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"The Center for Health Policy Research continues to play an important role in crossing the bridge from knowledge and research to meaningful and impactful health policy and systems change."
- Dr. Robert K. Ross, President and CEO, The California Endowment
AMID THE VOLUMINOUS COVERAGE OF EFFORTS to repeal and replace the Patient Protection and Affordable Care Act (ACA) in the ﬁrst half of 2017, the demand for data and analysis on issues related to the ACA, the alternatives under consideration and the health implications of it all reached a fever pitch. For many media outlets, that meant turning to the FSPH-based UCLA Center for Health Policy Research.
In the eight-plus months between November19, 2016, and the end of July 2017, the center was referenced by news outlets more than 1,300 times, with the vast majority of the mentions related to ACA repeal-and-replace efforts. “On average, I was spending up to two hours a day talking with media,” says Dr. Gerald F. Kominski, FSPH professor in the Department of Health Policy and Management and the center’s director. But Kominski isn’t complaining. “I see it as an extension of our role as educators,” he says. “Helping to illuminate these issues is an essential function and helps to make our work more inﬂuential.”
Even at times when healthcare reform isn’t at the top of the news, the demand for information and insights from Kominski and other UCLA Center for Health Policy Research experts is consistently high, and not only from members of the news media. Health officials, legislators and public health advocacy groups are among those who regularly rely on the center for everything from decisions on resource allocation to making the evidence-based case for new policies that improve access to care or take aim at health disparities.
“The Center for Health Policy Research continues to play an important role in crossing the bridge from knowledge and research to meaningful and impactful health policy and systems change — and by impactful, I mean beneﬁcial to real lives in real communities,” says Dr. Robert K. Ross, president and CEO of The California Endowment, a private, statewide health foundation dedicated to improving access to affordable, quality health care for underserved populations.
The center was founded at the Fielding School in 1994 on the premise that without reliable and detailed data on the health status and concerns of speciﬁc communities — particularly in California, where the center’s work is primarily focused — their needs were less likely to be addressed. “We had national surveys with state-level estimates of the rates of conditions such as obesity, asthma and diabetes, but what was missing was a level of detail that could help local health officials understand what was going on with their populations,” Kominski says. By introducing the widely cited California Health Interview Survey (CHIS), the center has contributed to an understanding of the health status of Californians at a much more reﬁned level — not only by county and in some cases ZIP code, but also broken down by race/ethnicity, sexual orientation and gender identity, social class, disability and other characteristics.
The center’s founder, the late Dr. E. Richard “Rick” Brown, was a pioneering leader in quantifying and describing the impact of lacking health insurance and in promoting policies that would increase the accessibility and affordability of health care. From the start, the center’s work included a strong focus on understanding who lacked access in California and how those deﬁciencies could be addressed. That focus continues to drive much of the center’s work, with implications throughout California and well beyond. In the debate leading up to the ACA’s passage, the state’s congressional delegation relied heavily on the center’s estimates of the number of Californians who would be eligible for health insurance exchange subsidies and expanded Medicaid under the proposed legislation. A 2010 study estimating that 8.2 million Californians were uninsured — nearly one-fourth of the state’s population — sparked widespread coverage that helped propel passage of the law.
As the ACA was being implemented, the center played an important role in the state through its California Simulation of Insurance Markets (CalSIM) program, a microsimulation model to estimate eligibility and enrollment under the new law. At a time of great uncertainty about the volume of people who would enroll, CalSIM provided what proved to be accurate projections that assisted Covered California, the state’s health insurance exchange, in properly preparing during the ﬁrst three enrollment seasons. More recently, CalSIM has provided data on who and where the remaining uninsured Californians are, and how many of them are potentially eligible for Medicaid and Covered California beneﬁts. “
“Since our early days planning for Covered California’s launch, the work of the CalSIM team has provided a valuable yardstick for us to measure our performance in increasing the number of insured Californians,” says Peter V. Lee, Covered California’s executive director. “It has been an invaluable partnership.”
The center’s inﬂuence has been widely felt in California policy circles. In 2008, a group of center researchers headed by Dr. Steven P. Wallace, FSPH professor of community health sciences and associate director of the center, was asked to calculate the true cost of living for California seniors as part of a larger national movement to replace outdated federal poverty guidelines. The resulting California Elder Economic Security Standard Index — which calculates costs by county, taking into account what elders need for rent, food, transportation, health care and other basic items — contributed to the passage of the Elder Economic Planning Act of 2011, which requires the state’s Area Agencies on Aging to use the Elder Index in their strategic planning calculations of the true cost of living for low-income seniors.
“The UCLA Center for Health Policy Research enabled policymakers to understand just how hard it is for seniors to make ends meet in California,” says State Senator Jim Beall, who authored the legislation. “It’s one thing to say it and another thing to show it, and the center’s data showed beyond a shadow of a doubt that seniors were struggling to survive, especially in high-cost areas. It is important to have the latest accurate data from a credible source that is presented in a clear and easy way to comprehend. The center makes that happen.”
The center’s position as a critical data source is based to a considerable extent on its administration of CHIS, the nation’s largest population-based state health survey. The survey is valued for both its local-level breakdowns and its rich and representative racial and ethnic data. “CHIS captures the diversity of Californians across the state, and is a policy tool to direct resources to people and places where they are most needed,” says Dr. Ninez Ponce, FSPH professor of health policy and management and principal investigator of CHIS. “And because it’s conducted every year, it provides a surveillance infrastructure that not only points to where the needs are, but also shows the impact of policies and programs.”
To ensure that a wide range of audiences can access and easily understand the survey’s results, the center launched AskCHIS, a user-friendly online tool that gives anyone the ability to obtain CHIS data. More than 1.1 million queries have been made since AskCHIS debuted in 2003. In 2014, the center launched AskCHIS Neighborhood Edition in response to local health officials and others who sought estimates by ZIP code and city.
This ability to present health information in accessible ways and to assist various audiences in putting it to use is a distinguishing feature of the center. Researchers at the center regularly meet with legislative and community contacts and conduct quick-turnaround studies to help advance policy initiatives. The center’s Health DATA program has trained nearly 5,000 representatives from community-based organizations in how to ﬁnd, use and communicate health data. The policy briefs produced by the center, which provide data and analysis on complex issues using clear, concise language and graphics, help to bring important health issues to a broad audience.
The determination to reach key groups in ways that will generate progress in health policy is a legacy of Brown’s original vision for the center. “Rick was always asking what we could do to be even more responsive, to make the data even fresher,” says Ponce, who was recruited to the Fielding School and mentored by Brown. “He was a champion for reducing social inequities, and he knew that you couldn’t move policy without good population- based data.”
“As an academic-based research center, we’ve never been satisﬁed to do high-quality research that only ends up in the hands of other academics,” Kominski says. “Democratizing data is in our DNA. It’s what this center has done for the last 23 years, and it’s what we will be doing when we celebrate our 30th, 40th and 50th anniversaries.”