Congresswoman Lois Capps, U.S. Representative of California and founder of the House Nursing Caucus, discusses her commitment to quality health care for all.

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Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Margaret, summer just began last week but the heat makes it feel
like we are in the dog days of summer already. And speaking of heat the posters
are still taking everyone’s temperature around healthcare reform, I noticed that
Washington post blogger Ezra Klein noted in his blog that the bill’s popularity
seems to be on the rise. He said that USA Today/Gallup poll that showed 49% of
Americans now think healthcare reform is a good thing. The latest AP Poll shows
the same movement. The posters had an interesting graph showing support
rising as the temperature does.

Margaret Flinter: Well I am _______ 1:04 very glad at summer and maybe it's
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the summer holidays maybe it's 4 of July weekend coming up but there does
seems to be a little bit of a lull in the health reform activity but it turned as positive
in the polls and that’s great and what we are hearing about this week is the first
real way that implementation as states begin to enroll people with preexisting
conditions and to the temporary high risk polls. This is the group of people we
heard from over and over joining health reform who are being so harmed by the
old policies. The web portal where consumers can shop around for affordable
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options launches this Thursday July 1 and I am proud to say here in
Connecticut we just became the first day in the country to expand Medicaid
enrollment to a group that historically has been shot out of Medicaid and that is
low income adults without young children. Under the new law CMS estimates
that 45,000 adults in Connecticut will now become eligible for public health
insurance under the expansion and that is great news.

Mark Masselli: That is great news and speaking of CMS, it still remains
rudderless. Don Berwick who is the nominee just can't get in front of the senate.
The senate finance committee has not scheduled a hearing on Berwick as of yet.
That was being held up by a couple of republican critics who just don’t want to
see this health care reform be successful you know the surprising thing is
Berwick is supported by George Bush’s former CMS administrators as well as
Gail Wilensky who has been on this show before along with a whole host of
national healthcare associations, let’s give them hearing, let the public have a
leader in CMS.

Margaret Flinter: Well anyone who knows Dr. Berwick’s work knows that he is a
real reformer and those reforms come down solidly in improved quality improved,
safety and decreased cost through both of those measure. So we are still
cheering foreman in his corner and there is lots of work ahead. Mark, did you
see the latest Commonwealth Fund Report, the US ranks last in overall

performance compared with 6 other industrialized countries Australia, Canada
Germany, the Netherlands, New Zealand and the United Kingdom and won’t it be
the true measure of how successful health reform is if that changes not just
recover more people.

Mark Masselli: Well I hope as the benefits of this law start to take hold our
healthcare system will move up in the ranks as the report notes various
legislative remedies and funds will help those symptoms under healthcare
reform. In any case we still have a long way to go in improving the key elements
of our healthcare system.

Margaret Flinter: And speaking of legislation and legislative remedies our guest
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today is Congresswoman Lois Capps who represented California’s 23 district.
Congresswomen Capps who is also the founder and cochair of the House
Nursing Caucus is a nurse, public health advocate and since being elected to
Congress in 1998 she has made her legislative priority to help underserved
populations gain access to quality healthcare. We are so happy she can join us
today.

Mark Masselli: And no matter what the story, you can hear all of our shows on
our websites Chcradio.com. You can subscribe to iTunes to get our show
regularly downloaded or if you would like to hang onto our every word then read
a transcript of one of our shows, come visit us at Chcradio.com.

Margaret Flinter: And as always if you have feedback email us at Chcradio.com
we would love to hear from you. Before we speak with Congresswoman Capps,
let's check in with our producer Loren Bonner for the headline news.

Loren Bonner: This weekend on Conversions on Healthcare we are interviewing
Congresswoman Lois Capps. Congresswoman Capps has championed several
pieces of legislation that concern access to quality affordable healthcare,
prevention and increasing the number of health professionals. One year ago
congresswoman Capps introduced the school-based Health Clinic Establishment
Act which also made its way into the Healthcare Reform Legislation passed in
March as an authorized federal program to provide a stream of funding to
support School-Based Health Clinics or SBHCs. Approximately two million
American children have access to one of the 1700 existing SBHCs in 44 states.
Most of the health centers serve children who face barriers obtaining health
services in their communities. School Health Centers provide access to
comprehensive medicare care, mental health and sometimes even dental
services. The Children’s Aid Society operates five SBHCs in New York City as
part of their community schools program. From the get to the implemented
SBHCs as the foundation because they knew that healthy students learned
better. Dr. Lisa Handwerker is the Children’s Aid Society’s Medical Director.

