Disgusted with federal attacks on Obama-era health reforms, a broad coalition of organizations and advocacy groups is pushing the state Legislature to enact a series of bills designed to expand health coverage in California and make it more affordable.
Labor unions, women’s groups, medical organizations, and immigrant and community activists are part of the more than 50 members of the Care4All California coalition. The top of their agenda is expanding Medi-Cal eligibility to all undocumented immigrants and increasing subsidies for people who purchase health insurance plans through the Covered California exchange.
The plan is not designed to compete with proposals for a single-payer health care system, said Anthony Wright, executive director of Health Access California, which is leading the campaign. Instead, it would allow California to move closer to achieving universal health care coverage at a time when the federal government is unlikely to sign off on allowing the state to pursue a single-payer plan, he said.
“We feel the opportunity and the urgency of getting more people covered and addressing issues of cost and equality in the health care system, and doing so in the short term without the need for federal approval,” Wright explained. “If we can forestall the repeal efforts at the federal level, then there’s real progress we can make in California, and that does not require us to run into a brick wall with the Trump administration.”
Altogether, the plan includes at least 20 pieces of legislation and budget items, some of which have been debated in the past and already introduced. Wright said the remaining pieces would be rolled out in the next couple of weeks. He said the coalition is confident many of the changes can be accomplished this year.
Expanding Medi-Cal eligibility to undocumented immigrants and increasing subsidies to make Covered California plans more affordable could reduce the state’s uninsured rate from its current 7 percent to 1 or 2 percent, Wright predicted. California’s high cost of living means some families still can’t afford health insurance, even if they’re eligible for subsidies, he said.
Other proposals in the package include measures to regulate health insurance company profits, cap co-pays for prescription drugs, and establish more oversight of health company mergers. Some components aim to undermine federal efforts to weaken the Affordable Care Act. These include banning lower-quality plans favored by the Trump administration and imposing a state-level individual mandate to purchase health insurance, replacing the federal mandate repealed in the Republican tax bill.
The cost of these changes and how they’d be paid for has yet to be determined, Wright said. Some could be accomplished within the state’s current budget, he added.
Gerald Kominski, director of the UCLA Center for Health Policy Research, said the coalition’s approach is a good strategy.
“If you can’t do everything at once, it’s better to do something to move things forward than to sit on the sideline and say, well we can’t have complete dramatic change, so therefore we’re not going to do anything,” he said. “I think there are millions of Californians who continue to suffer every day because they don’t have adequate access to health care, and anything we can do this year to reduce that suffering is a good thing.”
In a statement, the California Medical Association offered its support for several pieces of the proposed legislation, including expanding Medi-Cal access to undocumented adults, and further regulating for-profit insurers. The organization added that the state should also take measures to address a shortage of health care workers in many California counties.
Meanwhile, the California Nurses Association, which sponsored the single-payer bill, criticized the Care4All effort. Stephanie Roberson, director of government relations for the CAN, said the proposals are a “piecemeal approach to a problem that needs a global, comprehensive solution.” Specifically, the plan wouldn’t help Californians who have insurance but can’t afford to use it, she said.
“We’re skeptical,” she said. “There’s nothing in the … package that this coalition is moving forward that will actually fix the growing crisis for people who pay for insurance and skip needed care due to high out-of-pocket costs, deductibles and co-pays.”
The California Health Report is a statewide nonprofit news service that covers health and health policy.