It’s official: Gavin Newsom is the 40th governor of California. After taking the reins from outgoing governor Jerry Brown on Monday, January 7, Newsom wasted no time in positioning himself as a tech-savvy champion for health — he took to Facebook Live to introduce a package of health care proposals. The proposals aim to “move us closer to health care for all” by addressing critical issues like access to health coverage for undocumented adults, drug prices, the high cost of health care, and more.
In a sweeping effort to bring the Golden State closer to universal coverage, Newsom proposed the expansion of full Medi-Cal benefits to undocumented young adult immigrants. California already covers undocumented immigrant children up to age 19 through Medi-Cal; if the proposal goes through, undocumented people would be covered up to their 26th birthday. “It’s the right thing to do. It’s the fiscally conservative thing to do. It’s the moral thing to do,” Newsom said on Facebook Live. KQED’s Marisa Lagos and April Dembosky explained that the state would shoulder the full cost of Medi-Cal expansion because federal law prohibits the use of federal funds to cover undocumented residents.
For middle-income families purchasing individual insurance through Covered California, the state’s Affordable Care Act (ACA) marketplace, Newsom proposed both increasing subsidy amounts and expanding subsidies. His proposal would increase financial support for individuals with incomes between 250% and 400% of the federal poverty level (FPL). It would also create new subsidies for a group currently ineligible for financial assistance through Covered California: individuals with incomes between 400% and 600% of the FPL.
Aiming to Bring Back the Individual Mandate Penalty
To help pay for the expanded subsidies, Newsom proposed restoring the penalty for not carrying insurance in California. The 2017 federal tax legislation eliminated the financial penalty associated with the ACA’s individual mandate, which encouraged consumers to maintain health insurance. Peter Lee, executive director of Covered California, applauded Newsom’s plan, telling the Sacramento Bee, “At a time of ongoing uncertainty from Washington, the governor is not only embracing policies that will lower the cost of coverage for millions in the individual market, he is also offering help to those who are struggling with rising costs.”
Newsom proposed additional steps to improve affordability, signing an executive order that directs state agencies to band together to negotiate drug prices. The order also encourages private purchasers to join forces with public purchasers when negotiating. According to Newsom’s office, this will create “the largest-scale single-purchaser system for prescription drugs.”
POLITICO Pro’s Angela Hart reported (subscription required) that Assemblyman David Chiu of San Francisco was quick to applaud the executive order. Last year Chiu introduced a bill to address rising drug prices in a similar fashion, but he pulled the bill because Governor Brown didn’t support its approach. After learning about Newsom’s executive order, Chiu said, “Clearly, we now have a governor who is supportive of this. It opens up the door… to address rising drug prices and help Californians get the life-saving medications they desperately need.”
Nodding to a Future Single-Payer System
In a largely symbolic move, Newsom called upon the Trump administration to grant California an innovation waiver to build capacity for a single-payer system. In a letter to the White House and Congress (PDF), Newsom wrote, “I ask that you amend federal law to enable states to apply for and receive Transformational Cost and Universal Coverage Waivers, empowering California to truly innovate and to begin transformative reforms that provide the path to a single-payer health care system.”
Health advocates praised this request as a step in the right direction. Anthony Wright, executive director of Health Access California, told the Los Angeles Times, “We are very pleased that this is a governor who has put forward the vision of universal health care and also seeks to make tangible year-one steps to increase access and improve care.”
Finally, citing the need for a voice of “health care from a prevention framework,” Newsom announced the creation of a new California Surgeon General position. His executive order states (PDF) that the inaugural Surgeon General be appointed no later than February 1.
Expanding Medication-Assisted Treatment for Opioid Addiction
When Vox journalist German Lopez visited emergency rooms (ERs) in California, he was pleasantly surprised to see how clinicians treated patients suffering in withdrawal. That’s because in a handful of states, including California and Massachusetts, many hospital ERs are treating addiction like any other medical condition — and the approach is working. Lopez cites research from the Yale School of Medicine that found that “addicted patients who were given buprenorphine in the ER were twice as likely to be in treatment a month later as those who were simply handed an informational pamphlet with phone numbers.”
A new study published in the Annals of Emergency Medicine further supports the administration of medication-assisted treatment (MAT) — preferably buprenorphine — in ERs to help patients with addiction recover. Andrew Herring, MD, an emergency physician at Highland Hospital in Oakland and one of the study’s co-authors, said, “MAT administered in the emergency department helps patients avoid health complications and ease into longer-term treatment and recovery.”
Herring has been treating ER patients at Highland Hospital with buprenorphine since 2016. “When we started this approach at Highland two years ago, we saw only a few patients, maybe two a week,” he wrote on The CHCF Blog. “Now we’re seeing one to two patients a day and are able to connect them to outpatient services.”
Lopez reports that California is preparing to expand its innovative ER addiction treatment model, “with the state’s Bridge Program and Public Health Institute gearing up to award more than $8 million to as many as 30 hospitals in the coming weeks.” The funding comes from the state’s MAT Expansion Project, which aims to increase access to MAT across many settings, including hospitals, community clinics, and jails. CHCF is proud to support this work.
Did you tune in to Governor Newsom’s inaugural speech or Facebook Live stream? Tell me what you think about his health care priorities — email me.
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