Dr. Lisa Handwerker: Child doesn’t have to leave school to see the pediatrician
when they are six or if the kid is coming, child is coming in with an asthma attack,
if the child is first diagnosed with asthma we can take care of him onsite and give
them the medications they need to keep them in school. And then communicate
with the pedestrian about how well this child is managing his or her asthma or his
or her diabetes, are they in good control, are they in poor control?

Loren Bonner: SBHCs are designed to be a source of primary care but not to
replace the child’s medical home. Most of our staff by nurse practitioners will
support staff like outreach workers to help parents enroll their children and to
maintain good communication. Many operate year round even when school is
closed providing a vital link to healthcare and underserved communities. And
most SBHCs like the ones the Children’s Aid Society operates provides services
regardless of insurance status or ability to pay. Dr. Handwerker says that SBHCs
also work in partnership with the child’s own primary care physician to enhance
care.

Dr. Lisa Handwerker: To have a nurse practitioner at the school who sees that
child when they are sick or who can manage the child on a diabetes for instance
on a day-to-day basis who then can communicate with the primary care provider.
In that communication, when you have a child who has asthma you can work
along with the child in the family because you are where the children are. There
has been numerous studies that have been done that show that School-Based
Health Centers actually prevent emergency room utilization and considerably
decrease healthcare cost for children with asthma specifically.

Loren Bonner: SBHCs rely primarily on state and local funding but with the
current economic crisis and states slashing local funding many are at-risk of
cutting services or worst closing. The Health Reform Legislation allocated $200
million in capital expenses for current SBHCs to expand their facilities or buying
new equipment but there were no funds allocated for personnel costs or direct
health care services. Let’s turn now to our interview with Congresswoman Lois
Capps, a nurse, school advocate and now United States Congresswoman and
Founder of the House Nursing Caucus.

Mark Masselli: Today, we are speaking with California Congresswoman Lois
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Capps representing California’s 23 District, a Champion of Nursing, supporter of
Health Care Reform and an Advocate for Health Care for the poor and
underserved. Welcome, Congresswoman Capps.

Lois Capps: It's my pleasure.

Mark Masselli: You started your career with the degree in nursing practiced at
Yale New Haven here in Connecticut and then went on earn degrees in Divinity
and Education, you devoted many years to advocating for school health before
going on to congress where you were one of only handful of members of the

house who were nurses. Could you tell us about some of the core health care
initiatives that you are particularly involved with as the Health Reform Bill was
being crafted?

Lois Capps: Thank you for allowing me to talk about it. The subject very dear to
my heart is of course as one of the just three nurses in Congress, we all bring our
life experiences with us. And I have been blessed to have had real opportunities
to understand the challenges that many folks face, families particularly because
they have worked with school age children and pre schools families as well
where families are so concerned that they can survive and given the high cost
and difficult access to health care. So reforming health care and reforming
insurance and expanding health care to cover everyone it has goal of mine long
before for coming to Congress actually and long before the opportunity came to
work on this legislation.

Margaret Flinter: So congresswoman, we had the pleasure of watching you join
Department of Health and Human Service Sector Kathleen Sebelius and
announcing new funds to support the education and training of more advanced
practiced nurses and other nurse practitioners as well as funds to expand the
number of Nurse Managed Health Centers and I know that you founded the first
Congressional Nursing Caucus in 2003 as the form for members of congress to
be informed in to really discuss issues that affect both the nursing community but
also affect patients who need nurses to take care of them . So I am curious
about the link between the caucus and some of those innovations that we saw in
the health reform build it. Some of those ideas come directly out of the caucus.

Lois Capps: They came out of the caucus and the caucus was worn out of mind,
my awareness and passion about involving nurses in the health care decisions.
When I was first elected in a special action as you referenced, the Patient’s Bill of
Rights was being debated on the floor. We weren’t able to pass it. We almost
did. And now you know there are so many elements in our health reform
legislation that really have to do with a Patient’s Bill of Rights, who is speaking up
for patients, who is speaking up for consumers of healthcare, and for those
without it and those with difficulties accessing it. Well, it’s nurses who do
because nurses provide healthcare delivery. So I knew when I was first elected
that this would be a topic that would fit with my background. I also was aware
early on with the shortage of nurses that we were experiencing in California was
nationwide. And that led me to introduce the Nurse Reinvestment Act and it
became a law. And so the need for more primary healthcare providers because
of my interest in primary care and prevention in health care. These important
areas are offered and expanded upon by training and educating more family
practice nurses, nurse practitioners, physician’s assistance with the particular
skills in this area and also MDs who have an interest in providing primary care.

