Special Episode: Health Care – Interview with Dr. S. Monica Soni of Covered California

CAPITOL WEEKLY PODCAST: Capitol Weekly and the University of California Student and Policy Center presented A Conference on Health Care on Wednesday, October 1, 2025 in Sacramento.

In today’s episode we present the Keynote: A conversation between Dr. S. Monica Soni of Covered California and Capitol Weekly Editor Rich Ehisen.

California is reeling from devastating federal budget cuts to health care and social services while state leaders grapple with shortfalls in our own Budget. Whatever happens in DC and Sacramento, California’s health care system is poised to see major changes.

Stick around til the end; Rich and special guest Robin Epley of the Sacramento Bee tell you Who Had the Worst Week in California Politics.

 This transcript has been edited for clarity.

RICH EHISEN: All right. Well, thank you, everybody, for being here. Thanks, Tim. Thanks to all the sponsors. Thank you, thank you, thank you. And thank you, Doctor Soni. I’m really interested in this conversation because you know, I think so many Californians rely on covered California as the pathway to get their health coverage. And, of course, our legislature this year has been very outwardly vocally focused on affordability. So this is really a good place to start because we, you know, we’ve talked a lot in the first couple of panels about the impacts of H.R.1.

And really here, too, we fold in our own budget problems here in California because it’s all really impactful around Covered California. I want to make sure I have the numbers right. I believe it’s a little less than 2 million Californians get their health care coverage through a plan they found through covered California. Is that correct?

MONICA SONI: Yes, that’s correct. And we had a record high. So we’ve had, continued to have growth year over year, and we hit nearly 2,000,000 in 2025.

RE: Okay. Well of course, one of the biggest issues right now is whether or not the federal tax exemption subsidies are going to stay in place that make those premiums more affordable for Californians. I believe they expire on December 31st. Correct?

MS: They do indeed.

RS : All right. Well, I’m essentially going to ask you to, to try to predict the unpredictable here, but are not predict, but just maybe give us an idea. Where are we at with that? Because it’s not the exact same thing as the rest of the budget stuff we’re going through. But it is obviously a huge component. So where are we in terms of the situation with the tax credits/subsidies?

MS: So I’ll start a little bit with that 2 million number. So, 90% of those folks actually get some form of financial assistance to be on a Covered California supported plan. And I, you know, I’m a primary care practicing doctor. When I came to Covered California about two and a half years ago, I was curious. I was like, well, who are the people that we serve? And it’s really working poor. I mean, these are the folks that we support. It’s folks that make a little bit too much money to be on Medi-Cal, do not get it through their employer for whatever reason and have not aged into Medicare. And so the subsidies are critical. I mean, $5 makes a difference for folks in deciding will they get insurance this year or will they not?

They expire. That was what the tax law was at the end of this year. And I guess, I would start maybe, because I’m like a silver lining person I’m not a black cloud, with gratitude that even… that there is dialogue about this right now. There was a possibility that nobody was going to talk about it, and they were going to expire at the end of the year, and folks would just drop off of coverage. But actually, you see that this is the center of the some of the debate about the shutdown. And so we have public attention and energy around potentially an extension or of course, in our dream that they’re made permanent.

RE: And I would add, in addition to the working poor, a lot of entrepreneurs, I, I was talking to somebody yesterday who runs a framing shop to frame some photos for us. And she we got into this conversation and she was telling me without Covered California, that was the only way she could afford health care coverage at all.

“These are folks that often are multimorbid, right. They’ve got chronic conditions, high blood pressure, diabetes. This is not a population that can forego care” – Dr. S. Monica Moni

MS: 100% entrepreneurs, independent contractors, gig workers. I mean, you know, and of course, families. It’s it is California, right? The fabric of California is represented in Covered California. It’s extremely diverse, like I said, both from a socioeconomic perspective but from a race/ethnicity perspective. Languages spoken. We really are sort of this microcosm of our state.

Dr. S. Monica Soni, interviewed by Rich Ehisen at The California Health Care Conference, October 1, 2025 in Sacramento. Photo by Joha Harrison, Capitol Weekly.

