Shana Alex Lavarreda: Keeping Kids Covered
Shana Alex Lavarreda, M.P.P., is a Senior Research Associate at the UCLA Center for Health Policy Research and Project Manager of the State of Health Insurance in California Project. Shana has been researching public health issues for the past ten years and has focused on health insurance in California for seven years. Her work mainly focuses on health insurance for children, specifically the Medicaid and SCHIP programs. As the Project Manager for the SHARE project, Shana is performing programming, modeling, analytic, and writing work for this project that assesses whether 12-month continuous eligibility has benefited children enrolled in Medi-Cal.
We talked to Shana about California’s ethos, keeping kids covered, and crying senators.
Your study focuses on the Medicaid population in California, which has the largest number of uninsured children in the nation.
In 2005, we had over 700,000 uninsured children, which is a huge population compared to other states. We also have large numbers already enrolled in Medi-Cal and our Healthy Families program. The Healthy Families population alone was almost 800,000 children - greater than the population of several states. California is also a diverse state, in terms of racial/ethnic composition, income levels, and the urban-rural mix. Given its size and diversity, California ends up looking like a separate country.
Do you mean like a country that is governed by a separate set of rules from the rest of the states?
California has rules that are different than everywhere else in the country in terms of our budgetary process. Medi-Cal is administered through the counties, of which there are 55 in California. Each one has their own way of doing things. Our current political ethos is unique, too, we have a Republican/Independent kind of governor and a very Democratic legislature. We entertain health care reform proposals that are different than anywhere else. We’re still furiously talking about a single-payer system, but there are major political hurdles.
Do other states have trouble applying lessons learned in California?
Because the population is so large and we initiate so many reforms, we consider ourselves a bellwether for the rest of the country. If we can show that health reform works here, with our diverse and large population, we believe those lessons can be transferred to other states.
Specifically for your SHARE project, you’re asking whether 12-month continuous eligibility improves health care utilization outcomes. Is the premise that if enrollees do not need to reapply, there will be better continuity of coverage?
Yes. In January 2001, California implemented a presumption of continuous eligibility for a full year for children in the Medicaid program. We’re examining whether eliminating the semi-annual reapplication had an impact on utilization and health outcomes. We’d love to be able to say that a child with asthma who had 12-month continuous eligibility will be better managed so they have fewer emergency room visits and better health status overall.
This seems like a no-brainer.
The reality is that in California we are facing a 15 billion dollar deficit. Although Governor Schwarzenegger does care about children’s health insurance, getting rid of 12-month continuous eligibility will reduce the number of kids on Medi-Cal. It is a source of savings and even though nobody wants to do it, it is the fiscal reality we are living in. If this study demonstrates the benefits of continuous enrolment, then hopefully we will be able to keep it [12-month continuous eligibility was eliminated in this year’s budget].
Isn’t the idea of covering all kids a universal goal?
It used to be a subject that unified the parties. In 1997, there were bipartisan efforts to cover children nationally and from that, SCHIP was created, even though Republicans held the majority in Congress at the time. But last year the legislation to reauthorize SCHIP was vetoed by President Bush. The sponsors, Senators Hatch and Grassley held a press conference and questioned why the President vetoed the bill. They were almost in tears over SCHIP - it is really fascinating.
You seem particularly interested in the politics of reform. Do you have a public policy background?
Yes. I went to the School of Public Affairs at UCLA and did my Masters in Public Policy with a specialization in health. My interest has always been implementation and administration issues. Knowing how to create a policy is obviously very important, but I’m interested in how the policy actually translates into the real world. Do the policy measures actually get done? Do they actually make a difference?
Ignoring our fiscal and political realities, what reform would you enact?
A single-payer system that is privately administered. I’m not talking about a national health service here, but I do believe we need a nation-wide risk pool instead of our current system of multiple and separate and often-times very small pools. We need one 330,000,000 person pool instead of breaking everybody up into separate pools.