Frederick Isasi: Pioneering A New Age of Healthcare
Photo courtesy of Families USA
Frederick Isasi is the Executive Director of Families USA (FUSA), the leading nonpartisan, nonprofit health care advocacy organization. FUSA advocates for issues like fair drug pricing, racial equity, and maternal and child health. Isasi has led efforts to strengthen policies such as the Affordable Care Act (ACA), Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and Oral Health for All. Previously, Isasi held positions at the international law firm Bryan Cave LLP, Senator Jeff Bingaman’s staff, and Advisory Board Company, a leading international organization that advises 3,100 hospitals, health systems, provider groups, and payers.
Could you please introduce yourself and Families USA?
Families USA has been around for over 40 years, and our focus is to ensure the very best of health care is equally accessible and affordable to every living soul in our nation. You really see healthcare and the ability to choose to live our healthiest life as foundational to every living soul's ability to live.
In a country with as many resources like ours, quality healthcare shouldn’t even be a question. It should be a guarantee in this country that your health will be protected and nurtured, and that our health is not dependent on our wealth. That's what Families USA stands for.
We work really intensely federally. We work in Congress, with the White House, with the Development Association, and also with a lot of state capitals. This means governors and administration in the state. We are widely credited with being one of the key policy advocacy organizations that got the Affordable Care Act implemented. We also work on value transformation; How do we change and be paid for? Regardless of skin color, immigration, geography, sexual orientation, and gender, you can live the healthiest life. Finally, we focus on consumers and cutting out partisan rhetoric to serve all and drive policy in that direction.
Can you tell me a little bit about yourself?
So I come from a very large and vibrant family. Both my parents were born and raised in Cuba, and after the revolution, came to America at 16. They became a part of the American story. We moved to North Carolina when I was about six years old. We had been living in Europe, briefly; I was born in Philadelphia, but most of my life I grew up in North Carolina. I was 100% Cuban and raised in Latin culture, but I did not identify, often in my community, as Latin. And then you know, as I hit puberty and kind of became more aware of myself, I realized that I was gay and, you know, the late 70s, early 80s, were times when there were very different roads for a gay man.
My parents and my extended family are always very involved in social justice. I had an aunt who is a really famous, feminist Dominican Catholic theologian. My mom and dad were very involved in immigrant rights to North Carolina as well as with homelessness. My mom also helped to found a homeless shelter and soup kitchen
I come from one of the gayest families on the planet, on both sides of the family and for many generations. My mom's youngest sister, who was about eight years older than me, she comes from a traditional Latin family where she's 25-30 years older than her sister. Her youngest sister, who is kinda like my aunt, kinda like my sister, came out. The whole family, for the first time, got to really talk about the issues, even though we had previous generations of queerness.
My mom got very involved. She's testified in the state Capitol; my parents also marched in gay pride parades when my mom's sister came out and then, when I came out, then when my twin brother came out. They got more and more involved and engaged. It's kind of a progressive Catholic belief that our biggest and most important mission is to help the most forgotten, the most left-behind by society. They they took that idea and they really pushed a lot of their beliefs and their effort into gay rights.
“Power is rooted in being authentic, not in living up to some societal paradigm.”
That's really cool to hear that there's so much queer representation in your family. Could you speak a little bit about your the intersections between your Latinx and queer identities?
My gay identity is rooted in my lap because I grew up in a part of the country that didn't even understand what Cuban was at the time; there were very few black people here in North Carolina and people just didn't really understand the culture and where we came from. Overall, it’s been a really good experience for me.
It was really interesting in between life, where I felt 100% American, but I also knew that my whole culture, the language our people spoke, the food we ate, our familial structures were different in a lot of ways from those of my friends and neighbours here in North Carolina. There is this really profound unfeeling that I experience: I remember being like two years old. I had leftovers from my lunch bag at school and it's just croquetas, but it's the Cuban version of it. At lunch, all the kids made fun of it because it looked different to them. I remember being in second grade thinking “you're so wrong, this is delicious!” It felt like a very vibrant part of my life.
And I remember just thinking over and over again that the society I was living in did not understand how magical this thing was. Families are a profound truth; the world is so much bigger than the little microcosm that you might be in growing up. The truth I knew is that the whole world can think one thing and be wrong. That gave me the strength to be able to face my gay identity, along with my family that was incredibly supportive and loving.
I remember having this conversation back in the 90s, with a guy, who was a kind of a well known doctor/policy guy. He looked at me like I was the most immature person in the world and treated me like an immature person, for having this belief that we could be an equitable society. I remember thinking “you're completely blocked. You are so convinced of your position, but the world is much bigger than you think it is.”