RE: Now, again, this number may be fluid, but I understand you have a general idea of how many folks may lose their coverage if these subsidies are not renewed before December 31st. Can you share that with me?

MS: Yeah. I mean, we have some of the best modeling, I would say. And we’ve been looking at this number from every angle we can look at it. And the number is it’s it’s jaw dropping. It’s staggering. It’s 400,000 people that we expect to go uninsured who do not have another source to be able to get that coverage if the subsidies are not extended.

RE: That’s about the population of the state of Wyoming if anyone is doing comparisons. We talked a little bit, of course, about the working poor and about, you know, entrepreneurs, etc. but what other communities really stand to be hurt by this the most, losing this affordability aspect?

MS: The thing that’s really interesting about who we serve is, like I said, it’s really everybody. And you have folks that are a little bit too young to be able to qualify for Medicare, but it’s very expensive for them to be able to buy coverage independently if they were to attempt to do that. And these are folks that often are multimorbid, right. They’ve got chronic conditions, high blood pressure, diabetes. This is not a population that can forego care, right? You want to keep people healthy. And actually, frankly, for all of us as taxpayers, we want to keep them healthy before they go onto Medicare, which we are all paying for as taxpayers anyway.

And so that is a particularly vulnerable group, right? Those folks in the 60 to 64 age range. And then I’ll just give you some of the numbers as to what folks are facing. So this is from December to January, what you would have to pay in terms of premium for folks that are getting subsidies, which I said, most of the people we serve…

A 92% increase in their premiums December to January. And that number is worse for our communities of color. Over 100%, 120% increase in what an individual would see from one day to the next. I mean, these are…. this is sort of it’s outrageous. How can you expect somebody to come up with funds for care that they need and are already getting today?

“Someone was talking about the celebration that we should do. I mean, like, that is we should celebrate that as a state, right? Like, we went from 17% uninsured to under 6%” – Dr. S. Monica Soni

RE: Yeah, especially if you’re talking about a chronic disease like diabetes or any of these other things. You know, we’ve all, we’ve been hearing stories for a long time about people cutting their insulin medications in half and trying to parcel them out that way because of the affordability issue. That’s really a staggering and very scary perspective. I’m also concerned about maybe the impact on overall public health. I mean, we’re only talking here about getting health care coverage through Covered California, but having 400,000 people suddenly lose their health care coverage is going to chain out in a very big way. Maybe share a little bit of how that’s going to chain out, not just on the access aspect for people, but also the possible overall health impacts for the rest of the population.

MS: Yeah. You know, I practiced before the ACA was passed and I continued to practice in Los Angeles County. That’s sort of where I’ve done my clinical practice, and I just I remember it would be a daily occurrence that somebody would walk into the emergency room with metastatic cancer that could have been prevented. A 40 year old with cervical cancer, who frankly, I was now starting to have hospice conversations because of how advanced the disease was.

That is very infrequent now. That’s not actually what the day to day experience is, because of all the advances we’ve made in the state of California. And I know earlier in the morning, someone was talking about the celebration that we should do. I mean, like, that is we should celebrate that as a state, right? Like, we went from 17% uninsured to under 6% and we did it regardless of documentation status, finally. And so our health systems were actually able to do upstream preventive care and not the, you know, advanced late stage care that often presents in the emergency room.

I actually, and maybe this is hyperbole, so you can tell me if you think it’s hyperbole, but actually, I feel like we will be in a worse position with the erosion across our programs, Medi-Cal, Covered California, than we were ten years ago, because at that point in time we had all these, what I would call collaterals, right? Like a back end way to get someone to an ophthalmologist. Or we had programs like Myhealth LA in LA and the equivalent in San Francisco that were sort of had been elastic to absorb the volume. Those are gone.

We don’t have back channels. We don’t have those programs anymore. Right? Folks are sort of accustomed to having folks have coverage and get coverage through all the same pathways. So that’s the part that makes me feel really worried. You have folks who will show up in the emergency room who had previously been getting care. Now, with no place to go and an inelastic system unable to absorb them and no back channels anymore. We’re not as flexible as we actually used to be ten years ago.

