Formidable California Health Reform Advocate Moves to Nation’s Capital

For more than two decades, Anthony Wright has been an influential leader in the battle for health reform in California. As executive director of the consumer advocacy coalition Health Access California, Wright helped engineer significant reforms that expanded insurance coverage and access to care for millions.

Under his leadership, Health Access helped lay the groundwork for California’s successful implementation of the Affordable Care Act (ACA), the expansion of Medi-Cal to undocumented populations, state subsidies for Covered California plans, stronger consumer protections, new quality and equity standards for health plans, and the establishment of the state Office of Health Care Affordability. The California Health Care Foundation is a longtime funder of Health Access.

This month, Wright left California to become executive director of Families USA, a Washington, DC-based national health policy advocacy group. In late June, I spoke with Wright about his eventful time in California, the lessons he learned, and the obstacles and opportunities he sees ahead. This interview has been edited for length and clarity.

Q: You’ve seen a lot of progress in improving access to health coverage and care in California during your 22-year tenure as executive director of Health Access. If you had to pick the most important milestones on that journey, what would they be?

A: Obviously, the Affordable Care Act is the biggest social policy reform in a generation, if not multiple generations. In California, it’s provided both a policy and financing foundation for the state to take additional steps toward a more universal, affordable, and equitable health system. Prior to the ACA, California made multiple attempts at health reform, but it was very hard to do without that federal framework and financing.

I was privileged that Health Access was the lead advocate for the campaign to pass the Affordable Care Act here in California. That was a wild ride in terms of organizing, countering Tea Party town halls, and trying to get our representatives to appreciate how the ACA would benefit California. After the ACA passed, California went from being a laggard to a leader in terms of people enrolled in health coverage. We had the biggest decrease in the uninsured rate of all 50 states.

Q: Are there other things you would call out in terms of more recent progress that California has made by building on the ACA?

A: Much of our work has been around the budget. Over one-third of our state budget goes to the Health and Human Services Agency, and Medi-Cal is the single biggest program. It was a turning point in the 2009-2010 era when Californians voted for the revenue sources needed to sustain a budget, including for health, and also to change the threshold for passing a budget so that it could not be held hostage by a small minority in the legislature.

California is now in a much better position than we were 10 years ago. Even when we faced a bad budget situation this year, our state achieved a balanced budget while also protecting the progress that had been made. This budget stability has allowed us to make investments in our health system, whether it’s the CalAIM initiative or additional expansions on top of the ACA.

Lastly, there continues to be huge concern among Californians about affordability. Health Access successfully fought for state investments to provide assistance on the front end. These included lowering the out-of-pocket costs of Covered California plans; measures to deal with rising health care costs; protections from surprise medical bills; and broader reforms, like launching the Office of Health Care Affordability (OHCA).

Q: As you look ahead, what are the biggest issues in the health coverage and health access arenas for California?

A: While we’ve made a lot of progress getting to universal health coverage, we’re not done yet. We still need to open Covered California to all regardless of immigration status, win increased affordability assistance, and provide more automatic coverage so the burden of enrolling in health coverage is on the system rather than the individual.

We’ve done great work to get rid of the deductibles in Covered California Silver plans. More needs to be done to make sure that people with health insurance don’t face financial barriers to getting the care they need.

In terms of benefits, the legislature is just starting the conversation about revamping the essential health benefits package. That could mean requiring plans to cover specific things like in vitro fertilization and durable medical equipment as well as starting a broader conversation about getting to universal dental or mental health coverage.

Holding our health system and industry accountable for lower costs, better quality, greater equity, and ultimately better value is fundamental. There also are market failures to fix. OHCA and other oversight efforts aim to address those. There’s currently a debate in the legislature around giving the attorney general more tools to deal with provider consolidation, at least with regard to private equity.

These are all things that my colleagues at Health Access will continue to work on and that I will work on nationally.

Q: When you look back at the work you led at Health Access, what are you most proud of?

A: I have a lot of pride in the work we’ve done to empower people and organizations to engage in health policy and be their own advocates.

I’m proud of our work to prevent surprise medical bills when people go to the hospital and are seen by an out-of-network doctor and our successful campaign to end surprise ambulance bills. I’m glad for the work of the whole #Health4All coalition to achieve the expansion of Medi-Cal to children, young adults, seniors, and, finally, to all adults regardless of immigration status. We’ve also stopped efforts to roll the expansion back, and I feel that makes it more secure. Another thing is our effort to make Covered California more affordable. We pushed for state subsidies so that middle-income people are no longer cut off from affordability assistance. That spurred changes at the national level.

Speaking of costs, I’m excited about the new Office of Health Care Affordability. It’s set a rule to limit health care cost increases to no more than 3% by 2029. It’s a signal to the health care system and industry that we shouldn’t have health care costs rise faster than our paychecks.

Q: What were the key ingredients that made all that progress possible?

A: One is forming coalitions to build consumer power. There are a lot of moneyed interests in the Capitol and in our health care system, and it’s not a given that the patient voice is even in the conversation, much less at the center, where it should be. It’s easy to ignore patient voices if they’re not organized — if they’re not unified.

Another is persistence. Many reforms that we passed took much longer than a year. The Hospital Fair Pricing Act was a five-year campaign. The Prescription Drug Transparency Act was a three- or four-year campaign. If you don’t give up, you’re never defeated — you’re only delayed.

Q: You’ll be taking the helm of an important national advocacy organization, Families USA, on the eve of a presidential election. What are the stakes of this election when it comes to Americans’ health care?

A: Our health is on the ballot. Depending on how the election shakes out, I’m concerned that the Affordable Care Act could be repealed. That would lead to a dramatic loss of coverage and patient protections and create chaos in the health care system. Clearly there’s also a danger that access to reproductive health and abortion care could be further undone.

There are a couple of other issues. In the past few years, we authorized Medicare to negotiate better prescription drug costs. Will that be expanded or rolled back? Then there’s the additional affordability assistance in insurance marketplaces like Covered California. Right now, nobody has to spend more than 8% of their income on coverage. Do we extend that or let it expire — as it’s scheduled to — next year?  If those tax credits expire, the average monthly premium will increase over $400.

Q: I’ve heard some people say, “Well, California will make that up somehow.” Can you comment on that?

A: If the federal government undoes the ACA or even allows this additional affordability assistance to expire, the loss of federal money would be so great that California would be hard-pressed to make it up. California puts roughly a couple hundred million dollars into state subsidies for Covered California. The additional federal affordability assistance approaches $2 billion. It is hard to fathom how California could make that up.

With the expiration of the affordability assistance, the most recent projection is that five million Americans would lose coverage. That doesn’t include the impacts that would ripple through the entire health system and affect everyone who relies on health care.

Q: What excites you the most about your new role?

A: If we need to wage a defensive fight, I want to be in that battle. But I hope that we’re working on the next stage of health reform, some of which we’ve been piloting and pioneering here in California.

I’m excited to work on those areas where you can have more impact at the federal level, such as improving employer-based coverage, Medicare, health care costs, and prescription drug costs. Other things are best done at the state level. I would love to partner with my successors at Health Access California and my colleagues in other states to help them figure out next steps.

We have a system that is complex and confusing. How can we change it? What I’m excited about is the opportunity to envision what a better health system could look like by empowering diverse voices.

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