Interview with Beatriz de la Rocha

Hedrick Smith: We’re talking to Beatriz de la Rocha. What is your title?

Beatriz de la Rocha: I am the child coordinator for Los Angeles Unified School District.

Hedrick Smith: Tell me, what we’re seeing today is this a typical scene? Are you doing this a lot?

Beatriz de la Rocha: What you’re seeing today is an enrollment event that we’re having at an elementary school, and we are trying to do this pretty often. We’re finding that parents feel comfortable coming to schools and this is the place to reach them. So together with our partners, either community based organizations or community hospitals, we’re able to bring parents information about health care and help them enroll here at a school site.

Hedrick Smith: Now my understanding is that you enroll children and families in a lot of different programs. Our particular interest is in the Children’s Health Insurance Program as its known nationally. Healthy Families is how it’s known here in California. So tell me how is Healthy Families doing in terms of the growing people? Is it doing well?

Beatriz de la Rocha: I think Healthy Families is doing very well. A lot of parents feel good being able to pay for something, to contribute for a program. And Healthy Families is something new and something exciting for families and it doesn’t have the stigma that MediCal has had in the past for a lot of families.

Hedrick Smith: Have there been difficulties? Has it been a sort of either a stigma or somehow connected with welfare or this is another government program where people are weary of coming out, as in the past?

Beatriz de la Rocha: I think there is some of that. I think MediCal has had a stigma. In a lot of the cultures it’s looked at as government assistance rich people don’t want and so Healthy Families presents parents an option to be able to have health care insurance yet contribute into an insurance program. I think some of, some of the difficulty comes in with parents having to learn about prevention or paying into a health insurance program while you’re healthy, knowing that you’re paying a premium every month to able to have a health care insurance that’s going to help your children. So that’s something new for a lot of parents, especially in countries where health care is free.

Hedrick Smith: I thought that some people say there was resistance at least in the early period for Healthy Families because it was associated with other government programs. Is that true?

Beatriz de la Rocha: I think it is true. I think there’s been a lot of changing in clarifying Healthy Families as separate from MediCal and making that distinction to help be able to promote the Healthy Families program.

Hedrick Smith: MediCal is a term for California nobody else in the country knows. You mean California Medicaid, right?

Beatriz de la Rocha: Yes.

Hedrick Smith: So there was confusion among Californians between California Medicaid and Healthy Families, is that right?

Beatriz de la Rocha: Somewhat because they’re both seen as government programs, although Healthy Families has had a different type of publicity around it. I don’t know how to explain it, but the publicity has been, well there’s been more of a campaign to promote Healthy Families as a new type of insurance program separate from MediCal. And since it’s new it doesn’t have the stigma that MediCal has had. And just the word for us, MediCal, many people associate it with welfare. And though it isn’t welfare, it is an assistance, it’s a medical program. But people still don’t make the distinction between MediCal as being health care versus welfare in government financial assistance.

Hedrick Smith: People have told us that there are a number of changes that are taking place, that now Healthy Families is being marketed in a different way -- in the schools instead of on television, different length forum, different procedures. Can you give us a before and after? What was the way that Healthy Families started and how is it proceeding now?

Beatriz de la Rocha: Well, Healthy Families started as a really long application, I think it was twenty-something pages at one time. So it was just really complicated for, for any person to fill it out we were finding that even people with college degrees had a difficult time filling out these applications. So that’s been simplified; that’s now down to four pages which has made a big difference. That and then changing the income guidelines in terms of the qualifications for people. I think that was one of the biggest issues — the length of the application and simplifying it, deleting questions that really didn’t make sense, that most families didn’t know weren’t’ really necessary to obtain health care insurance.

Hedrick Smith: What about the whole approach? Was there a good way of approaching the families and was it tried at first or not? Initially they tried to sell it through, uh, advertising on the television. How’d that work?

