Healthcare, Reproductive Rights a Big Part of Pediatrician's Congressional Campaign – MedPage Today
by Joyce Frieden, Washington Editor, MedPage Today December 27, 2021
As part of MedPage Today‘s occasional series on healthcare clinicians running for office, Washington Editor Joyce Frieden spoke with Yadira Caraveo, MD (D-31), a pediatrician and Colorado state representative who is running for a U.S. House seat in Colorado; her most well-known Republican opponent is former state senator and current Weld County (Colorado) Commissioner Lori Saine, who has suggested that local hospitals are falsifying data on unvaccinated COVID patients.
The interview, which was conducted via phone, has been edited for length and clarity.
How did you end up becoming a doctor?
Caraveo: I decided from a very early age that I wanted to go into medicine. I’m not totally sure what that was due to; I like to say that maybe it was my mom who grew up in a small town in Mexico and would have liked to have been a doctor, but didn’t have the opportunity to do that. So I always knew that I wanted to be a doctor.
I went to the University of Colorado [for medical school], and then I did my residency at the University of New Mexico in Albuquerque. It wasn’t until medical school that I really decided to go into pediatrics, during our third-year rotations. Working with children was something that I really enjoyed — the fact that we focus so much on prevention, that there’s a big aspect of policy and advocacy work because children can’t advocate for themselves, and that they get better, usually, no matter what they have going on.
And how did you become involved in politics?
Caraveo: In New Mexico, we were unionized — which is unusual for doctors — through the Committee of Interns and Residents through the SEIU [Service Employees International Union]. I actually got to do a lot of — not just policy training in residency, but I got to do a lot of advocacy through the union. I ended up meeting a lot of people involved in policy and politics in New Mexico. I kind of developed a taste for that during residency, and when I came back to Colorado I knew that that was something that I was going to incorporate into my work as a pediatrician, and I did so by joining local boards that focused on early childhood issues and mental health issues at the state level. And that way, I kept my foot in the advocacy door. [One advocacy group] was called the Early Childhood Partnership of Adams County, and we were focusing on integration of early childhood education and medical and dental care.
I found over the first 6 or 7 years of private practice that even if I was involved in advocacy and policy-making, a lot of the issues that I was seeing in clinic were really frustrating — to have conversations with families about CHIP [the Children’s Health Insurance Program] not being funded when it was being held hostage, and how they might lose their healthcare access, and talking more and more about the price of prescription drugs as opposed to just what I recommended for treatment, and talking to families about homelessness and not being able to provide them with any real services.
I became involved eventually with the local Democratic Party and ended up with an officer position. And then when the [Colorado House] seat that I hold now came up vacant, I was really asked and encouraged to run by a few people. I was initially hesitant, because I didn’t think it was something that I could do at the same time as medicine, because that’s pretty inflexible and high-pressure as a job, but really found a lot of support from my colleagues and my boss at work, who really saw it the way that I did: it was me doing the same job, just at a different level. And so I ended up running in 2018 and won my first term, and am about to start the last year of my second term.
The legislature is only part-time in Colorado, so we meet January through May. We of course have work to do all year for our constituents, and we continue looking at policy. So what I’ve done in previous years is I’ve worked full time the other 8 months, layering my legislative duties on top of that, and then I’ve gone from January through May with just a little bit of rounding. Since I announced my campaign for Congress, I have been doing all three: campaigning and the legislative session and working full-time.
What healthcare issues have you focused on in the state legislature?
Caraveo: I’ve done a lot of work around access and affordability. I passed a bill to really look at primary care spending in Colorado to decide how much we were spending and try to increase the spend. I think we all realize that if you invest in prevention, that saves a lot of money down the road. I have also passed a bill around prior authorization — trying to decrease some of the administrative burden for doctors, so that they can practice medicine and not have to focus as much on cumbersome paperwork. I passed a bill last year around prescription drug affordability; it’s really the first of its kind in the nation where we’re going to set up a committee that looks at the most expensive medications in Colorado, and sets an upper payment limit for a few of the most costly medications.
I have also really tried to venture into all areas that might affect the health of kids that I take care of. I’ve done a lot around air quality measures. Unfortunately, we saw a lot of issues over this summer and the prior summer over wildfires and the increase in ozone, which I see manifest in asthma attacks at the clinic. So I [cosponsored] a bill that looked at air quality monitoring in Colorado and what the companies that pollute should be doing in terms of keeping track of what they’re expelling into the air.
