Podcast Interview Transcript
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In each volume of Progress in Community Health Partnerships: Research, Education, and Action, the PCHP editors select one article for our Beyond the Manuscript podcast interview with the authors. Beyond the Manuscript provides authors with the opportunity to tell listeners what they would want to know about the project beyond what went into the final manuscript. Beyond the Manuscript podcasts are available for download on the journal's web site (www.press.jhu.edu/journals/pchp). This issue's Beyond the Manuscript podcast was conducted by Associate Editor Eva Moore and features Michael Cousineau, the lead author of "Using an Alliance of Independent Health Consumer Assistance Centers to Change Public Policy in California." The following is an edited transcript of the Beyond the Manuscript podcast.
The manuscript describes successful examples of accomplishments on policy and issues that were brought in response to budget cuts. Budget cuts are a reality in many jurisdictions now. Can you tell us more about how the partnership addressed the costs of the proposed changes that they advocated?
In part, they addressed them by helping to identify additional revenue sources to offset some of the costs that were associated with new programs, new expansions, new policies, or, in some cases, trying to prevent cuts. Some of those were difficult arguments to make. For example, they went to the federal government and insisted that the state would lose money if they went ahead with these cuts—in terms of leverage funding. Losing federal dollars that perhaps were matching state grants, so trying to argue that when the state was going to lose—would cut grants, say for the CHIP program at Healthy Families, that in fact would result in a reduction in federal funds to the state. So, they helped to clarify and showed how a state reduction would impact federal funding. That was probably the most persuasive part of their argument.
They also launched legal arguments to try to prevent these cuts knowing that that did not actually have a revenue attached to it, but by suggesting new revenue sources such as oil recovery taxes and increased car taxes, for example, that could help the state to identify some new revenue sources to offset these cuts. It did not always work, but at least they tried to make their argument and make the effort to identify these new sources of funding for these programs.
In the end, did the government and insurance companies feel that they were benefiting from the changes as well? [End Page 341]
The state less so. Parts of the state, particularly the state bureaucracy that oversaw the Medi-Cal program—it is California's version of Medicaid—did see the benefit of it. Certainly the people who administer the CHIP program, the Children's Health Insurance Program—we call it Healthy Families in California—recognized and became an ally in many of the efforts by the Consumer Health Alliance to try to stop these cuts. They recognized the difficulty that the families were going to have if they were going to lose coverage.
The other ally that understood it well were local government. And I am glad you brought up other jurisdictions, because the counties, which are the focal points for indigent health care in California, recognized early on that the state reductions in health programs had an impact on them because, if children no longer had health insurance and get sick, they go to the hospital emergency rooms. So, too, did some private hospitals that see these patients as uncompensated care. Local governments as well as private entities really saw expanded coverage as a benefit.
This was an amazing example of a medicolegal partnership and really required a buy-in from both the medical facilities, as well as legal advocacy. Can you speak a little bit more in general about medicolegal partnerships and any recommendations you would have to other groups who might want to develop a partnership between medical facilities and legal advocacy groups?
The Health Consumer Alliance is not a strict medicolegal partnership in the sense that we have...