RE: Well, on the back channel thing, you know, we’re starting to see also maybe more in the private sector. I see things like Amazon, and menopause care. I think we were talking about that earlier. That has to be a little concerning to you to see, I mean, do you really want to get your healthcare through Amazon?

I mean, maybe address a little bit about what is going to actually be showing up and people are going to be asked to maybe consider that as a viable option.

Dr. S. Monica Soni, interviewed by Rich Ehisen at The California Health Care Conference, October 1, 2025 in Sacramento. Photo by Joha Harrison, Capitol Weekly.

MS: We’re recorded, so I cannot comment on Amazon specifically, but I will say there’s this interesting tension right about, does everybody just want high tech, on your phone, you know, pay cash, right?… This is a real policy dialogue that’s happening… for their care. Do we really need quote unquote big government intervening in putting these programs in place?

You know, I read the studies. I look at the surveys, I think, you know, yes, of course, across every demographic, folks want convenience. They want to be respected, they want to be listened to, listened to and they want their care needs met. But again, like I’ve spent my entire career from training and to, you know, clinic on Fridays, taking care of folks that mostly the systems have not cared for very well. And I’m not saying that that digital tools won’t work for them, but I do think generally, like how to develop trust, meet needs, both socio, social health needs and mental health needs, physical health needs, is often more complex than what one click on a phone can give you.

And I think the evidence is clear. Coordinated integrated care…. primary care as the center of our health system is really what we should be building versus a bunch of point solutions, which actually might be more costly but not keep us healthier in the long run.

RE: Yeah, health care by chatbot. That ought to scare everybody.

You know, Medi-Cal has got a big role in all of this, too. In California’s overall health care. We’ve been talking a lot about access to health care and the impact on clinics. How does that play into Covered California?

MS: Yeah, I mean, one of the beautiful parts, and this is also a comment in the morning, was about all the things that had been working well. Medi-Cal and Covered California, we have an integrated system. Part of the reason why California did so well with the unwind of the public health emergency was that we really were able to automatically enroll almost 200,000 people from Medi-Cal who were eligible for Covered California with minimal needs from them. Because the government is working well and in an integrated fashion.

We have navigators that, you know, thousands of navigators across the state in community, in language, that support folks regardless of how they get insurance. We win. If someone goes to Medi-Cal, we don’t need them to come to Covered California. It’s just about making our health… the state of California’s health better. And so, you know, any time there is an erosion of funding or red tape on the Medi-Cal side, we really worry just because we’re Californians and state employees.

And the other part that’s really challenging is if you don’t meet the Medi-Cal requirements, you cannot come onto the exchange. That’s part of the law. So you’re sort of by force forcing people off of coverage, and there is no place they can go. We cannot catch them under this new rubric.

RE: Let’s talk a little bit about messaging. Messaging in healthcare has been a real problem for a long time. And especially now we have this whole MAHA thing coming from, from D.C. it’s around vaccines and a lot of other things. Talk to me a little bit about the messaging changes, I guess, that Covered California might be either considering or planning to implement because, you know, if you’re going to lose all the subsidies, it’s going to have this impact we’re talking about.

How is this impacting the messaging and trying to get out the information that you need to have out there to the public?

MS: One of the things I love about Covered California is that we’re really a listening organization. So we run, you know, dozens of focus groups every year. We do thousands, you know, survey thousands of folks to get a sense of, you know, why would you get coverage? Why didn’t you get coverage? What are the needs that are not being met at this time? We’re out in community listening at, you know, I go to churches sometimes, listen to folks after they’re, you know, the congregation meets. We really try to listen and adapt. And I will say some of our previous messaging had been around affordability, right?

“If someone does have a chronic condition, if someone is in the middle of a cancer treatment, they have to save money now if they’re going to continue their plan” – Dr. S. Monica Soni

It was that you can get plans for free. You can get plans for $10. That is unlikely to be the case for so many folks. And so I just I give a lot of credit to our communications and our marketing team. If folks haven’t seen it… It makes me cry every time. Our new, our new marketing ad came out. And it’s literally just called “For the Love of Californians”.

