Q&A: Dr. Rep. Yadira Caraveo, Vice Chair of Colorado’s House Health & Insurance Committee
Dr. Rep. Yadira Caraveo is a first-year legislator representing Colorado House District 31. Caraveo serves as Vice Chair of the House Health & Insurance Committee and sits on the Public Health Care & Human Services Committee. Outside of the Legislature, Caraveo works as a pediatrician.
In this Q&A, Caraveo talks about bringing her unique perspective to the Legislature and health care bills to watch this session.
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SG: You’re the only doctor in the Colorado General Assembly, correct?
YC: Yes, I’m the only medical doctor.
SG: Your statement regarding SB 181 might’ve answered this, in part, but I’d like to know how your background as a pediatrician has shaped your perspective, so far, as a legislator.
YC: I think it gives me a unique perspective, both in terms of knowing the real health care issues that docs see and patients see in-clinic every single day; and, also, focusing on children’s issues.
I think it’s very easy to talk about the needs of kids and to focus on children as part of campaigning. But then, not everybody keeps them in mind as they’re legislating or even thinks about — as good as their intentions might be — with a piece of legislation, it could affect kids in a different manner than it does adults.
SG: Do you think that impacts you more as you’re introducing legislation, or do you feel like you’re bringing it as a defense?
YC: I think it’s a little bit of both. But, it does provide a lot of defense.
Particularly in Colorado, and during this session, I’ve seen it with marijuana legislation. It’s something that has been legal here for some time, both medically and recreationally, and something that our party, basically, as a Democrat, has been very supportive of. But, I think I have a completely different perspective on legalization and the expansion of use for medical conditions, because I think of it through the perspective of a pediatrician and how it’s going to affect children. And so, I’ve taken a few votes against the rest of my caucus, because I look at it solely through the lens of how it will affect kids.
SG: Do you remember the specific bills that you broke from your caucus on?
YC: Medical marijuana use in Autism was the first one that came up. It just got signed into law by the governor last week, I believe.
What a lot of the legislation around medical marijuana use in children had done, in the past, is that one of the two physicians evaluating them needed to be a pediatrician, a psychiatrist, or a family medicine doc. The bill that was introduced this year stripped that completely, so that it only had to be two doctors.
My concern was that they were just going to be two medical marijuana specialists who didn’t know the child, might not have experience treating the child, and that there would be no communication with the primary care doctor. So, I introduced an amendment that did not pass in the hearing, specifically to make sure that the primary care doctor was involved in the discussion, that one of the people who evaluated the child had some experience in pediatric care.
On the floor, another legislator, who had introduced the PTSD bill in the past with that kind of language, was able to introduce an amendment that did pass. So, on second, I was the only person who voted against the bill. And then, on third, the amendment went through and I was able to join the rest of my caucus in voting yes.
That was the first big one where my perspective on the bill was completely different from, actually, not even just my caucus, but the entire rest of the House.
SG: Is there anything similar you’ve found, from your perspective as the daughter of immigrant parents? Has that shaped the way you approach health policy, in particular?
YC: I think it always provides the perspective of somebody whose parents didn’t grow up in an environment like this, where there were so many freedoms or things that were a given — like a good education or the ability to really build your future in a way that you want, the way my family has been able to do here.
I think it’s going to provide a particularly rich perspective as some of the immigration legislation comes to the House over the next couple weeks, around how ICE interacts with state and local law enforcement. Because I have family members and community members who have been going through normal court procedure for something else, or even just procedures to legalize their status, and have been picked up by ICE and deported.
And so, it gives you a very different perspective when your family has been going through the process of being an immigrant, of being, sometimes, profiled or discriminated against — and when you see the process of deportation in people that you know.
SG: These perspectives are also in addition to the perspective of a first-year legislator with a leadership position on the Health & Insurance committee. And, I noticed you’ve introduced some consequential legislation that’s moving this session — the comprehensive sex ed bill, the public welfare bill. What has your first session felt like?
YC: It’s been very fast-moving. And it’s interesting, because it’s very much learn-as-you-go.
It’s much different from my training in medicine, where it’s a very long process of learning and a very detailed, set-out process that has been the same for decades. So that, by the time that you’re in charge of seeing patients on your own, you’ve been trained for years and years, and you feel very prepared for it.
For this job, basically, all you have to do is win, and then you go on to legislate. So, it’s a lot of learning as you go. And it’s been interesting, especially as a vice chair, to be in a position where I can chair committees when the chair isn’t there or when she’s presenting a bill. And, it all kind of comes at you very fast and furious.
What I have found most interesting, I think, and probably because I am the only doctor in the Legislature, is that I’ve been given a lot of opportunities that not all first-years have been given.
I did get added on to the comprehensive sex ed bill to provide my perspective, as a pediatrician in particular, of why this education is important.
I was added onto the Speaker’s bill for oil and gas, 181, which was also a very big, controversial bill. And also, I think, to provide a very different perspective on what is really looking at public health and safety, because of work I’ve done in the past around climate issues as a resident.
And then, I think, I probably have had more of an influence over some of the things we’ve seen in Health & Insurance and in Public Health, because I have that unique perspective. People will look to me and to the nurse who is on both committees — Kyle Mullica — to see how we stand on certain issues.
