New research from the UCLA WORLD Policy Analysis Center shows that the United States is falling behind its global peers when it comes to guarantees for key constitutional rights. “The new decade begins with clear constitutional gaps that place the United States in a global minority” for failing to guarantee rights to healthcare and gender equality, said Jody Heymann, founder of the nonprofit policy research center. “Globally, the U.S. now lags 165 other nations with stronger constitutional protections for women. And the U.S. is absent from the 142 countries globally … that provide some degree of constitutional protection for the right to health,” said Heymann, a distinguished professor of public policy, medicine, and health policy and management at UCLA. Worldwide, the center’s researchers found a considerable expansion of protections over the past 50 years but noted that millions are still left without human rights guarantees, leaving them vulnerable to discrimination. Groups experiencing the greatest gaps in rights guarantees include migrants, people with disabilities and the LGBTQ community. To produce the report, researchers analyzed the constitutions of all 193 United Nations member states. “Constitutions help shape social norms and send clear messages about who matters and what nations value,” Heymann said. The report is now available as an online resource featuring policy briefs, maps and downloadable data as well as the book “Advancing Equality,” available for download at UC Press. The book’s authors, Heymann, Amy Raub and Aleta Sprague, also wrote an op-ed for CNN arguing that it’s time for the United States to guarantee gender equality by enshrining the Equal Rights Amendment to the Constitution.
The New York Times spoke to Public Policy Professor Mark Peterson for a story about House Democrats’ focus on rising prescription drug costs in their reelection campaigns. Democrats, particularly those in districts that flipped from red to blue in the 2018 midterm elections, are betting heavily that they have solidified an image as protectors of affordable health care, the story noted. “The Republican efforts at ‘repeal and replace’ ironically highlighted the protections in the [Affordable Care Act] that would be lost and generated more public support for the law than at any time since its passage,” Peterson said. “Now more attention has turned to the other live issue that remains, that has largely always been present and that the A.C.A. has done little to forestall, and in some cases is perceived to have made even worse: out-of-pocket healthcare costs for individuals and families.”
Public Policy Professor Mark Peterson spoke to Elite Daily about the potential repercussions of eliminating private health insurance, a point of debate among those vying for the Democratic presidential nomination. The candidates disagree on whether to allow private insurers to coexist, and compete, with a government-run insurance system. Peterson noted that most other countries with state-run health-care systems allow private insurers to fill gaps in coverage or, for those willing to pay, receive speedier care. He added that eliminating private health insurance could cost millions of jobs. “Whether you think the private insurance industry and health care realm is evil or good, there are a lot of people employed,” he said. Peterson also noted that many Americans prefer that their health care needs be met through the private sector. “For a lot of people in the United States there is a deep skepticism of government,” he said.
Joel Kotzin of the World Health Organization, second from right, addresses those gathered to explore universal health care in California. Photo courtesy of the UCLA Center for Health Policy Research
UCLA hosted experts in health care and policy at the E. Richard Brown Symposium on universal health care in California. Faculty with joint appointments at UCLA Luskin contributed to the symposium through workshops and presentations. The March 1-2, 2019, event honored the legacy of E. Richard Brown, a UCLA professor and public health leader who advocated for health care reform. The UCLA Center for Health Policy Research, founded by Brown in 1994, celebrated its 25th anniversary with the symposium. The first day of the conference, which can be accessed via webcast, took place in Sacramento and focused on planning, policy and political perspectives. UCLA professor of health policy and management Gerald Kominski gave a presentation on the contributions to coverage policies made by the Center for Health Policy Research. UCLA hosted the second day of the conference, including a workshop on the successful implementation of universal health care systems in Taiwan, Canada and other middle-income countries. UCLA professor of health policy and management Thomas Rice spoke about realizing Brown’s wish for universal health care. The symposium also featured UCLA professor of public policy Mark Peterson and professor of health policy and management and public policy Jack Needleman. Joseph Kutzin of the World Health Organization summarized the importance of universal health care: “Everyone should be able to have access to good-quality health services, without fear of the financial consequences for themselves, their families, their businesses and their jobs.”
From left, AltaMed's Berenice Núñez Constant, vice president, government relations, and Sonja Diaz, executive director of LPPI. Photos by Gabriela Solis
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.”
“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.
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.
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.”
UCLA Luskin Public Policy Professor Mark A. Peterson engaged with citizens on the other side of the country during a forum on health care policy this summer. Peterson spoke at the inaugural “Egghead Evening,” organized by the Lincoln County Democratic Committee in Maine. The open sessions encourage discussion about policy-related or historical topics. Peterson, an expert on Medicare reform, HIV/AIDS policy and other national health care issues, spoke about “The Winding Road to Universal Health Care in America.” A video of the evening’s exchange can be found here.
A research article published in the Journal of Health Politics, Policy and Law by Mark A. Peterson, professor of public policy, political science and law, compares the “political vulnerability and resiliency” of the Affordable Care Act (ACA) with the repeal of the Medicare Catastrophic Coverage Act (MCAA) nearly three decades before. “The political-institutional contexts and the processes of coalition change could hardly have been more different for MCCA and ACA,” notes Peterson in his article, “Reversing Course on Obamacare: Why Not Another Medicare Catastrophic?” in the Duke University Press publication. “However, they had some shared vulnerabilities stemming from program design,” he argues. “The ACA survived the political weakness inherent in its policy attributes due to its particular balance and timing of benefits and costs and by being shielded long enough by election results and the constitutional separation of powers to have its benefits take root.” — Stan Paul
Thanks to a partnership between UCLA Luskin Social Welfare and the David Geffen School of Medicine at UCLA, medical students at UCLA are again learning from social workers about the issues they face in medical workplaces. The project, now entering its second year, was initially put together by former Social Welfare chair Todd Franke; Gerry Laviña MSW ’88, director of field education; and Michelle Talley MSW ’98, a member of UCLA Luskin’s field education faculty and a licensed clinical social worker (LCSW). Read more about the effort.
An analysis of the potential impact of a proposed amendment to the American Health Care Act of 2017, known as the Graham-Cassidy plan, found that the now-abandoned proposal could have triggered the near-term collapse of California’s individual health insurance market. The analysis, developed by John Bertko, chief actuary for Covered California, and UCLA Luskin’s Wes Yin modeled two scenarios that examined how California leaders might respond to a federal funding cut of nearly $139 billion between 2020 and 2027. In both cases, the consequences of the cuts would start taking effect in 2020 and quickly lead to millions losing their coverage. In one scenario, California’s individual market could experience what is commonly referred to as a death spiral, according to a news release issued Sept. 25, 2017, by Covered California. “The decline in the number of those receiving financial help to buy individual market coverage, while requiring health plans to provide coverage to those with pre-existing conditions, would very likely lead to the collapse of the individual market by 2021 if not before,” said Yin, an economist and coauthor of the analysis who is also an associate professor of public policy and management at UCLA Luskin.