And it’s such a, to me to have the narrative in the world, frankly, when we’re hearing a lot of hate, to be saying the opposite, like, we are here for the love of you, to care for you in whatever way is necessary. And sometimes it’s not going to be a win at the end of the day, but we’re here to still fight for you and haggle for you and try to support you.

So from a marketing perspective to what we’re doing when we pound the pavement, to frankly, we sent out messages to every person who’s currently on Covered California saying, look, if the subsidies go away, like this is how much you might have to pay. We don’t know yet. There’s a lot of uncertainty, but we’re not keeping secrets to ourselves.

If someone does have a chronic condition, if someone is in the middle of a cancer treatment, they have to save money now if they’re going to continue their plan, right. Like people have to make choices starting now to be able to afford coverage. In, you know, in January. So we did send those messages out. We are kind of renewing and refreshing our approach. We’re not going to do some big splashy, you know, people might remember the Covered California bus. That’s not what the campaign’s going to be. It’s going to be like out in the world trying to make sure, similar to what was said this morning, like, what do you need to do and how do we support you to get whatever kind of coverage or care you need, even if you can’t afford it with us.

RE: Do you have a sense that people understand the, the urgency of this? Not that… I mean, there’s very little we can do out here in the world, but do they understand that message that you really need to start preparing for this now?

MS: I think so. I don’t, I always feel impressed when I’m out in the world. Like the questions are hard. The questions are good. There’s like healthy skepticism about like, are we a good actor or are we a bad actor? Like, what is government doing?

I mean, I think people are really engaged and hungry for change and curious about what is happening. So do folks exactly know, you know, how much money I need to keep in the bank? You know, I think we’re trying to help support them on that front. Do they realize that any day now, maybe they might reopen the government and potentially make a decision about subsidies? Maybe not the specifics of that, but do they realize that what’s playing out in D.C. has a direct impact on them? I think people do.

RE: So we talked about the marketing, but maybe tell some of the other ways that Covered California is trying to be prepared for these possible changes. And I know there’s still so much uncertainty. We just spent all this time talking about the uncertainty around the subsidies. But there’s a lot of other stuff, too. So maybe tell us how how you’re prepping for all of this.

MS: Yeah. I’ll give one example of something that’s done and then another example of something that’s kind of burgeoning. So one is you know, so CMS released some data. I think someone made a comment this morning about that the rhetoric is about worthiness, right. Who’s worthy of coverage? And that’s the same on the exchange. The rhetoric has been fraught, right?

There’s so much fraud. All these folks are on the exchange that aren’t actually getting care. And so CMS released some data that got picked up by some conservative think tanks. And then there was some sort of Wall Street Journal op eds about it. And when we looked at it, we were the only, we’re the only state based marketplace that has claims of our own. We have all of our, all the billing information, all the claims from all of our plans. And that team, that health informatics team is part of sort of my portfolio. And I was like, that’s not what our data looks like. And actually, we have much more nuance about, you know, are the folks that are on exchange actually getting care or not? Right? Is it a wasted dollar or actually are they getting care?

And so within a month we were able to run our own, rerun our own analytics, write a piece and get it published in Health Affairs, sort of as a rebuttal to what was being communicated sort of nationally. And so this is sort of the idea of like, are we meeting the moment? Are we both providing information and also trying to help protect our folks? So that’s like the type of thing we’re trying to do in real time.

And then to your point about things that are at risk, we’ve talked about this morning, you know, all of our laws point towards things like ACIP or USPSCF, right? The panels that make the recommendations around preventive care and vaccine. Right. They point to those. That’s how it’s how you get zero cost preventive care.

And so we’re very grateful for the trailer bill that came through that revised that to allow the California Department of Public Health to potentially adjust. But like, how do you disseminate that across our entire ecosystem? So we, I just the, the strength of the state right now, I don’t want to minimize… like we’re on group chats. We’re, you know, every day emailing like it’s my counterpart at CalPERS, my counterpart at Medi-Cal, three primary care physician women. And we represent over 45% of all California across the three public purchasers. Like that’s pretty substantial.

And so to be able to be coordinated with California Department of Public Health, I know there are folks in the audience too, is very critical. So I think we’re trying to support the Department of Public Health in information dissemination, listening, keeping our ear to the ground. How do we think about helping folks make the right decisions for themselves when there’s so much noise through so many channels?