Can you speak about how the politics of queerness have transformed within the last four decades?
I think the intersection of gender identity and sexual orientation used to be rooted in feminism and, for me, the connection between misogyny and homophobia was always super clear. I think for a long time in the gay rights movement there was such a resistance to talking about gender identity. I think it's super exciting that we're bringing those things together and seeing them for what they are: which is just embracing that people should live what's inside of them. Power is rooted in being authentic, not in living up to some societal paradigm.
“When people can't be honest about sexual orientation or gender identity, they can’t really achieve health because they're not getting the correct insights for their care.”
How can policy be wielded to improve the lives of LGBT folks, particularly within the framework of healthcare?
One example is the idea of culturally-competent appropriate care. I never knew what it was like to have a gay doctor until I got one. I found a queer doctor about 20 years ago and it changed my entire experience in healthcare. If you're living in a societal environment where your identity is different or misunderstood, it is so common for providers to bring that into the experience without them being aware of it.
So I think that having real representation and real training of healthcare workers about what is it like for a gay person to try to be healthy and what their needs are, as well as what kinds of biases you might have that you don't even know about. It's just a good example of the kind of cultural appropriateness and sensitivity that we should bring to the designing and the provision of health and health care in this country.
In terms of policies, there's a lot of work in the Affordable Care Act that was done to prevent discrimination. That’s everything from ensuring that you're with your partner in the hospital, that you have the same rights and abilities that anybody else who is in a loving relationship and caring for somebody has. It’s also things like ensuring that when a transgender person walks into a hospital, the institution understands what their gender is and their biological needs have to be addressed as they are presented authentically, not in some kind of predetermined societal box that then results in them not be able to be honest and open with healthcare workers.
When people can't be honest about sexual orientation or gender identity, they can’t really achieve health because they're not getting the correct insights for their care. For example, my primary care doctor made sure I got the HPV vaccine because HPV isn't just the leading cause of cervical cancer, but also the leading cause of anal cancer. I'm the only person I know among my gay friends who got that advice because my doctor was gay.
Wow, that's really scary to hear. What do you wish people in healthcare knew about LGBT folks?
I think my deepest aspirations for the fields are really rooted in the connection between homophobia and misogyny. I think it is rooted in the idea that when a woman wields power in her way, society almost always tries to stop her voice. I think we're getting a lot better, and I think that in healthcare we're going to really get to the highest quality, most effective health care when the misogyny rooted in our society and health care system is purged.
The worst example of this is the standard of care for little babies that are born with non gender-informative genitalia. Right, we live in a society where, to this day, you still have doctors who look at all the babies, telling them to choose between a penis or vagina; they've been taught that that is what little babies must get cut into. They can physically make that baby conform and then force them into a binary gender. That's an example of how deep the misogyny is in our society, and how far we have to go still.
Do you have any advice for LGBTQ+ youth interested in the fields of policy, healthcare, or social justice?
Three pieces of advice. The first is, I think my greatest power control is being one of these in-between people. We are living in a democracy and, by definition, it means that on some level, you have to be able to generate some level of consensus amongst people to actually create change. And, often because we have a two party system, and in part because of the way social media has been sorted wielding itself upon the American public, we are becoming more and more polarized. When we get so polarized, you can’t make any progress because our system is consensus. It is really the currency of our policymaking system. Those of us who live in between spaces can often be a really powerful glitch.
You know I grew up in mostly North Carolina and I love the South. It has its problems, but it also is a wonderful place to live. My house was filled with progressive southerners for, you know, three, four or five generations. We have to reach across the divide and bring people together to get the consensus that we need to build real, lasting powerful change towards justice. So if there’s a part of you that is different, that part of you can become the source of this strength to build consensus. We need people who can show up and own the strategy around building the right kind of coalition. Building the right kind of political power base, building “strange bedfellows” who can bring different perspectives to bear on policymakers' ticket to create that consensus.
For a pluralistic, diverse policymaking body that almost always is not as diverse as society, you've got to deal with policymaking bodies that are very, very white or very, very male and very, very old. Ask yourself: how do we move those folks?
That would be my second and my third would be this. I remember when I was graduating from law school and sat down and looked at where I wanted to go. I wasn’t sure if I wanted to be out when I applied for jobs, but every single person I talked to said “Frederick be out, be totally, totally out.”
I think I got more job offers than anyone else in the class. Being gay has always been a humongous leg up in my experience. It has never ever caused me any downside, so I would say that being authentic, showing people who you are goes a long way towards professionalism.
Written by: Saranya Kolli