Single-payer, better access are top priorities for California health care in 2020, Influencers say

Note to readers: Each week through November 2019, a selection of our 101 California Influencers answers a question that is critical to California’s future. Topics include education, healthcare, environment, housing and economic growth.

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One of the most highly-charged issues in the Democratic presidential primary campaign is the debate over expanding health care coverage to uninsured Americans. Not surprisingly, the same argument also rages among California’s leading health care experts, pitting those who support a faster move to a single payer government-run system against those who prefer a more gradual expansion of coverage.

“Governor Newsom promised he would be the ‘health care governor’ and has voiced support for single payer,” National Nurses United Executive Director Bonnie Castillo said. “As longtime fighters for Medicare for All, at both the state and federal level, nurses know how important it is for him to lead the nation on this issue.”

Other Influencers agreed with the need for universal coverage, but emphasized specific next steps needed to move toward that goal.

“Our health system works better when everyone is included, getting primary and preventive care,” said Anthony Wright, executive director of Health Access California. “Expanding Medi-Cal to all income-eligible Californians regardless of age or immigration status would cut the uninsured rate even further.”

Robert Ross, president of the California Endowment, lauded the long-term benefits of government-run health systems, but advocated for what he called a “boldly incremental path”.

“The top policy issue of 2020 for Governor Newsom and our legislature is plotting the affordable path to universal health coverage and relevant reforms for Californians,” Ross said. “This means building on Obamacare/The Affordable Care Act, using the successful Covered California Health Exchange as a stepping stone, and reforming the state Medi-Cal program to improve care quality and care coordination and rein in costs.”

But several Influencers stressed the need to improve quality of care rather than expanded coverage as the most urgent priority for lawmakers.

“If I could impart a single concern to Governor Newsom and the legislature … it is that health care coverage frequently does not translate into meaningful access to care for those who need it,” said Dr. Joseph Alvarnas of City of Hope Comprehensive Cancer Center. “Providing health care coverage to Californians is not a meaningful end unto itself; our leaders should not rest until they ensure that coverage translates into meaningful access to the right care, at the right place, at the right time.”

Sacramento public affairs specialist Robin Swanson reinforced the point more starkly.

“While the goal of universal health care coverage is one we should strive to achieve, we need to take a step back and examine what we are actually providing for consumers once they finally get the elusive health care they were promised,” Swanson said. “Far too many Californians already pay a premium for health care coverage (they) don’t actually get. If we’re going to promise health care for all, let’s make sure it actually means something.”

In addition to coverage and quality of care, many Influencers also pointed to skyrocketing health care costs as a top-level concern.

“For many people, the costs of premiums and out-of-pocket costs are too high, even with the subsidy that the ACA provides and the added assistance the state provides for those that are not eligible for the federal subsidies,” said former AARP President Jeannine English.

California Medical Association CEO Dustin Corcoran focused on reining in high prices for prescription drugs.

“In addition to pushing for federal action, California can and should do more to help patients, including expanding access to generic drugs and targeting drug companies and pharmacy managers that engage in anticompetitive business practices,” Corcoran said. “By targeting bad behavior from companies that put profits over the needs of patients, California can ensure that those who need medicine are able to afford it.”

The topic of behavioral health received significant attention as well, with California Hospital Association President Carmela Coyle calling it “one of the greatest unaddressed issues of our time.”

“For too long, the care and treatment of our bodies has been separated from the care and treatment of our brains,” Coyle said. “This fragmented approach has led to a lack of coordinated care for our family and friends across the state.”

Le Ondra Clark Harvey, director of policy and legislative affairs for the California Council of Community Behavioral Health Agencies, also called for an integrated approach to treating mental health challenges.

“For too long, our state has compartmentalized mental illness and substance use disorders as though they are separate conditions,” Clark Harvey said. “As the state becomes more aware of behavioral health, this should be reflected in how the state funds treatment and defines, expands and supports the workforce who provide behavioral health services.”

This story was originally published November 24, 2019 at 3:01 AM.