RE: There’s definitely noise. Yes. I want to stick to something you said to essentially dealing with quality control and the Quality Transformation initiative. I really want to ask you about that. Can you explain what that is to folks and how that works? And the goal behind it?

MS: Sure. So, you know, I think we did, we as a state did great in terms of coverage, right? We essentially went from, like I said, 17% to under 6% over that decade. But what did not seem to have changed, at least for the exchange population, and I would say probably other lines of business too, including Medi-Cal, is the quality of care was not clear that people were getting healthier for that coverage, right?

Medi-cal? Yes, Medicaid saves lives. I think that had been well demonstrated. But in the exchange, we didn’t have that same robustness of data. And we saw, you know, we have 12 or 13 different health plans, some of whom for some other quality measures were the 25th percentile. It’s pretty bad right? So if you’re paying money, hard earned money for your care, and maybe you are landing in a place where you’re not getting basic preventive care. Is that acceptable to us? Well, for us, we’re an active purchaser. That was not acceptable to us. We said, look, if you’re going to come and be on the exchange health plans, we have some expectations for you. And if you don’t meet those expectations, we will kick you off, number one. And number two, there’ll be financial consequences for you.

So we just chose a few things. Diabetes control, blood pressure control, colorectal cancer screening. We did choose childhood immunizations, which has been particularly challenging. But we did that with those three purchasers. And we now have two years worth of data, like real money on the line for the health plans.

And we have seen outside of childhood immunization, which I’ll put in its own category, improvement across all of those three measures, to the point where all of our folks that have diabetes actually are above the 66th percentile compared to national benchmarks. And for plans that did not actually achieve that, there were, there’s money on the line. It ended up being $15 million that we ended up collecting in 2025, and we put that money back in the pockets of our enrollees.

We gave them funds to be able to purchase food for folks that were food insecure. We’re funding child savings accounts for kids who are two and under. Right. Like this isn’t being absorbed into the ether. It’s actually going back to our enrollees and the providers that care for them. So this is like the state can do a lot with sort of the will and in response to what folks are asking us to, to meet the moment to meet.

RE: So I, I can’t leave this one without talking about the vaccines, because that’s obviously such a hot topic right now too. Maybe expound a little bit on the role Covered California has in immunizations and what are any potential changes happening there?

MS: So, you know, as you all know, with the Affordable Care Act, there was a suite of services that are free, right? There’s a suite of things that are like, it’s free if you get your colon cancer screening, it’s free if you get your breast cancer screening and vaccines.

But things change. Science change guidelines get updated. And so as part of that law, it was the federal panels that made those decisions. And those panels have been reformed, or all of those folks have been let go. And so then you’re left sort of in this limbo, right? You definitely want folks to have access to preventive services at no cost. But are you confident that you know what the experts are saying or that those services are actually what’s recommended still?

So again, that was some of what the trailer bill corrected for. But also we just we just like with the Department of Public Health, with the other public purchasers, with many folks, UC system folks stood up public health for all Californians together a coalition again to like, listen, respond, think about what a media strategy is around vaccinations. Think about how to make sure we’re not missing the mark with some of our public health messaging, too. Because again, things are moving so fast that if we’re not as nimble and connected as we can be like, we’re going to, we’re going to we’re going to miss it, right? We’re not going to be able to protect people and to keep our kids healthy.

RE: All these changes. But there’s a lot of other changes too, that I noticed you guys are noting. I’m just going to run down a little list here and give me a little bit of a of a thought on each one of them. Open enrollment changes. Can you share what some of those have been?

MS: Yeah. One of the things that wasn’t discussed as much this morning was a lot of, some of this was in H.R.1, but actually a lot of this came directly from CMS. So CMS is able to issue what’s called a final, kind of final rule every year for all of the marketplaces with sort of new, new expectations. And so a lot of the red tape and a lot of the barriers were not for the marketplaces in H.R.1, but were actually in CMS final rule. The language had been stripped out of both the Senate version before it even went to the House.

