California health care advocates discuss new challenges

SACRAMENTO, Calif. – Leaders in California’s extensive public health reforms gathered here Dec. 13 to think together about how to carry forward the state’s achievements, as the incoming administration of President-elect Donald Trump portends a very uncertain future.

The discussion emphasized the urgency of building a broad national health care reform campaign, forming networks across issues including immigrant rights, labor rights, environment, housing and homelessness, jobs, and more. Participants affirmed their commitment to upholding the many gains of recent years, including building Covered California’s health exchange and expanding MediCal (the state’s Medicaid) coverage under the Affordable Care Act, as well as covering undocumented immigrants.

Following the Medicaid expansion under the Affordable Care Act, more than a third of Californians, and over 60 percent of children, are now covered by MediCal. Some poorer Central Valley regions represented in Congress by Republicans have the highest proportion of MediCal coverage, topped by Tulare County at 55 percent.

The afternoon also featured many tributes to the broad Health Access coalition, now celebrating its 30th anniversary. The coalition’s 100-plus members include health policy organizations, health providers, labor, immigrants, women’s, seniors and LGBTQ rights organizations, community and religious groups.

In his keynote remarks, Health Access Executive Director Anthony Wright outlined the problems the state’s public health care community faces. “The scale of what we’re talking about is major,” he said, rivaling the slashes to health care eight years ago during the Great Recession.

The first fight will be the repeal of large parts of the Affordable Care Act, he said, with the U.S. House of Representatives voting in early January followed by a Senate vote in mid-January, so the new president can sign the legislation on or soon after Inauguration Day.

“If Congress can rip away the health care for 30 million people without a pushback,” Wright said, “it will just keep going. Our first job is to be very clear: it is wildly irresponsible to repeal the ACA, especially with no replacement in place. Three or four senators, a handful of House members, need to recognize the chaos and backlash that would cause, and see the cliff they are now hurtling toward.

“So,” Wright said, “we need to be prepared for a sprint in January, and for the marathon ahead.”

Wright emphasized working with and educating California’s large Congressional delegation, and the importance of being part of a broad national campaign.

On its 30th anniversary, Health Access can point to a long list of achievements, from its fight in the mid-1980s to outlaw “dumping” of uninsured patients, through the coalition’s recent role in supporting the launch of Covered California, the state’s health benefits exchange under the ACA, and making sure the MediCal expansion included immigrants, LGBT communities and people of color.

In just four hours, featured speakers and panelists including leaders from a broad range of health-related organizations shared their perspectives on waging the most inclusive and effective fightback.

Health Access’ Tam Ma noted that without the Affordable Care Act, millions wouldn’t be able to afford coverage, and millions more would fall out of the safety net. Preventive care would cost more than people can afford, and insurance companies could pick who and what conditions they were willing to cover.

“This was the reality until not too long ago,” she said. “It would be hard to imagine going back to a world without the consumer protections and financial support provided through the ACA and our other health care programs.”

State Senator Ed Hernández, D-West Covina, who chairs the Senate Health Committee, put it this way: “We have a two-tiered system: one for those with means and one for those who are poor. You can predict someone’s life expectancy by their zip code. What does that say about the most powerful country in the world?” If we care as a country, he said, “we have to ask that question of those who would dismantle what we have.”

Edwin Park, of the Center on Budget and Policy Priorities, envisioned two stages: repeal of the Affordable Care Act without any guaranteed replacement, and then, if a replacement plan is enacted, threats to Medicaid and Medicare.

“We are seeing the largest threat to the social safety net that we have experienced,” Park warned, with 10s of millions threatened with loss of coverage, impaired life expectancy, and financial catastrophe.

SEIU State Council Executive Director Alma Hernández added, “In California, we are as close to universal health care as we ever have been. We have to make sure every conservative district in California understands the life-altering consequences their decisions have made.”

State Sen. Ricardo Lara, D-Bell Gardens, who chairs the Senate Appropriations Committee, urged standing together as a united front and rejecting “little crumbs” from the incoming administration.

The “united front” theme ran throughout the discussion.

Diana Dooley, who heads California’s Health and Human Services Agency, said the state’s expansion of health coverage has been so successful because it was a bipartisan effort starting during Republican Arnold Schwarzenegger’s term as governor in the mid-2000s. She urged informing members of Congress about the real consequences of precipitous action, and called on meeting participants to explore possibilities to interact with “red and blue states together.”

The California Pan Ethnic Health Network’s Sarah de Guia added, “It’s not about different groups, it’s really about the intersections of these groups. The LGBT, immigrant rights, communities of color who are limited-English-proficient, undocumented communities – all these intersections have to be at the forefront of the policies we put forward.”

Peter Lee, Executive Director of Covered California, cited the major role licensed insurance agents have played in the exchange’s expansion by signing up millions of new participants.  “Advocates take a lot of shapes and forms,” he said, “and we should be working with all of them.”

The California Immigrant Policy Center’s Ronald Coleman summed it up: “We haven’t yet looked at a horizontal expansion to make sure all Californians can benefit and get out of poverty.” He called on meeting participants to “make sure we are investing in programs so all Californians are thriving and we’re not just focused on who may benefit from programs today.”