Can you talk more about the prior authorization bill?
Caraveo: What we did was fabulous. We expanded on the prior authorization legislation that have been passed a couple of years prior around medications — setting a time limit that insurance companies had to respond to prior authorization claims [for medications]. We tried to set a definition around what a clinical issue was, and what the recommended treatments for it were, so that if there were treatments that over and over again were being approved after a prior authorization, that would be kept track of so that we could look back and say, “Well, does this really need a prior authorization? You authorize it every single time.” This was specifically around services and procedures.
And how does the prescription drug affordability committee work?
Caraveo: The commissioners that will be on there are people who have to have expertise in the provision of healthcare or research, and will look at cost/benefit ratios and the information that [drug] companies give around their research and development and decide, “Does this medication really have to cost six figures?” And if not, they can say, “[All payers] will only pay this much.” Other states have set up an affordability board, but haven’t been able to place that upper payment limit. Colorado will be the first to do that.
What made you decide to run for Congress?
Caraveo: In particular, around issues related to healthcare — but really every issue that I’ve worked on — you have walls as to what the states can do. You start to come up with legislative ideas and people are like, “Oh, we can’t do that. That’s the federal government’s job.” So a lot of the same frustrations about what the pediatrician can do come into what I do as a state legislator, and I think the next step — especially once the district was drawn around the area where I grew up, where my parents still live, and where I’ve been seeing patients for the last 9 years — it seemed like a good space to continue advocating for patients.
What are your thoughts on healthcare reform? Do you favor a single-payer healthcare system?
Caraveo: Being a physician, it’s very easy to think of healthcare as a right, not a privilege. I think that we need to expand the system in whatever way works, so that we can achieve universal coverage. I know that there’s lots of options out there in terms of the public option, Medicare for All, and Medicaid for All. I think that there’s a reason that we haven’t figured that out in the last 60 years, because it’s a big, messy, detailed system, and more of us who work in the system need to be part of the analysis and the decision-making process because we know how it works from the inside.
The COVID-19 pandemic is obviously our biggest health issue right now. What are your thoughts on mask mandates?
Caraveo: A lot of the metro area counties [here] have instituted their own mandates because there isn’t one at the state level. We’re seeing the spike in [case] numbers and unfortunately, people are letting their guard down because they’re tired. I understand that they’re tired after 2 years of wearing masks and socially distancing, but this pandemic is certainly not close to over, so I definitely think that there should be a universal mandate to decrease the level of transmission.
And how about COVID vaccinations, especially when it comes to the children you treat? Although the vaccines have been authorized for children ages 5 through 11, are you looking forward to getting the younger kids vaccinated as well?
Caraveo: Yes, definitely. With every wave of vaccinations, we feel the pressure kind of shifting in terms of the age of kids we’re seeing with the most infections. So when [only] adults were getting vaccinated, we were seeing more children of all ages be an outsize number of infections, and now that teenagers are getting covered, we see that kind of trend down into other school-aged kids, and then as they’re getting vaccinated, we’re seeing really little ones be a big number of infections. So I’m definitely looking forward to that vaccination; I have parents ask me about it every day. Obviously, I’m a big proponent of vaccines; I think that’s the only way that we’re really going to stop this pandemic, and get back to a normal life where we can all do our normal work and normal activities without worry.
What other issues do you hope to focus on if you’re elected to Congress?
Caraveo: A lot of my focuses continue to be around health and reproductive justice. Colorado is lucky in that we actually don’t have a lot of legislation on the books around reproductive healthcare because we wanted it to be open to what healthcare workers and patients need to do to preserve a woman’s right to choose and her autonomy over her body. That’s something that has slowly been chipped away at the national level. In Colorado, we’ve been at the forefront of protecting that.
I remember as a medical student having a patient who came in with abdominal pain; she was 14 years old, and by the end of that visit, we realized that she was pregnant and we were lucky to be able to have a conversation with her about what her options were. The thought of a doctor not being able to do that for their patients is really scary to me. In Colorado, we will continue to work to protect a woman’s right to choose, and that’s definitely something that I will continue to focus on in Congress.
Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
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