Mark Masselli: Congresswoman, you have a broad and sophisticated
understanding of public health and really understand the intersection of

community practice and policy. And talk to us little bit about what you see on the
horizon in terms of public health issues that you see still needing some more
cultivation and understanding by the public and by your colleagues in
Washington.

Lois Capps: We know we have challenges because the cost of healthcare is so
high and hard to reach for so many people. But it’s measured in how we access
treatments that are life saving and we want them to be available but we would
hope that there would be behavior changes and these changes that are needed
are seen as very clearly in the epidemic which we now know as obesity. And this
is an epidemic that begins in childhood. Now to our credit First Lady has really
taken this one as an issue and brought it to the forefront of public awareness so
that a few days ago when I was in my district I was able to be part of a program
in California at least and I wonder that it isn’t in different parts of the country
called Rethink your Drink and I was at a boys and girls club and here is a way of
melding some federal dollars with some state resources and focusing on
exercise and nutrition and making it available in summer programs like boys and
girls summer. Kids are they spent some time during the day and just getting
young people to understand what’s in a soda .

Margaret Flinter: Well obesity has certainly grabbed everybody’s attention finally
and that’s a really interesting program you described. We will follow up on that.
Let me ask you about another area that I don’t get as much attention within the
health reform bill and that’s behavioral health, mental health, substance abuse
and parity. And I would like to ask you, do you think that there is enough in the
Reform Bill that addresses this issue in terms of both access and innovation,
were there things that you wanted to see that might have to wait for another day
or another legislative session?

Lois Capps: This is not a perfect bill and of course I would have like, I would like
to have seen much more in the area that you talk about, because this in many
ways underlies a many of our health care needs and compounds experiences
that veterans come back from service with that we see you know in terms of our
homeless populations, that we see hogging up our emergency rooms, areas that
can be addressed also in preventing that primary care ways. There are some
good parts of the bill and there are some standards that I am very proud of. One
is to include in the basic healthcare package that will brow out at 2014 all
insurance companies must provide is mental health coverage. Now, this is going
to be a striking change. We started it before the health care bill by passing as
you referenced mental health query. So that mental health no longer can be
stigmatized by having it the way of the charts not even considered at all but must
be considered as a health challenge but as many of our other chronic conditions
are considered.

Mark Masselli: One of your roles as a congresswoman is obviously political
practitioner and art of politics is so important in terms of communicating with the

public. The polls on health care reform certainly we would like them to be going
up but what advice would you have for the president in terms of the types of
communication that he needs to do and I am sure everyone else needs to do as
well. So that we can get a better understanding and turnaround any negative
use that some people have about their reform bill that’s been passed.

Lois Capps: You know Mark what you finger on something that started very long
before the bill was finally passed and signed into law and that was the special
interest that you know are sustained by the status quo and that have prevented
us from passing legislation in earlier administration perhaps because the status
quo is much easier to maintain the w you know maybe easier than the w you
don’t and so people are fearful of change and we saw a tremendous pushback.
Now, we want that to change in the best way for to change and the president has
been doing the best he can I think under the circumstance and we want him to do
as much as he can to help us, to get the word out about the ingredients in the bill
that are actually in place now that people can begin to take advantage of. And
my colleagues and I are doing this as well as we now rag shortly for few days in
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our district around the 4 July I will and I know my colleagues will as well be
talking about the points in the healthcare legislation such as being able to stay on
your parents insurance, a coverage until you are 26, a huge boon to those just
graduating from college who thought they were going to be swamped not only
with finding a job but finding some access to healthcare. Now they have this
cushion of time and the donut hole, you know people who fall into that Medicare
recipients who will now get the first installment on our beginning to close that
donut hole, things like that and small business getting an insurance incentive to
provide insurance for their employees. These ingredients that are tangible that
can be realized now will help us take the story to negate some of this fear that
still maybe lingering here.

Margaret Flinter: Well let's springboard that a little bit into, let’s look at California
as a bit of a reference planning, we have referenced it on our show several times
because of a large size and significant population of people who are both
uninsured and on public insurance and we notice that your legislature there took
action early just recently to implement the health insurance exchanges that are
going to help individuals buy affordable insurance and really to control that so
once again California seems to be out ahead and I guess the question would be
how is it playing out in California specifically. How is public response changing
both in your district but also statewide as the state simultaneously faces just such
enormous budget challenges.