“California will not be able to have financial assistance for 112,000 lawfully present immigrants. 40 other categories. These are folks who were trafficked, refugees, asylees people on work visas ,like those folks are no longer eligible” – Dr. S. Monica Soni

And that I will just say one of the provisions was that open enrollment would get substantially shortened. We run a very long, robust open enrollment to be able to capture anybody. We know that the young, healthy people wait until the last, last moment, and that is what keeps our marketplace stable. That’s what actually keeps our prices as low as they can be. And so actually that particular provision ended up not applying to state based marketplaces. So we’re going to run a sort of a regular open enrollment campaign this year.

But we are prepared to have, we have two full different scenarios loaded: Subsidies continued. No subsidies. I mean think about the like, tech infrastructure that has to be in place to be able to support two entirely different scenarios, like it’s very substantial.

RE: I do not envy you. Eligibility. We know that has changed to and some of that is from the feds and some of that’s from us. So maybe bring us up to speed on what the eligibility rules are right now.

MS: Sure. So again, not as part of H.R.1, but as part of the CMS rule… 2025 had been our first year ever able to be able to offer coverage with support for DACA recipients, and that got revoked.

So we had to call people in the middle of their year and tell them that we can no longer support coverage for them. I mean, just like heart wrenchingly horrible, right? But I will say also like to the comment about the folks who understand what’s happening. Like people are really engaged and people were appreciative of the fact that we were making the calls and explaining the situation. So there will be no folks DACA recipients eligible for 2026.

“I think I would be remiss if I didn’t say that the subsidies will be $2.5 billion gone. But, thank you to the state of California, $190 million are available to try to close some of that gap” – Dr. S. Monica Soni

The other one that you know, hasn’t gotten as much attention, I think is California will not be able to have financial assistance for 112,000 lawfully present immigrants. 40 other categories. These are folks who were trafficked, refugees, asylees people on work visas ,like those folks are no longer eligible for financial assistance. That’s 112,000 people in California. So that’s a meaningful portion of that top number I gave you of the 400,000. So yes, we’ve got eligibility changes.

RE: And I believe there’s some changes to what the offerings are for gender affirming care. Correct?

MS: Yeah. So for other marketplaces, but not for us. So California already has rules around what’s covered. Sort of similar to some of the laws around abortion and reproductive services. We already have protections for gender affirming care. It was really a question of could there be dollar…. federal dollars used to support the care for gender affirming care. So the subsidies and that was yes, that was taken away similarly from this from CMS, not H.R.1. But we are grateful. Part of that trailer bill that went through was appropriation. So dollars to be able to support gender affirming care. So there will be no lapse in the ability to provide gender affirming care from from that perspective.

I will say, though, to your point about the ecosystem impacts, the delivery system is… they’re shook, right? Like we have heard multiple programs, closed surgical services, not just for pediatric, being, you know, removed from large delivery systems. So we worry. Okay, fine. The law is there and the funding is there. But can people find a provider to be able to to, you know, serve them?

There’s still is some of that threat that anybody can report someone including, you know, like a pharmacist who is dispensing hormonal therapy, you can report someone. You don’t even have HIPAA protection. So there’s a lot in the background that I think remains to be seen about gender affirming care on the ground.

RE: Yeah, we’re definitely seeing stuff, you know, talk of setting up hotlines to report people for all kinds of things. That’s a topic for another day.

Well, look, I want to go to questions, but before we do, just really quickly. Is there anything else that you feel people should know about Covered California that I didn’t ask you about? And then we’ll open up for some questions.

MS: I think I would be remiss if I didn’t say that the subsidies will be $2.5 billion gone. But, thank you to the state of California, $190 million are available to try to close some of that gap. So we will be able to reduce and support folks with premium support. Not everybody. Right. The gap is too big to be able to close, but for some of our most vulnerable lower income folks… so that is substantial. We will have fewer folks leaving our exchange than other states will have. Which, PS, the states that didn’t expand Medicaid, so Texas and Florida, they have huge marketplaces. The impact for red states is very substantial, which is partially why you’re seeing the shutdown like this is, it’s actually it’s an issue that impacts not just the blue states or purple states.

