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Getting all Californians health care coverage will be gradual process, 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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There’s an old saying in politics: “You campaign in poetry. You govern in prose.”

Gavin Newsom’s approach to health care policy reflects this thinking. Newsom’s most ambitious campaign promise last year was to provide health care to all Californians through a government-run, single-payer system. But as the election drew closer, qualifiers like “inevitably” and “ultimately” began to creep into his conversation, suggesting a longer-term effort would be necessary.

The California Influencers prescribe a similar approach to providing universal health care to the state’s residents. While they agree that achieving 100 percent access should be the ultimate goal, most of them emphasized a range of intermediate measures to move gradually closer to the target.

“Next steps: expand insurance premium subsidies for low-income families, establish a state-level individual coverage mandate and make coverage available to undocumented individuals,” said Carmela Coyle, president and CEO of the California Hospital Association. “It’s time to finish the job.”

Assembly Speaker Anthony Rendon is one of several Influencers who is more measured than Newsom about the path forward.

“I absolutely believe California, and our nation as a whole, should make certain that every person has access to quality health care. It is one of the defining challenges of today,” said Rendon, who has come under fire in the past for not supporting immediate single-payer legislation while pushing for a more gradual approach. “We have the building blocks to transform our health care system and a path to take on a thoughtful approach towards that goal.”

But words like “building blocks” and “path” are a red flag for more aggressive advocates like Bonnie Castillo, the California-based executive director of National Nurses United.

“Nurses every day care for people denied care due to cost, insurance restrictions, and disparities created by a system premised on profits and ability to pay, not patient need. It’s inhumane, and it must end,” Castillo said. “If our elected leaders believe, as many profess, that health care is a right, not a privilege, there’s only one solution, guaranteed care for everyone through… single payer/Medicare for all.”

But most of the influencers recognized that incremental progress was the most plausible route toward more ambitious objectives.

“While I’m not a fan of chipping away at the problem, I’ll rally behind any thoughtful advance to make coverage for all a reality,” said Sierra Health Foundation President and CEO Chet Hewitt.

California Health Access Executive Director Anthony Wright said he agreed with Newsom’s plan for a “more efficient, effective, and universal Medicare for All-type system.”

“Complementary short- and long-term steps to a universal system will provide health and economic benefits for not just the uninsured, but their families and the community as a whole,” Wright said.

Other Influencers say reining in health care costs should be the higher priority, suggesting more affordable care would lead to increased access.

“Access to insurance does not mean access to care. It doesn’t matter if you have an insurance card if you can’t get in to see a doctor or your co-pay is prohibitively expensive,” said state Assemblywoman Marie Waldron (R-Escondido), who has proposed ways to reduce bureaucracy, increase competition and consumer choice, raise Medi-Cal provider rates, and create incentives for providers to work in rural and underserved areas.

Hoover Institution Fellow Lanhee Chen agreed.

“The state has expanded coverage over the last several years, but these gains will be unsustainable or rendered ineffective if additional changes aren’t made in a fiscally prudent manner,” said Chen, a former policy director for Mitt Romney’s 2012 presidential campaign. “More government intrusion into the health-care space… will only drive costs higher and make it harder for us to expand access to coverage for those who may need it.”

California state Senator Richard Pan (D-Sacramento) pointed out that more effective management of chronic conditions, which represent the great majority of health care spending, would be a smarter way of reducing costs.

“Health plans should be competing on value, not on which plan has the most favorable case mix,” Pan said. “Reductions in the growth in health care costs from improvements in chronic diseases management including mental health care will help fund coverage expansions. In fact, expanding coverage may prove to be more cost effective than leaving people uninsured.”

Robert Ross, president and CEO of The California Endowment, hinted that infighting should not get in the way of progress.

“(My colleagues and I) are growing increasingly agnostic about allegiance to a single right approach,” Ross said. “Let’s just get everybody in the boat.”

Dan Schnur, a veteran analyst and longtime participant in California politics, is director of the California Influencers series for McClatchy.

Editor’s note: This piece has been updated to more accurately reflect Assembly Speaker Anthony Rendon’s view on single payer health care.

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