economic climate. "Now, with the recession and budget cuts, stepping up to the plate will be very challenging."

Under the legislation, states are charged with administering new insurance rules and expanding Medicaid coverage. States have the authority to establish health insurance exchanges, which function as clearinghouses for consumers to purchase insurance.

New resources are available to help states take on a wide variety of pilot and demonstration projects related to health care payment and delivery-system reform. According to Wallack, "The law provides badly needed resources to states, but states have to develop strong proposals for how to spend the money. Right now they are all scrambling to identify the opportunities and position themselves to respond."

Still, Wallack believes that, despite these challenges, the new law is both workable and affordable with the support of the federal government. As one example, she cites a new Medicaid provision that mandates the federal government's payment of 100 percent of the costs of covering newly eligible individuals through 2016.

"In the end, it is the federal government that has the ability to redistribute income on a large scale and create robust social insurance," she says.

Through her work at MMPI and the Blue Cross Foundation, Wallack was actively engaged in the Massachusetts health care reform initiative enacted in 2006. The law mandates that nearly every resident obtain a minimum level of health care insurance coverage and provides free insurance to residents earning less than 150 percent of the federal poverty level (FPL). It also partially subsidizes insurance costs for those earning up to 300 percent of the FPL.

Wallack calls the Massachusetts law a success and a model for other states to follow. The key, she says, has been the spirit of cooperation among government officials, business leaders and provider communities. "Of course, there are some shortfalls in the budget, but this is the worst economy in decades, and almost all states are having shortfalls without health care reform," she says. "Some elements of the Massachusetts plan have been easier than others to implement, but it is not true that health care is bankrupting the state."

Wallack's foray into health care began in the late 1980s, when she accepted a staff position to head the Vermont legislature's Committee on Health and Welfare. She later worked for a government-relations and strategic-communications firm in Montpelier, Vt., Kimbell Sherman Ellis, before being tapped by then governor Howard Dean to be his policy director and deputy chief of staff.

"It was then--when I was exclusively working on health policy--that I realized I had health care in my DNA," Wallack says.

Wallack served Dean for one term, moved for a brief time to Oregon, and then returned to Vermont to lead the state's Program for Quality in Health Care, a quasigovernmental agency that specializes in quality measurement and improvement at the state level.

Wishing to burnish her academic credentials, Wallack next enrolled in Heller's Ph.D. program in social policy--choosing it over Harvard's Kennedy School at the urging of renowned health economist Bruce Spitz. Her doctoral dissertation focused on Medicaid.

Looking ahead, Wallack says one of the country's greatest challenges will be covering the costs of long-term health care, an issue only marginally addressed by the recent law. In the meantime, a provision introduced by the late Sen. Edward Kennedy softens the financial blow by creating savings plans for long-term care insurance.

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