Even today, as a caucus, we were discussing a certain bill and somebody turned to me and said, ‘Are you OK with this, doc?’ And I said, ‘Yes.’ And they were like, ‘OK, then I’m OK with it.’
So, it’s kind of an undue influence that I have, even as a first-year, just because of the different perspective.
SG: Can you tell me about the health care bills — ones you’re sponsoring or otherwise — you see as the most important to watch for the remainder of session?
YC: Sure, there’s been a lot of movement on health care legislation. There was an estimate that about a third of the 500 to 600 bills that we were going to see this session have something to do with health care.
Being on both health committees, I see anything that comes into the House — whether introduced in the House or from the Senate side.
There’s a big reinsurance bill that is trying to control costs in rural Colorado; because, in many of these communities, there’s only one insurance company that goes through the exchange. They can basically charge anything they want to for premiums. So, it’s pricing a lot of people out.
There’s been a lot of hospital- and pharmaceutical-transparency bills come through that have gotten a lot of attention.
The two that I’ve been doing probably have been flying under the radar:
One would create a ‘care network.’ A lot of docs have experience with evaluating child abuse and neglect, based on their training. But, a lot of them don’t. Actually, outside of the Denver metro area and Fort Morgan, there are no child abuse specialists. So, unfortunately, when a kid has an allegation of abuse or neglect, the quality of the exam or even just the availability of the exam that they’ll receive has a lot to do with luck-of-the-draw: Is your doctor comfortable with that?
This would establish a resource network that would train doctors, via internet training, to really get comfortable with seeing signs of abuse early. And then, when there is an allegation, how to do that exam. And then, how to hand the care of that kid off to mental health specialists and how to go about recording it and taking advantage of the rest of the system that’s there, around abuse.
Another is about an investment in primary care, modeled after what they’ve done in Rhode Island. There, they studied, through the Department of Insurance, the total percentage of health care dollars that were being spent in the state that were going toward primary care.
They found that it was probably, really only around 5 or 6 percent. So, they made a concerted effort to increase the amount of investment into primary care, because it is so important — in not just preventing further health care issues, but also saving money long-term. If we catch illnesses earlier and prevent them altogether, obviously we save health care dollars. By increasing the percentage that they’re spending up to about 10 percent, they saw huge cost savings and, actually, stabilization of their premiums, which had been going up previously.
So, there’s two unique ones that were probably a little more wonky than what some other people were looking at, but they were important to me because of issues I’ve seen with patients and just being a primary care provider.
SG: Your website says you’re an advocate for the ACA. With all of the national conversation around the ACA happening, what do you feel like you can do in Colorado to advocate right now?
YC: That’s really one of the reasons that I decided to run: Because there is so much at the federal level that’s out of our control now. The influence of states is all the more important now.
A lot of the kids I take care of are on Medicaid and CHIP. Last year, when CHIP was being held hostage, basically, by congress, it was yet another incentive for me to run and be able to protect the investment in things like Medicaid and CHIP at a state level, because states do have an influence in the funding.
But, I think that one thing we’ve seen through legislation this year in the health committees, and I’m sure we’ll continue to see, is: How can the states protect health care benefits if the federal government starts to chip away at things like the ACA?
So, whether it’s looking into providing our own public option, or there’s a study we will hopefully fund to look at a few different — I think it’s four different — health care systems to decide what would be the best for Colorado, it’s trying to establish what is right at the state level and what can we do independent of the federal government.
SG: I also read that you serve on the Colorado Behavioral Health Transformation Council. How did you react to yesterday’s news that Gov. Polis is launching a behavioral health task force? Is this something that needs to happen?
YC: Absolutely. We’ve seen a lot of mental health bills come through the Legislature, as well, because we’re hearing the stories every single day of the crisis, the suicide rate in Colorado.
I see it in clinic, unfortunately, much too often, where even kids as young as 8 I’m seeing with suicidal ideation. Getting mental health help for them is really, really difficult. When a kid needs an endocrinologist or a gastroenterologist, it’s pretty easy to secure a referral and send them onto specialist care. When we need to see a psychiatrist, or even a therapist, it can be much more difficult.
I’m very excited that we’re concentrating on it and the governor is, as well. I think it’s something that, in the next couple years, we’re going to be seeing a lot more bills come through. Because we just can’t be losing that many people to suicide. And we can’t be losing them to depression and anxiety, because — even if they’re still here with us physically — it really, obviously, affects their life and their productivity.
SG: Is there anything else you’d like to add or talk about?
YC: I think the reason I decided to run and why we need more health care providers to become involved, at any level, in legislation, is because we have a really unique perspective.
Patients share very private details, very important parts of their life with us. And so, we have a lot of knowledge — in not just medical issues, but all sorts of issues that affect the people of Colorado.
The reason I decided to run was because there were so many things that I couldn’t fix for kids as a pediatrician. Whether it was how much their housing cost, what was going on at school, whether they could even access medical care — tons of things I couldn’t fix in-clinic.
So, it’s important that health care providers get out of clinic, get out of the hospital, and try to influence things at the state level, because we have a really unique voice.
This interview was edited for length and clarity.