Hayley Sayrs is a Master of Public Health student studying public policy at the Keck School of Medicine of USC. She spoke with Larissa Puro in the Department of Preventive Medicine.
Students at the Keck School of Medicine of USC do more than learn to be physicians: A group of them got a taste of government policymaking after meeting with state legislators in Sacramento on June 6 and 7.
To give students firsthand experience in working with policymakers, Professor of Clinical Preventive Medicine Michael Cousineau, DPH, regularly takes students on a trip to the capital as part of his Public Health Policy and Politics class, not just to meet state lawmakers but to seriously discuss health care policy concerns with them.
Cousineau’s most recent trip brought 10 policy students — eight MD/MPH students, one social work student and a PhD candidate — to the Capitol for one-on-one meetings with their individual elected representatives.
“Most of our work has been on access to care — financial needs, insurance coverage, Obamacare,” Cousineau said. “Increasingly, you have people with insurance cards, but they don’t know how to get access or make appointments.”
Focusing on vulnerable groups in L.A. County
Most of Cousineau’s work has been in Los Angeles County, including issues involving vulnerable groups such as immigrants and the homeless.
“Beyond issues of access — how to get people coverage financially — and assurance — making sure people actually get the coverage — a lot of these issues are driven by state policy and increasingly by federal policy,” Cousineau said, adding that federal changes to the Affordable Care Act have caused state policymakers to scramble to find ways to continue coverage for Californians.
Before the trip, students are assigned to first make an appointment with their own regional representatives — ideally, one Democrat and one Republican. Cousineau said that, contrary to what one might expect, it’s more effective for USC students to not identify themselves as such.
“You say, ‘I’m a constituent,’ and remember that they work for us,” he said.
Cousineau estimates that about two-thirds of his students succeed in getting one-on-one face time scheduled in Sacramento. For the rest, Cousineau intercedes with assistance from the USC staff in state government affairs at the Capitol. He also schedules a group meeting with a senior legislator involved in health care policy.
“I take them through the steps: This is how you make an appointment, this is how you go into the legislature, and what you say — and what you don’t say,” he said. “These are lifetime skills.”
Ahead of their meetings, Cousineau counsels students with the acronym PPO: prepared, professional and on time.
USC medical students meet lawmakers, discuss single-payer proposal
With support from the Keck School, this summer’s participants flew to Sacramento for two days and met as a group with Democratic Assemblyman Jim Wood, co-chair of the special committee formed in the wake of last year’s failure in the Legislature to enact a single-payer health plan. Cousineau said students focused on the state’s response to the lack of federal support for the Affordable Care Act, specifically: If we’re not going to do a single-payer plan, under which the state would handle all health care funding and payments centrally, what are we going to do?
Wood took the students seriously enough to extend his planned 20-minute meeting to an hour and ask them to send their final course project, Cousineau said. Other legislators found themselves drawn into earnest discussions with students about health care policy.
“They take us seriously,” Cousineau said, “because these aren’t just students. They’re medical professionals who have clinical training and research skills with real patients and projects. It’s good to have all the data, but the personal anecdotes are often what gets policy makers’ attention.”
In return, Cousineau said he hopes that personally meeting legislators with practicing medical backgrounds — Wood is a dentist — will inspire some of the students to run for office themselves.
“We met with [state Sen.] Richard Pan,” he said. “Here’s this guy who was a practicing pediatrician for 15 years and decided to run for office. One of the students came away saying, ‘I could do this. I could run for office.’ I can’t teach that.”
— by Paul Boutin
Photo courtesy / Michael Cousineau
The percentage of adults and children without health insurance declined dramatically in Los Angeles between 2011 and 2015, according to a new report from the LA County Department of Public Health, compiled with assistance from USC.
The sharp decline—from 28.5 to 11.7 percent—spanned racial, ethnic, age, gender and geographic groups of adults 18 to 64 years old throughout the county. The news was even better for children: The percentage of uninsured dropped to 3.4 in 2015—a clear improvement from 10.1 percent in 2002.
Good news—for now
The county findings are consistent with trends reported in California and nationally. The report notes private insurance coverage declined between 2007 and 2011, and attributes the lack of further decline between 2011 and 2015 to the expansion of Covered California—the state’s health care marketplace—and the improving economy.
The Patient Protection and Affordable Care Act—also known as Obamacare—was signed into law in 2010, and fully took hold in 2014. In addition to providing more private insurance options, the bill expanded Medicaid, the nation’s free low-income health program, to cover millions more Californians than were previously eligible. Today, those individuals may lose parts of their coverage, or get dumped from their insurers, should the ACA get repealed or replaced.
“This report shows that we should be working to extend the benefits of the ACA, not to repeal it,” said Mitchell Katz, director of Los Angeles County Health Agency, in a press release.
Michael Cousineau, USC professor of clinical preventive medicine and a contributor to the report, agreed. “It’s not perfect, but the ACA has gotten us closer to a more equitable health care system,” he said. “Research shows that, even in Los Angeles, more people are receiving life-saving medical treatment, hospitals are facing lower uncompensated care costs and health care spending projections continue to fall.”
The statistics spell good news for LA County, according to Barbara Ferrer, director of the LA County Department of Public Health. “We know that having health insurance coverage is an essential step in ensuring people get the medical care they need, including access to preventive services,” she said in a press release.
While the positive news means more LA residents have access to affordable health care, glaring disparities persist among the uninsured.
Among Latinos, the percent of uninsured adults was nearly three times higher than African American, Asian or white uninsured adults.
In addition, the uninsured adults percentage in the “South Service Area,” which includes Athens, Compton, Crenshaw, Florence, Hyde Park, Lynwood, Paramount and Watts, was more than triple that in the “West Service Area” of Beverly Hills, Brentwood, Culver City, Malibu, Pacific Palisades, Playa del Rey, Santa Monica and Venice.
Numerous USC public health programs in the Department of Preventive Medicine are working to eliminate health disparities at the local, state, national and global levels, including the USC Institute for Global Health, USC Environmental Health Centers, Immigrant Health Initiative, Centers for Health Equity in the Americas, Institute for Health Promotion & Disease Prevention Research and the Program on Global Health & Human Rights.
In the classroom, Cousineau is teaching his Master of Public Health students about the ACA debate—and even took 18 to Sacramento in February to meet with legislators and attend a health reform conference.
“In order for us to continue our work to minimize health disparities and inequity, policymakers need to protect the gains we’ve already made,” Cousineau said.
Photo: A representative from L.A. Care Health Plan, a public agency that provides health coverage to low-income Los Angeles County residents, speaks to USC students and alumni Mar. 24 at a career fair hosted by the Department of Preventive Medicine.
— by Larissa Puro
Michael Cousineau is the director of the USC Master of Public Health program’s Health Services and Policy Track. Interested in learning more about health services and health policy education at USC? Learn more about our MPH programs »
As part of the USC Center for Health Journalism’s “Remaking Health Care” blog series, Michael Cousineau, professor of clinical preventive medicine, explains how Medicaid has assisted Los Angeles County’s efforts to house the homeless.
The Affordable Care Act’s expansion of the low-income health care program “was a game-changer for homeless adults and their doctors,” Cousineau writes, noting that before the ACA, barriers to health care especially impacted the homeless. “In a recent study, clinics that provide health care for the homeless in Los Angeles now report that 80 percent of their homeless patients are covered by Medi-Cal.”
Cousineau argues that repealing the ACA’s Medicaid expansion “would threaten much of the progress we’ve made on homeless health.”