California a key player in federal health care debate

A photo illustration of the California flag presented as a medical mask. (Image: kovop58, via Shutterstock)

Health care is once again front and center in Congress. And once again Californians will play a critical role in the federal budget debate that could result in the biggest expansion of help to access, afford, and improve health coverage since the enactment of the Affordable Care Act (ACA).

California’s own Speaker Pelosi is a veteran of health care debates, as a negotiator for the initial passage of the ACA in 2009, and now working to finally fulfill the ACA’s original vision by providing more robust affordability assistance.

The budget package also includes bold efforts to lower the cost of prescription drugs, as well as a long-sought effort to expand benefits in Medicare, such as dental and vision. These improvements have always been needed, but are well-timed as an urgent response to the pandemic, as we recognize more than ever that our health is directly linked to the health of neighbors and our community as a whole.

Given our size and high cost-of-living, no state is benefitting from this federal help more—yet it expires at the end of 2022 unless Congress takes action.

The Biden Administration already took initial action earlier this year with the passage of the American Rescue Plan, which included public health investments to counter the COVID-19 crisis, and bolster our health care system.

The package included significant new subsidies to afford health insurance in the ACA marketplaces like Covered California.

This new financial help provides individuals hundreds or even thousands of dollars of premium assistance, and a government guarantee that no one has to pay more than 8.5% of their income for coverage–and even less for lower-income families. Hundreds of thousands more Californians have enrolled as a result.

California played a key role in piloting and providing proof-of-concept for this premium assistance, when our state offered first-in-the-nation state-level premium assistance for middle-income families three years ago.

But as helpful as California’s efforts were, we can’t match the resources the federal government is able to provide. Given our size and high cost-of-living, no state is benefitting from this federal help more—yet it expires at the end of 2022 unless Congress takes action.

Congressional leaders have a strong interest in making the financial help permanent, which would prevent a big premium rate spike for California families. But the slim margins in the Senate and House make the votes of California’s two Senators and 53 House members crucial to the effort.

Beyond making Covered California more affordable, this “budget reconciliation” package includes other key health care components to help millions of Californians. This includes expanding home and community-based services, adding vision, dental, and hearing benefits to Medicare, the first update to benefits in decades, helping millions of Californians. The proposal would also expand Medicaid in states that have resisted it so far.

To pay for these investments, the proposal would ask more from the multimillionaires and billionaires that saw their net wealth increase by over 60% during the pandemic even as so many lost their jobs and related health coverage. They can pay their fair share to bolster the health system we all rely on.

Another funding source is prescription drug pricing reform. Included in the reconciliation package is the “Lower Drug Costs Act,” which allows the government to negotiate prices directly with pharmaceutical companies, and extend those discounts to all purchasers, including employers, insurers, and individual consumers.

The package also deals with problematic pricing practices, like manipulation of patents that allow some drug companies to extend their monopoly prices.

Our state has provided positive examples of how to lower the cost of coverage and prescription drugs.

California has taken important steps against some of these practices, but federal action can go further to provide real help for patients paying at the pharmacy, to reduce the overall cost of coverage and care—and to help provide the savings to make these other needed investments in our health system.

The drug companies are opposed, and have been trying to pick off Congressional members, especially in states like California where Pharma has sway. But even here, these reforms are popular and common sense.

California remains central to this debate. Our state has provided positive examples of how to lower the cost of coverage and prescription drugs, and our two senators and 53 members, including the Speaker and House Minority Leader, are significant in Congress. But what matters most is the millions of Californians who would benefit from these reforms.

Our leaders need to hear from all the Californians that will have more affordable coverage, lower prescription drug costs, and more benefits in Medicare with this package.

By asking our most fortunate to pay their fair share and finally give our federal government the ability to negotiate drug costs, we can make these long-needed improvements in the health system.

California has a critical voice in this debate—but it’s up to us to use it.

Editor’s Note: Anthony Wright is the executive director of Health Access California, which advocates for greater availability of quality health care.

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