Q&A: Asm. Joaquin Arambula is continuing to push for Medi-Cal expansion

Assemblymember Joaquin Arambula, MD, is one of the most proactive health policymakers in the California Legislature. A former emergency room doctor, his experience in the medical field inspired him to become a lawmaker to address the issues he observed in state health care. He was first elected to the Assembly in 2016 — the first Latino physician to hold a seat in the chamber — and represents Assembly District 31, which encompasses much of the city of Fresno. 

This year, Arambula has been instrumental in securing Medi-Cal coverage expansions in the budget — but he says his work doesn’t stop there. In this Q&A, the assemblymember discusses his efforts to build upon the state’s progress to cover more underserved Californians, as well as his work to increase training for medical professionals and his bill to limit step therapy’s limitations on medication access.

 

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Eli Kirshbaum: What has your experience on the Assembly Health Committee been like this session? Compared to previous years, what have been some obstacles – either COVID-related or not – that have impeded health policymaking? Are there any “themes” in California health policy this year that you’ve noticed?

Asm. Joaquin Arambula: “We started to notice, when we were doing vaccine distribution, that we were having concerning areas in our rural communities, and I and my office got very involved in helping to run vaccine clinics and partnerships with our county Department of Public Health as well as our Fresno state mobile nursing unit and local community benefit organizations to get out in front, helping to give the vaccines to our farm-working communities who were getting left behind.

That experience of being on the front lines — of being out hearing from Californians about their experience during this pandemic of the century — really did allow me to gain a perspective that was helpful this year that I have not had in previous years. And it was a reminder that the health of each of us is dependent on the health of all of us. That for us to focus and to help keep California safe, we had to work on keeping all Californians safe. As someone who’s worked on “Health for All,” regardless of immigration status… I believe it was important for us to have that lesson and to have that theme. And that has been a major theme, regarding health equity.

Many of our disparities that we saw during this pandemic were born by our communities of color, and oftentimes it was the social determinants of health that exacerbated or magnified the effects of this pandemic. So I really do believe that for us to be effective this year, we have to figure out how to help to change some of the systems that so many Californians are reliant upon, and was so pleased that we were able to work on the Advancing and Innovating Medi-Cal [CalAIM] proposal this year, which one-third of all Californians rely upon.”

EK: What motivated you to sponsor AB 347, your bill to limit step therapy’s limitations to medication access? Can you describe what your experience has been pushing this bill through the legislature? Are you optimistic it will become law?

JA: “I am pleased to report the bill is currently moving through the process. [It has] moved through [the Senate] Health [Committee] and is now sitting before Appropriations. I will say that from my experience as an emergency room doctor with patients who were suffering from delays in their ability to obtain medication because of utilization management, which includes both prior authorization and step therapy, that I was moved to want to work on this bill.

I also believe it’s important — when there are denials — that we make sure the review is by a physician who’s adequately trained in the area of medicine and in the patient’s condition. I think those are important factors for us and a major reason for us to want to work on this bill. Ultimately, I believe this bill will more adequately provide medications to people in real time and believe this is a big step forward for us as a state.”

EK: You mentioned your “Health for All” initiative, AB 4, which is currently in the suspense file and calls for the universal expansion of Medi-Cal. Can you describe your experience with this proposal this session and its relationship with the budget? How do you plan to continue pursuing universal Medi-Cal coverage?

JA: “AB 4, “Health for All,” is one of the reasons why I left my practice of medicine, [which] was to make sure that we were addressing the injustice that occurs for too many Californians who are tax-paying [and who are] being excluded from accessing a health care safety net that they pay into. This movement has been going on for a number of years. In 2015, we expanded health care coverage to children who were immigrants and in 2019 we similarly expanded it to young adults up to the age of 26. 

This year, within the budget, we were able to extend it to those who are over the age of 50 who are elders and seniors, and while the budget that we had this year was a significant down payment, there still remains a need for us to end the exclusion which is the purpose and rationale for us to continue to advocate and push for AB 4, which would be the legislation for us to create a roadmap for us as a state to get to universal coverage. 

I will continue to push and advocate this year with many organizations like the California Immigrant Policy Center as well as Health Access, as well as Dolores Huerta and her foundation, who have helped to provide some momentum to make sure that we are providing an essential right in health care to our essential workers here in California.”

EK: After the legislative break, how do you plan to keep pursuing “Health for All?”

JA: “The plan is for AB 4 to make it off of the suspense file within Appropriations, to go to the floor of the Senate, to be voted through the Senate, and to be put on the governor’s desk to seek his signature. The hope is, by the end of the legislative year this year, that the governor will sign AB 4. That is separate and apart from what we were doing in securing a down payment by ensuring that we were covering all income-eligible undocumented Californians over the age of 50. But I believe we need the legislation as well to ensure the long-range goal of getting us to universal coverage.”

EK: Can you describe your involvement in the budget-making process and your experience working with other legislators and Gov. Newsom’s office to secure key health funding, such as Medi-Cal coverage for undocumented individuals 50 and older?

JA: “As the chair of Sub 1, which oversees every dollar that our state spends in health care and human services, I played an integral role in helping to advocate and negotiate our budget. I am quite pleased to be working in collaboration with the administration to address many of the complex and vexing problems that face our state.

Specifically, I believe the work the administration did in the Children and Youth Behavioral Health Initiative will go a long way towards addressing the sequelae that this pandemic will have on us as a state. That four billion dollar investment happened by working with us in the legislature, and I believe we play a very important role in ensuring that the implementation is done in an equitable fashion. 

Being a provider of medicine, I understand that during this pandemic we’re not able to manufacture providers in real-time, and thus believe it’s imperative for us as a state to make investments into programs that ensure that the providers of the future are reflective of the communities that they will serve.

I was very integral in making sure [we had] funding for programs like the Health Professions Career Opportunities Programs [HCOPs] or UC Prime or Song-Brown programs that will help us to train future providers.”

EK: Aside from AB 347 and AB 4, what other bills are you focusing your attention on? What do you think are the most impactful health bills on the table this year?

JA: “I just had talked about HCOPs, so at minimum I’d point you to AB 1306, which is the bill that’s allowing us to do that. [Another] bill [which is] in Human Services is on the Adult Protective Services Act, and how we’re looking to lower the age from 65 to 60. That’s a significant way for us to be getting upstream of many of the problems that occur [for] our aging California population.”

This interview has been edited for clarity and length.