But I’m grateful to be in California, where there was a commitment made to try to maintain affordability for folks. So we’re dampening the impacts that we may have seen, you know, without it.

RE: Well, with that does anyone have any questions? I got one right up here.

JERRY  JEFFE: Jerry Jeffe, Open Minds and Public Health Institute. Two brief questions. Number one, what’s the impact of behavioral health on the premiums? And number two, can you talk a little bit about your work in health equity? I know that’s a fairly new area.

I used to be on an advisory committee [for] Covered California, so I’m aware of some things you’ve done, but that’s one area you talked generally about Covered California, but what about specifically the, because of such the attack on health equity by the federal government? You know, California’s trying to take a different direction. And if you just talk a little bit about what’s going on in that area.

MS: Yes, certainly. And thank you for supporting Covered California in the past. Yes. And the behavioral health side. So you know, we of course have behavioral health parity. We are lucky to be in a state that actually has a lot of consumer protections on top of what some of the federal ones were. And, and we require as part of our contractual requirements with our health plans, virtual or telehealth options.

Mary Beth Barber of the California State Library poses a question to S. Monica Soni at The California Health Care Conference, October 1, 2025 in Sacramento. Photo by Joha Harrison, Capitol Weekly.

And we have actually found, just as an aside, you know, the behavioral health utilization in covered California went up substantially with the pandemic, like many others saw, but it didn’t crash back down. Our utilization is substantially higher now than it was in 2019, and over 70% of it is delivered through a virtual modality. So sort of like our people have spoken in terms of how they want to receive those, receive those services. I don’t see that there’s going to be any sort of change in that, right? Like, we try to encourage folks to be able to get behavioral health services. And so some of our plan design is designed to support both primary care and behavioral health care with sort of stable or minimal co-pay. So that’s all that’s all the same because we think it’s equally important.

The health equity question is such a good question. So if you, if you copped my bio right, My division is the Health Equity and Quality Transformation Division. I spend my entire work week thinking about health equity. And there’s been no retraction from us on that. Right. Like that’s my job. That’s what I do for California. That remains our mission and vision.

I will say Covered California’s mission has included to reduce disparities since it started and that so, you know, we’re a little bit like OG in terms of this work. And I think we’ll have our next set of data released in the next few weeks. But we released what’s called a plan performance report, where all of our clinical metrics are stratified by almost anything you can think of. Certainly race, ethnicity and language, region, income, rural, super rural. And we are moving into intersectional stratifications where it’s multiple factors combined. Where do we see where we have the most impact? So if anything, we’re moving faster, more nimbly, forward. And we’re very transparent about it. Like you can go Google that and it’s available to anyone. So I feel very grateful to be in an organization where that work has continued.

RE: More questions. I see one in the back.

AUDIENCE: Thank you. Hi, I’m a state employee who also lives locally. Which, there’s a large number of refugees in my particular neighborhood. Have a question. When you were saying that the refugees are no longer eligible, does that include the 100% like the Medicare? And does that include the kids, and if so, where are the school districts with all of this, particularly with the requirements of physicals, vaccinations, regular checkups, etc..

MS: Yeah. Great question. And I’ll be very specific. That only applied through CMS to exchanges. So just to our particular line of business not the others. And there were a couple interesting carve outs. It’s really interesting to go look at the exact language, because I can’t totally follow why certain groups were included and other groups were excluded. But yeah, no refugee status is no longer eligible for financial support, on federal dollars for financial support, only on the exchange. I have not heard that there’s any other retraction. And, you know, certainly in the, in the Medi-Cal space, that would be I would be surprised if there was retraction there.

RE: Another question.

AUDIENCE: Hello, my name is Angel. I work for International Rescue Committee, so I work with refugees, specifically immigrant health. Overall something, as you mentioned, DACA recipients, their coverage got terminated in August 30th of this year. It’s unfortunate, especially because uninsured, their health is unpredictable, becomes unpredictable overall. So I wanted to know what kind of advocacy is Covered California doing for them?

Dr. S. Monica Soni, interviewed by Rich Ehisen at The California Health Care Conference, October 1, 2025 in Sacramento. Photo by Joha Harrison, Capitol Weekly.

