Promising to build on the Affordable Care Act, a coalition of influential interest groups announced a new legislative push Thursday for a patchwork of measures that aim to make healthcare in California cheaper and more accessible.
Advocates touted a slate of proposals, including expanding Medi-Cal access to adults without legal status and increasing subsidies to those buying insurance on the Covered California exchange, as priorities for this legislative session.
"This uniquely Californian campaign seeks not just to protect our progress, but advance an aspirational agenda that is achievable without the need of approval from a hostile federal government," said Anthony Wright, executive director of the advocacy group Health Access California, at a Capitol news conference.
The ability to act independently of the federal government is a key contrast from the single-payer proposal, Senate Bill 562, which has consumed much of Sacramento's healthcare debate in the last year. That bill would rely on permission from Washington in order to establish a sweeping system that covers all Californians' healthcare costs, including those who would otherwise be on Medicare or Medi-Cal.
Wright said he did not see a tension between the approach taken by his coalition, which includes labor unions, community health organizations and immigrant rights groups, and that of single payer proponents.
"This is entirely complementary with other efforts that are on different tracks and different timelines," he said, arguing that success of these incremental measures now could lay the groundwork for single-payer in the future. "If that window of opportunity opens up at the federal level, we will be better positioned if we can get to universal coverage, if we can get to cost controls, if we can get to improvements in these key consumer protections."
The California Nurses Assn., the sponsor of SB 562, praised elements of the package — notably the expansion of Medi-Cal to immigrants who are in the country illegally — but said its proposal also would have extended healthcare coverage to that population.
"Overall, it would be less fragmented to do a comprehensive approach like SB 562 that actually solves the problem without scrambling to push piecemeal legislation, some of which only reinforce the existing profit-focused insurance system," said Chuck Idelson, spokesman for the nurses' union.
Proponents don't yet have a cost estimate for the proposal but rough estimates would total in the billions of dollars. Wright said they would seek money in the budget but did not rule out proposing new taxes to pay for the proposals.
California's uninsured rate plummeted from 17.2% in 2013 to 6.8% currently after the implementation of the Affordable Care Act. Of the remaining 1.8 million Californians uninsured, more than half are immigrants who are in the country illegally.
Advocates successfully pushed Gov. Jerry Brown to expand Medi-Cal to children without legal status, but were unsuccessful in an attempt to extend that coverage to young adults last year.
"Immigrants are an integral part of our state and shape our neighborhoods, workplaces, schools and communities," said Cynthia Buiza, executive director of the California Immigrant Policy Center. "With Health4All, California has an opportunity to remove barriers on healthcare based on immigration status."
The Medi-Cal expansion got an endorsement Thursday from the California Medical Assn., the influential lobbying group for the state's doctors. The association also backed other components of the plan, including establishing a state-level mandate to purchase insurance to replace the federal requirement repealed last year.
The scope of the package touches nearly every aspect of the healthcare system, from health plans to prescription drugs. Some measures are holdovers that were introduced last year, but failed to advance. Other elements are still to be fully fleshed out, including the form of subsidies offered to make insurance on the individual market cheaper, and the possibility of crafting a public option to ensure more options on the Covered California market.
Some components of the package include establishing quality assessments for Medi-Cal managed care plans, regulating health plan mergers and maintaining a $250 cap on prescription drug co-pays.
Other measures take aim at actions by the federal government that advocates say undermine the Affordable Care Act. One bill would ban the availability of "short-term" insurance plansthat do not have to meet requirements under Obamacare, which have been encouraged by the Trump administration. Another bill would bar work requirements for Medi-Cal, a policy pursued by several other states, including Kentucky, with the blessing of the White House.