Briefing Seeks Solutions to Latino Doctor Shortfall UCLA Latino Policy and Politics Initiative’s gathering of medical professionals, policy analysts and advocates looks at underlying causes and why the impact is keenly felt in California

By Gabriela Solis

Although Latinos comprise the largest ethnic group in California, Latino doctors in the state are in short supply, according to recent research from the UCLA Latino Policy and Politics Initiative (LPPI).

On Jan. 15, 2019, the UCLA Luskin-based think tank co-hosted a discussion in Oakland that brought together doctors, medical practitioners, academics and advocates to discuss California’s Latino physician shortage.

“California has an alarmingly low rate of Latino doctors. There are 46 Latino doctors for every 100,000 Latino Californians,” said LPPI Executive Director Sonja Diaz, citing data derived from the U.S. Census Bureau’s 2015 American Community Survey. “In contrast, there are 405.7 non-Hispanic white physicians for every 100,000 non-Hispanic white Californians.”

Diaz led the discussion co-hosted by the Latino Coalition for a Healthy California (LCHC) and the Greenlining Institute, which is based in Oakland.

“We graduate about 110 Latino medical doctors every year. If we continue forward, it will take almost five centuries to close the gap,” noted Diaz. That data from the Association of American Medical Colleges is included in the LPPI report, “5 Centuries to Reach Parity: An Analysis of How Long It Will Take to Address California’s Latino Physician Shortage,” which was produced under the guidance of LPPI faculty expert David Hayes Bautista, a distinguished professor at the UCLA David Geffen School of Medicine.

Joining Diaz in debate and discussion were Jeffrey Reynoso, executive director, Latino Coalition for a Healthy California; Arturo Vargas Bustamante, associate professor of health policy and management at the UCLA Fielding School of Public Health and public policy at UCLA Luskin; Carmela Castellano-Garcia, president and chief executive officer, California Primary Care Association; Berenice Núñez Constant, vice president, government relations, AltaMed Health Services Corporation; and Carmen Estrada, MD candidate at the UC Davis School of Medicine.

The wide-reaching conversation focused on the shortage’s effects on California’s economy, the needs of medical providers and the shortcomings within higher education that contribute to the shortfall.

Medical student Carmen Estrada of UC Davis

Estrada spoke about her personal experience of being one of the limited number of Latinos currently pursuing a medical degree. Estrada’s first-hand experiences traced her personal journey to medical school from a California State University and the lack of outreach that she said created unnecessary challenges in her career choice.

Núñez Constant shared that although her organization, AltaMed, is constantly looking for Latino physicians, “The supply is just not there.” She also highlighted the difficulty of retaining a Latino physician in such a competitive job market.

Vargas Bustamante’s research supported Núñez Constant’s comments on workforce recruitment. Bustamante said he has found a substantial pipeline problem for Latinos in their transition from high school to college and their transition from college to medical school. Based on his interviews with Latino pre-med students, medical school applicants, Latino medical students and recently graduated Latino physicians, Vargas Bustamante said students who may have an interest in the field often feel discouraged by the lack of investment to recruit and retain Latino students. Many then choose another career.

The panel agreed that this complex issue requires a strategic collaboration of California policymakers, medical providers and academia to form solutions.

But, said California State Assemblyman Robert “Rob” Bonta, expressing his support, “I think we have some wonderful opportunities.” Bonta, a Democrat whose California District 18 includes Oakland, Alameda and San Leandro, serves on a number of legislative committees, including the Health Committee. “Your timing couldn’t be better in terms of uplifting and raising the issue. This is something I’d be proud to work on, and I think it needs to be worked on.”

To learn about California’s Latino physician shortage, visit latino.ucla.edu/health.

View additional photos on Flickr.

Latino Physician Briefing

UCLA Report Provides Strategies for Making Covered California More Affordable Public Policy's Wes Yin helps develop policy options to keep insurance costs down

By Mary Braswell

With California taking steps to revamp its health care system, research by the UCLA Luskin School of Public Affairs is guiding the conversation.

The report, published Feb. 1, details strategies to improve the affordability of Covered California, the state’s health insurance marketplace. It was co-authored by economist Wes Yin, associate professor of public policy at UCLA Luskin.

Affordability is “the top challenge for individuals who are insured as well as those who remain uninsured,” according to the report (PDF), which lays out a wide array of proposals to meet that challenge, including:

  • capping out-of-pocket premiums for all eligible Californians;
  • offering expanded cost-sharing benefits, which would lower deductibles and the cost of office visits; and
  • creating a California-only penalty for those who opt out of coverage, to replace the penalty that was phased out by the federal government.

“This will help push the conversation forward, now with policy options that we know will improve affordability and market stability,” said Yin, who wrote the report with economist Nicholas Tilipman of the University of Illinois, Chicago, and Covered California’s policy and research division.

Commissioned under a state law, the report was presented to the governor’s office and state Legislature. It was developed amid a shifting landscape for health care in California.

On Jan. 30, Covered California reported mixed figures for 2019 enrollment. Although the number of Californians held steady from 2018 to 2019, the number of new enrollees dropped by 23.7 percent. In addition, on the first day of his term, Gov. Gavin Newsom unveiled his own far-reaching health care plan, calling for increased premium subsidies and Medicaid coverage for undocumented youths up to age 26, among other reforms.

“Our analysis gives policymakers a sense for how different approaches benefit Californians and at what cost,” Yin said. “So this report bolsters the governor’s effort to improve health care access.”

The dialogue, he said, will include a debate over the state’s funding priorities.

“From a wider lens, it’s helpful to think about how we can best spend that next public dollar,” Yin said. “It could be health care, it could be pre-K programs, it could be public education or parental leave benefits. These are all important. And there is a strong argument for improving the affordability of health care coverage and reducing cost-sharing burdens. Coverage improves health — especially mental health — it improves chronic disease management and it drastically reduces the risk of catastrophic spending and debt incurred by consumers.”

The report includes proposals to address the divisive issue of penalties for Californians who choose not to buy health insurance. Covered California attributes the decline in new enrollments to removal of the federal individual mandate penalty beginning this year. A statewide penalty would create a fresh incentive to opt in.

“The penalty appears to be quite impactful,” Yin said. “What we’re seeing in Covered California the past year shows that, and our modeling also shows that. Zeroing out the penalty has directly caused premiums to increase and enrollment to drop. Including a penalty while making plans more affordable can be both an effective and fair way of expanding coverage and lowering premiums.”

The report also notes that premium costs can vary widely for consumers based on their age and geographic location. “For consumers nearing retirement age living in high-cost regions, premium costs can exceed 30 percent of income for the most common benefit package,” it said.

To make health insurance more affordable for those consumers, California could use subsidies to cap all premium payments at 15 percent of annual income. Currently, subsidies are offered only to people who earn up to 400 percent of the federal poverty level, or $103,000 for a family of four. Consumers who earn just over the 400 percent threshold would not qualify for federal premium subsidies, Yin said. A 15 percent cap would also eliminate this so-called tax-credit cliff.

The report’s policy options are based on a model developed by Yin and Tilipman that shows the potential effects that various policy proposals would have on health care enrollment, consumer health spending and public spending.

As elected officials and consumers debate competing visions of health care reform — from repealing the federal Affordable Care Act to moving to a state-run single-payer system — Yin said the proposals are aimed at expanding coverage and increasing affordability as much as possible.

“Let’s find ways to build on the successes of the Affordable Care Act and make it work better,” Yin said. “These are models for improvement.”