Lois Capps: Well you see out of that challenge that we have with our own
budget comes to this opportunity to take the good in the healthcare legislation
and to meet it halfway because ours is a state that will benefit so enormously
under many of the provisions because we have a large number of people living in
low income communities and with poverty needs are so expanding Medicaid we
know it as Medicare in California to serve a wider population is a definite benefit

for the State of California and enough of these other kinds of interest that our
state legislature widely has seen as a possibility. It means that the public in
California has already become attuned to the fact that this is a win-win for our
state and therefore you see that our phone numbers, when the health care bill is
still not fairing so well in some areas because of our great need, we have
embraced it more quickly and it is now a positive part of the political landscape in
California and that’s a good thing. And now I am eager that other states will see
the same kind of opportunities I don’t know if there are state houses will be as
responsive as ours but I know there are ways that communities can come
together as hospitals reached out you know and worked with a private practice
and outcome based studies and so forth. There are many pilot projects in the
legislation that folks are bidding to look at and seeing if they want to apply for the
communities will see some growth in the support for the legislation as
communities take hold of the issue.

Mark Masselli: Congresswoman, when you look around the country and the
world, what do you see in terms of innovation and who should our listeners at
Conversations keeping an eye on?

Lois Capps: I believe keeping an eye on some modeled projects that spring up
in Connecticut where you are based in communities around the country if
individuals are listening to this show of your specific program and one of my
doubt was going on their member of Congress then can put them in touch with
some best practices that are already in place, we are going to be modeling the
future on what’s already working in communities and incentivizing communities of
both professional communities and also just communities at large to look to
reach out. This is a legislation that is very creative in its scope. It doesn’t
mandate from the Federal Government and this is the fear people have, they
don’t want the government telling them what they must do but holding out
panoply an array of opportunities that people that can take advantage of,
communities can take advantage of, by bending together, by forming consortia or
best practices of grouping then there will be resources for them and we will see
what we do best is where our local communities can make great price forward.

Margaret Flinter: Today we have been speaking with California Congresswoman
Lois Capps, supporter of Healthcare Reform and an advocate for quality
healthcare for everyone. Congresswoman, thank you so much for joining us
today.

Mark Masselli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities into everyday life.

Margaret Flinter: This week’s bright idea comes from a Cleveland-Ohio
organization called City Fresh which is tackling obesity by improving access to
healthy affordable food in low-income neighborhoods. Like many of the countries
urban areas Cleveland is plagued by food and security. Many residents live in

food desserts, regions where food sources are nonexistent or unhealthy. For
example, residents of Cuyahoga County which includes the Cleveland Metro
area travel twice as far to reach a full service grocery than a fast-food restaurant
or a convenient store. This kind of food insecurity is one of the main culprits
behind obesity and low-income urban areas because when people try to
maximize their caloric intake per dollar they are much more likely to purchase
cheap, processed, packaged food versus fresh healthy fruits and vegetables and
that’s where City Fresh comes in. Founded in 2005, City Fresh is a nonprofit
organization with a goal of building a more just and sustainable local food system
in Northeast Ohio and much likely increasingly popular community supported
agriculture programs, City Fresh distributes weekly shares of locally grown fruits
and vegetables to fresh stop pickup locations around the city. Unlike CSAs
though members pay for their shares by week rather than all at once at the
beginning of the season and this makes the program accessible to people who
can’t pay several hundred dollars upfront to join a CSA. There are two sizes of
weekly City Fresh shares, $12 single shares, $24 family shares, all of which are
cheaper than any of the city’s grocery stores and contain more abundant
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amounts of fresh fruits and vegetables. 1/3 of City Fresh members are low-
income and they pay half price which is completely subsidized by those paying
full price. When combined with a large number of fresh shops around the city,
this subsidy makes fresh, healthy food affordable and accessible for low-income
Cleveland residents. And City Fresh also works to help stimulate the local
economy by purchasing all of the food it distributes from urban and rural farmers
no more than 50 miles away. By making healthy food accessible to all
Clevelanders, City Fresh is combating obesity, stimulating the economy and
making Cleveland a healthier and safer place to live. Now that’s a bright idea.
This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli peace and health.

Conversations on Health Care, broadcast from the campus of Wesleyan
University at WESU, streaming live at wesufm.org and brought to you by the
Community Health Center.

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