MS: We do a bunch of technical assistance. So California has the largest DACA population in the United States. We, leading up to it, really support the work of other advocates in the room and amplified those messages showed that it would be cost affordable, better for us all to be able to support them. And as soon as we had the opportunity, you know, again, pounded the pavement to try to to re-enroll folks.

The problem is we are, we are governed by by CMS. And in terms of financial assistance, like there, it’s, we don’t have an ability to to sort of rebut that. Although, I will say our Attorney General has been very active from a litigation perspective. So the gender affirming care provision is still being litigated, even though California is mostly protected. A number of the provisions under the CMS final rule is also being contested, and there was actually a stay for some of those provisions as well.

So I think where we have the opportunity, it’s going to be in court, like that’s that’s going to be where it’s got to be fought out. And we do lots of technical assistance to support any active litigation.

RE: I have a question. Because, you know, I think this administration has been pretty blunt in maybe saying the quiet part out loud sometimes about wanting to literally break the will of some of the entities, states they don’t like, including us, obviously. How is the morale around Covered California right now with all of this going on?

MS: Yes. Some of you in the room know me, and I, I was a cheerleader. [Laughter]

And I don’t know if that gives me, like, extra resilience or what, but, like, I try not to be toxically positive, but I do, It’s not hard for me to, to find the motivation, at least the to the next task. And one of the things that has been very helpful to me is many of the folks at Covered California have been there for 12 or 13 years. So since it was started, right where it was like eight people creating covered California and they were here under the last Trump administration.

And so just the like, level headedness of folks there, it helps me to get out of bed and do my job like we did survive that one. Right? And then we saw record growth. We saw the state step up in really critical ways. And so one is that, the team is mature, sophisticated and lived through some of this. So that helps me. And then I do I think the, who was I talking to? We were talking about sort of allies in all sorts of places.

Like everyone here in California, it feels like wants to help, is opening up any resource. They have people time. Not a lot of money to go around, but money if they’ve got it. You know, expertise to like, offer what they can offer. And that I mean, certainly in the state, we’re working way across silos, but across all sorts of other sectors. So that also has uplifted morale a bit. Right? Which is no one’s like staying in their lane like it’s all of our lanes. And what can we do to help? And that maybe keeps us a little bit more buoyant.

RE: Got all hands on deck. One last thing. You know, programs do not start from scratch and are operational tomorrow. That’s not how they work. Winding them down doesn’t work that way either.

Let’s make a wild presumption and say things are dramatically different after November of next year, or 2028? How scalable back up are a lot of things that we’re talking about here. I mean, I know the research folks, the research panel before, they’re talking about how you break things sometimes it’s really, really hard to unbreak them. Jodi was talking about this this morning to at Planned Parenthood. It’s really hard to, you know, when something is closed to just try to reopen it. It’s almost impossible.

What is the lay of the land there for Covered California in terms of what you’re offering? What may go away, and whether or not that could somewhat easily, or not be brought back?

MS: Yeah, I think for us easily, easily. I mean, I think the fact that we have two entirely different scenarios right now in a very complex tech system is just a good example of like, we’re ready, we’re ready now, and we’ll be ready tomorrow. Frankly, even if the subsidies aren’t extended this year, even if people have started on their plans without subsidies and then money comes later, we will find a way to get that money to people. And is it easy? Is it going to be cheap? No. But will we do it? 100%.

That mentality at Covered California, it’s very much like a startup mentality in, in government. So like that’s not the, like that’s going to be hard, and we can’t, that’s we don’t that’s nowhere in our worldview right now. And I guess I would challenge us all to think about that differently. If there is something that’s going to have a very long, long runway, of which of course there are things, what do, what are the small things we could do now to start to plant the seeds, you know, to shorten that, that cycle? I just think even in the workforce spaces, it’s worth thinking about. Even if it’s trust building, even if it’s keeping the pipe, the pipelines or the pipes warm, like there’s just stuff that could be done to mitigate or dampen the impact. So maybe that’s what we need to be doing, right? Harm reduction.

RE: Any other questions? Seeing no other questions. I will, I will release Dr. Soni from her, from her obligation to be sitting here next to me. Thank you all very much.

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