5 Things California: Affordability Hearing, State of the State, Diana Shiba, MD

DJ is taking a well-deserved vacation, so I’ll be bringing you this edition of 5 Things We’re Watching. I have been following health policy in California for some time now, and with the new governor’s heightened focus on the issue there’s a lot to watch. Feel free to email me any feedback or tips on what you think we should be covering.

DJ will be back next time, but until then, here’s what we’re watching in California health care!

Marjie High
State of Reform

1.  Affordability hearing highlights policy options

The Legislature held a joint committee meeting on affordability last week to consider policy responses to the growing affordability crisis. Though California’s uninsured rate has fallen to 7.2%, the committees heard that up to 1/3 of individual market enrollees report financial stressand up to 24% forego or delay care due to costs.

The committees considered both a comprehensive package and individually targeted policy options presented in a Covered California report developed pursuant to last year’s AB 1810. In testimony, Covered California, the Governor’s Office, and the Legislative Analyst’s Office each emphasized that the individual mandate penalty may be one of the most effective tools that the state has to influence increased insurance coverage rates.


2.  State of the State provides more details of health care agenda

After bold announcements on health care, Governor Newsom’s State of the State address last week focused on moderate, practical steps to move his long-term agenda. Though health care did not lead the speech, the governor pledged to scale back high profile infrastructure projects, calling instead for investment in aging, health care affordability, and the social determinants of health.

Key health initiatives to watch: $500 million for navigation centers and $100 million more for Whole Person Care and affordable housing investments to address social determinants; deeper exchange subsidies, higher Medi-Cal rates, and Medi-Cal expansion aimed at access and affordability; and a Master Plan on Aging and Alzheimer’s Task force lead by Maria Shriver to target California’s graying population.

3. LA County to replace jail with mental health facility

After a heated debate, the L.A. County Board of Supervisors approved an amended plan to replace the Men’s Central Jail with a Mental Health Treatment Facility. While all parties agreed that mental health treatment is preferential to jail, arguments against the move centered on whether the planned 3800+ bed facility is really the most appropriate way to provide effective mental health services.

Behavioral health professionals and advocates, including L.A. County’s Director of Mental Health Dr. Jonathan Sherin, voiced concerns that spending $2.2 billion for such a large facility ignores evidence that community-based treatment is more effective at preventing criminal justice involvement. Though the amended plan passed, Sups. Solis and Kuehl both voted against the plan with Sup. Solis calling for restraint to give time to develop creative approaches to preventative mental and behavioral health services.

4.  Diana Shiba, MD, Southern California Permanente Medical Group

Diana Shiba, MD, is the Chief Government Relations Officer and Regional Assistant Medical Director for the Southern California Permanente Medical Group. She joins us for this edition of “What They’re Watching” to discuss the cost and stability of the health care market.

“There is this question not only on legislators minds, but on the public minds of health care costs, and the burgeoning cost of care. I truly believe that more research or really investigation into integrated systems like our own [is necessary]. How can we promote better care coordination, access, and affordable care for the millions of not only Californians, but across the United States?”



5. Workforce report confirms shortages, recommends actions

The California Future Health Workforce Report came out earlier this month with 184 pages of analysis and recommendations regarding California’s looming workforce shortage. I break down the report’s important elements into 5 takeaways for you here.

The commission recommends a $3 billion investment over 10 years to boost training capacity and distribution of new workers entering the system. It also cautions that without attention to base-level system reform, stakeholder coordination, and flexible implementation, the recommendations’ impacts could be constrained.