“At some point even the wealthiest people can’t afford to deal with our healthcare system.”
Physician Irene Aguilar brought a doctor’s sensibility to law making at the Colorado State Legislature. Her eight-year tenure as a state senator concluded at the end of 2018. One of her main goals was to try to obtain universal healthcare for Coloradans.
“I told someone the other day that I’ve given up hope that the government will make it happen,” says Aguilar, “I think that there are too many special interests in healthcare to see the government de novo looking at the data and saying ‘this is what we should do.’ Data versus well-financed campaigns; data loses every time. I do think that the people will get us there. [In] polls, [support for universal healthcare] …climbs a little bit every year because at some point even the wealthiest people can’t afford to deal with our healthcare system.”
“We need to use data and innovation to figure out how to help people with chronic illness, including mental illness, live productive lives.”
On the issue of the high cost of medical care, Aguilar encourages courageous conversations: “We need people with the courage to take on the services that are driving up costs without adding value. We need to use data and innovation to figure out how to help people with chronic illness, including mental illness, live productive lives. You don’t just stabilize and dump. It’s not just that person who loses, society loses. How do we help those people who are not showing up in jail or in my office but need support?”
One of the hardest challenges for a scientist in the legislature “was to understand that politics trumps data.”
Aguilar trained as a basic scientist before studying to be a doctor. She says one of the hardest challenges for a scientist in the legislature “was to understand that politics trumps data.” She says, “I continuously had the mis-impression that if I just gave them the right data, they would come to the right conclusion. And sadly, I think that’s false. And now, under Trump, …people will say it’s ‘alternative facts.’ People are making up the data. They’re skewing it to come to the results they want to see. They’re creating language, undermining data evidence.” By way of example she sites a contentious debate in the legislature several years ago about long-acting reversible contraceptives (intra-uterine devices, IUD’s). With grant funding the state had provided the devices free to young women between the ages of 18 and 24 who did not have health insurance. “We saw a 50% decline in teen pregnancy, you know numbers you never get,” says Aguilar, “a 40% decline in abortions. And so the grant ended and the Department of Public Health and Environment asked the JBC [Joint Budget Committee] to fund the program, and they wouldn’t because a couple of the conservative members thought that IUD’s were abortive agents. …So that’s the biggest frustration.”
Because of the need to balance the state budget, law makers are used to reaching across the aisle to reconcile the numbers.
One of Aguilar’s positive take-away’s from her legislative experience is that “unlike the federal government, we got a lot of work done at the state in our 120 days.” The Colorado Constitution requires that the legislature pass a balanced budget every year. If it doesn’t get done in 120 days, a special session is held. During her first few years as a state senator, Aguilar says, it felt like lawmakers were forced to cut more than ‘to the bone’: “We were having to cut into the bone to make it balance,” she says, “in better economic times it’s a matter of where are your priorities and what will you give money to?” Because of the need to balance the state budget, Aguilar says, law makers are used to reaching across the aisle to reconcile the numbers.
“…when people think about ‘Obamacare,’ they think about more traditional hospital-based and clinic based care, which is where we’d like mental health to be, but it isn’t right now.”
Aguilar’s healthcare agenda got a big boost with President Obama’s Affordable Care Act. “But I do think that substance abuse and mental health are somewhat segregated from that. I think when people think about ‘Obamacare,’ they think about more traditional hospital-based and clinic-based care, which is where we’d like mental health to be, but it isn’t right now.” The opioid epidemic made the discussion of substance abuse more bi-partisan, says Aguilar. “The prescription drug epidemic helped make substance abuse accessible to all people, not just a symptom of some underlying social deterioration…”
Jails are not therapeutic settings, said Aguilar, who called for additional beds at the psychiatric hospital in Pueblo…
Aguilar found herself thinking like a doctor when she was faced with the question of what to do about people with severe mental illness who are accused of crimes and are being held in jail. A 2012 Federal agreement prohibits the state from confining those with severe mental illness in punitive settings for more than 28 days while they await trial if they’re being held because either the determination about their competency to stand trial is pending, or they’re being held while they wait for treatment that would lead to their competency to stand trial (Aguilar, 2). Jails are not therapeutic settings, said Aguilar, who called for additional beds at the psychiatric hospital in Pueblo to meet the state’s need to house the severely mentally ill in therapeutic settings while competency decisions are pending.
“…resources are so strained that they’re focused on crisis and you find yourself sometimes spinning wheels because they get you out of crisis, they don’t maintain, and then you’re back in crisis.”
Aguilar is encouraged that health outcomes are being improved for Coloradans because of the expansion of Medicaid. This doesn’t, unfortunately extend to mental healthcare, she says, which is often treated at facilities like emergency rooms and crisis centers, on a crisis-by-crisis basis. “If you’re not in crisis, they don’t have time for you,” says Aguilar, “and, you know, in their ideal world they probably would have time for you, and you’d probably make their job a whole lot more satisfying, dealing with somebody who’s on the road to recovery, but their resources are so strained that they’re focused on crisis and you find yourself sometimes spinning wheels because they get you out of crisis, they don’t maintain, and then you’re back in crisis.”
“We ignore mental health to our own detriment,” says Aguilar, “[people with mental illness] are in the police station, in the county jail. They’re homeless on the street, perhaps [something negative] happened because of their instability. And all that happened because we’re not investing in treatment and in long term outcomes.”
“We need to work on helping people understand how much they save by not having people treated only in emergency settings…”
Aguilar hopes that with time more and more people affected by health concerns in their families and their communities will appreciate the cost shifting that takes place in the system as it exists. “If you could have hospital administrators saying to people that when [ill people] come in, we do admit them, and that goes into the rate we charge all insurers, your rates. We need to work on helping people understand how much they save [by not having people treated only in emergency settings]… to demonstrate that you’re paying for it one way or the other. Here’s how this alternative way makes a person better and controls costs.”
Aguilar remains committed to the issue of healthcare in Colorado and says she’ll be a resource to sitting and incoming law makers. She is with the City of Denver as the Neighborhood Equity and Stabilization Program Director. Aguilar is also on the Board of Directors of the Denver Health Medical Center.
Aguilar, Irene. “Take Responsibility For Inappropriately Incarcerating People With Mental Illness.” coloradopolitics.com,
28 June 2018.