Beatriz de la Rocha: I don’t know that it was very effective because people still were leery, didn’t have enough information about it. I think what’s been most effective is parents telling other parents. What we have found has been more productive is to be able to hire parents who communities trust to be able to spread the word. And parents are the best people, especially parents who have been enrolled themselves in Healthy Families or other health care programs and believe in the program and the positive impact that it has on that family, the advantages to having health care, insurance. They’re able to tell other parents and recruit that way through word of mouth.

Hedrick Smith: A lot of the families in this school district, I understand, are Latino. How is the Latino community at organizing this kind of an effort? Is it a strong community?

Beatriz de la Rocha: It is a strong community. And again it’s something new to families because in many Latin countries there is no such thing as health care insurance; they can obtain health care fairly reasonable or free, no cost. So they now have to learn about a health care program where you pay into it and then you have all these benefits of, of hospital care, et cetera. It has impacted the immigrant population in terms of being careful that this is going to penalize them when they’re applying for residency or legal status. So that’s been a large barrier in terms of enrolling families. They believe in utilizing health care and many of them use home remedies or some of the herbal stores for remedies which have also been effective.

Hedrick Smith: Why does the school system care so much about getting the health care out there?

Beatriz de la Rocha: For the school system it’s important that kids be healthy because if a child’s healthy they are going to come to school ready to learn. They’re going to be able to take advantage of the educational program. Many kids come to school with toothaches, with health problems or even just not having breakfast in the morning. A lot of our children are on or reduced breakfast or lunch programs. And that’s extremely important to us because if we want to teach children, which is our business, you have to be able to learn, you have to come ready to learn and not be preoccupied with pain or discomfort. And also because we believe in prevention; we always have in terms of having school nurses available and providing immunizations and we have school-based health clinics. The prevention is important because it helps illnesses before they become serious conditions.

Hedrick Smith: Do you have kids with a lot of serious illnesses or are we basically talking about touching just minor things?

Beatriz de la Rocha: We have both. We have some children who have very serious illnesses. We’ve seen some very serious cases. A lot of our children have serious dental problems; that’s one of our major problems that we have. When kids have vision screenings at the schools, we find a lot of children need glasses, can’t see the blackboard. So, if you can’t see the blackboard, you’re not going to be able to take in the lesson very well.

Hedrick Smith: So the connection between health and academic performance is crucial?

Beatriz de la Rocha: Oh, yes, it really is. There’s a strong link between a healthy child and a child that’s ready and able to learn.

Hedrick Smith: Let me just pursue this idea where you’re talking about people understanding and it’s a new concept that you buy health insurance. Is this something that’s appealing to Latinos? Or is it not? Is it something where it feels better not to be on the go and contributing yourself or is it a surprise that the government isn’t providing it? How does the Latino community react to that?

Beatriz de la Rocha: Well I think there’s been a real positive reaction to contribute to a health insurance program because Latinos do not want to utilize any government program. They want to work or contribute to [having] a benefit they’re receiving. So in that sense it’s been very positive because there’s a lot of families that qualify for these health care programs but they view them as government assistance and so they don’t want to enroll in them.

Hedrick Smith: Who are we talking about here? Who are the people we are talking about, we’re not talking about MediCal and Medicaid, we’re not talking about people in poverty? I think to many people around the country, we’re talking about welfare payments. Are we talking about welfare people or are we talking about working parents?

Beatriz de la Rocha: We’re talking about working parents. A large percentage of our parents work but they can’t afford to insure their children or their spouses — the only health coverage [is available] through the employer and it is very costly to be able to add the family to that plan.

Hedrick Smith: So these are folks who are working hard and having trouble making ends meet?

Beatriz de la Rocha: Exactly. They’re called the working poor. The majority of our families are working, but they can’t afford health care insurance.

Hedrick Smith: What kind of jobs are you talking about here? These are people working in what kind of factories doing what kinds of things?

Beatriz de la Rocha: I think mainly your blue-collar workers. They’re factory workers, restaurant help, those type of jobs.

Hedrick Smith: What does it take to sign people up?

