The inauguration of Donald Trump as our next president seems likely to bring significant change to the health care system. While we at the California Health Care Foundation (CHCF) can only guess how the story will play out, the intense debate highlights to us that the foundation’s core mission — improving the health and care of all Californians, especially the underserved — is more important than ever.
We are proud of California’s gains from the Affordable Care Act (ACA). Five million more Californians are now covered, the uninsured rate has been cut in half, financial stability has increased for families and health care institutions, and thousands of jobs have been created.
Much remains unknown about how President-elect Trump will collaborate with Congress and stakeholders to reengineer the $3.5 trillion US health care system. Time will tell whether the president-elect repeals and replaces the ACA and orchestrates fundamental changes in Medicaid and Medicare.
All we have now are questions. Will new policies take effect abruptly or be phased in over years? Will coverage and care be disrupted? Will new public policies raise or lower the number of uninsured people in California and nationwide? How will changes affect lower income and vulnerable populations, such as those with chronic conditions? What will be the effects on the financial stability of payers, providers, and consumers? Will large swaths of the health care sector need to be reorganized? And what will be the impact of these potential changes on public health in California and nationwide?
CHCF is responding to changes in the federal policy environment by employing our core strengths. First, we are tracking federal legislation closely in order to understand how actions in Washington might help or hurt California’s 39 million people. We will continue to support timely, rigorously researched data on the implications of ACA policy changes and on California’s response to those changes. A primary focus will be assessments of the future of Medi-Cal and its comprehensive benefits to 14 million enrollees and of how the delivery system adapts to the changing fiscal environment. We will also consider the implications of the ACA on the health of low-income Californians and the impact of federal policy on the state economy and jobs picture.
Whatever may happen in Washington, CHCF will seek to identify opportunities to collaborate with leaders from every part of the state’s health care system to ensure that everyone, especially low-income Californians, has timely access to affordable, quality health care.
Second, CHCF will continue to test and evaluate innovative approaches to improving care. We will commission research and analysis that policymakers, clinical leaders, payers, consumers, and the media can depend on to better understand and help improve California’s complex delivery system. CHCF remains focused on maintaining and strengthening access to care and coverage for vulnerable populations in our state, including the millions enrolled in Medi-Cal under the ACA’s expanded eligibility.
Third, through our grants, investments, analyses, reports, and convenings, we will continue promoting the adoption of evidence-based innovations that make care more accessible, more patient-centered, more efficient, and more cost-effective. We will keep encouraging the statewide health care system to provide whole-person care that integrates behavioral and physical health services. And the foundation remains enthusiastic about using program-related investments to encourage innovative companies to improve care and services in the safety net.
We at CHCF do not believe in turning back the clock on California’s achievements in preventing and reducing illness and suffering. Using science and common sense, we will do our part to maintain the state’s momentum as an innovative health care system committed to expanding access for all Californians, especially the underserved.
Dr. Sandra R. Hernández is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also co-chaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.
Sandra is an assistant clinical professor at the University of California, San Francisco, School of Medicine. She practiced at San Francisco General Hospital in the AIDS clinic from 1984 to 2016. She served on the External Advisory Committee at the Stanford Center for Population Health Sciences in 2016. She currently serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and the UC Regents Committee on Health Services. Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.