Beatriz de la Rocha: It’s difficult to sign people up. It takes a lot of personal contact, a lot of phone calling. If you have a personal relationship, that’s real important. If they know you from school or they trust you, they’ll come. But for the most part many families have so many other priorities that sometimes health care isn’t a priority until an emergency comes up. It takes a lot of staff time; it takes staffing to be able to call them to follow up. It takes at least seven contacts if a family actually comes to enroll.

Hedrick Smith: It’s not automatically done is it?

Beatriz de la Rocha: Right. And then you have to screen them if you don’t screen them before they come to see which program they’re eligible for. And some families may have two or three programs, or each child will be in a different program. So you can have one family with four different health care programs, which is also very frustrating.

Hedrick Smith: So maybe it takes ten contacts, not only to get them to come but to get them in?

Beatriz de la Rocha: We’re not even talking about keeping them. You know one thing is to enroll them and the other goal that we’re working on is actually keeping them enrolled and teaching them how to utilize the health care instruments.

Hedrick Smith: And then they have to reenroll?

Beatriz de la Rocha: No, but they have to learn how to use that, you know, not wait for an emergency but take your child for preventive care or select their doctor and all that they have to learn about it.

Hedrick Smith: How often do you do this?

Beatriz de la Rocha: About once a month.

Hedrick Smith: You talk about going for different areas. I mean you got seven hundred schools or something like that in your district. That’ll take you seven hundred months to get through your district?

Beatriz de la Rocha: Right, we were divided into twenty-seven areas. We would do an area at a time. But we’ve been focussing our energy on areas that have the highest percentage of kids that qualify for MediCal and Healthy Families.

Hedrick Smith: Where is that, mostly east of LA?

Beatriz de la Rocha: East LA, South Central, and San Fernando Valley are the areas of highest need.

Hedrick Smith: How many children do you have already enrolled in Healthy Families and how many more you need to enroll?

Beatriz de la Rocha: Los Angeles County has enrolled eighty-three thousand students, children already as of, uh, last month. And we still have two hundred thousand more that are eligible.

Hedrick Smith: So again about one out of four?

Beatriz de la Rocha: Yes, we’re about one out of four.

Hedrick Smith: Why not more? Why after two or three years only one out of four? Is it because it’s too complicated? Or is it fear? Or what?

Beatriz de la Rocha: There’s a lot of reasons. There’s too many programs, they’re fragmented programs. There’s families that have to fill out paperwork and then in a year we fill out re-certification papers. We haven’t simplified it enough to make it easy for families to just be able to enroll and stay enrolled.

Hedrick Smith: Why not? Is it designed by people who didn’t understand? Is there a cultural gap? You would think that would be something people would figure out.

Beatriz de la Rocha: Well I think it’s costly. It’s costly to think about universal care or having one health care program that’s for everyone. Right now we have this program that only covers this age group and this income and if you’re over that income, you fall into this program. And so we have about five programs like that.

Hedrick Smith: So to a certain extent it’s political decisions that are making fragmented health care available rather than one unified program? Is that it?

Beatriz de la Rocha: Yes, I think it is political.

Hedrick Smith: What do you like most about this program? And what frustrates you the most? What do you like most?

Beatriz de la Rocha: I like being able to give parents health care insurance and being able to let parents know that there’s programs available to them that they’re entitled to, that they’re not taking advantage of, that are going to help their children, themselves, their family, their community, the world. And if they’re healthy, we all stay healthier.

Hedrick Smith: And what frustrates you the most about the program?

Beatriz de la Rocha: What frustrates me the most is that the programs are still too complicated. Too many requisitions and are asked of parents which also turn them off. They feel some invasion of their privacy. You know if we have private health insurance, we’re not asked a lot of the questions that parents are asked when they’re applying for MediCal or Healthy Families.

Hedrick Smith: So [it can be] very humiliating?

Beatriz de la Rocha: Yes, yes I think it can be. We ask way too many questions, private questions, personal questions and many people are leery, are leery and distrustful of programs that the government is sponsoring.