By Pauline BartoloneMay 7, 2018
California’s leading gubernatorial candidates agree that health care should work better for Golden State residents: Insurance should be more affordable, costs are unreasonably high, and robust competition among hospitals, doctors and other providers could help lower prices, they told California Healthline.
What they don’t agree on is how to achieve those goals — not even the Democrats who represent the state’s dominant party.
“Health care gives them the perfect chance to crystalize that divide” between the left-wing progressives and the “moderate pragmatists” of the Democratic Party, said Thad Kousser, a political science professor at the University of California-San Diego.
Consider the top two Democratic candidates, who both aim to cover everyone in the state, including immigrants living here without authorization.
Lt. Gov. Gavin Newsom — billed as a liberal Democrat — supports a single-payer health care system. That means gutting the health insurance industry to create one taxpayer-funded health care program for everyone in the state.
But former Los Angeles Mayor Antonio Villaraigosa has called single-payer “unrealistic.” He advocates achieving universal health coverage through incremental changes to the current system.
Under California’s “top-two” primary system, candidates for state or congressional office will appear on the same June 5 ballot, regardless of party affiliation. The top two vote-getters advance to the November general election.
A poll in late April by the University of California-Berkeley Institute of Governmental Studies puts Newsom in first place with the support of 30 percent of likely voters, followed by Republicans John Cox, with 18 percent, and Travis Allen with 16 percent. Trailing behind were Democrats Villaraigosa, with 9 percent, John Chiang with 7 percent and Delaine Eastin with 4 percent. Thirteen percent of likely voters remained undecided.
Health care is in the forefront of this year’s gubernatorial campaign because of recent federal attempts to repeal the Affordable Care Act, which would have threatened the coverage of millions of Californians, said Kim Nalder, professor of political science at California State University-Sacramento. California has pushed back hard against Republican efforts in Congress to dismantle the law.
“There’s more energy in California around the idea of universal coverage than you see in lots of other parts of the country,” Nalder said. Democrats and those who indicate no party preference make up almost 70 percent of registered voters. Those voters care more about health coverage than Republicans, she said.
“Whoever is most supportive [of universal health care] is likely to win the votes,” she said.
The top Republican candidates, Cox and Allen, are not fans of increased government involvement, however. They favor more market competition and less regulation to lower costs, expand choice and improve quality.
“Governments make everything more expensive,” said Cox, a former adviser to former House Speaker Newt Gingrich during his presidential run. “The private sector looks for efficiencies.” California Healthline reached out to the top six candidates based on the institute’s poll, asking about their positions on health insurance, drug prices, the opioid epidemic and hospital consolidation.
Name: Gavin Newsom
City of Residence: Kentfield (Marin County)
Lt. Gov. Gavin Newsom’s pitch for a government-run, single-payer health care system has become a key platform of his gubernatorial campaign.
“Our current health financing system is unsustainable and a drag on our economy,” Newsom, 50, told California Healthline in an emailed statement from his campaign.
The gubernatorial front-runner has taken heat from opponents over the cost of single-payer, which could require an additional $200 billion annually in public money.
But Newsom, a Democrat, also said he’s open to other universal health care models, such as Medicare-for-All, which could include insurance companies, or something similar to San Francisco’s Healthy SF program, according to an interview he gave to The Sacramento Bee last year.
The Healthy SF program, which he approved in 2006 when he was mayor, builds on insurance-based health care by using a mix of public, private and patient dollars to cover those who remain uninsured.
Newsom’s embrace of single-payer will likely appeal to the “Berniecrats,” or the left wing of the Democratic Party. It has already secured him the endorsement of the 100,000-member nurses’ union, the California Nurses Association (CNA) — a powerful lobby in the state.
As governor, Newsom said he would “fight toe-to-toe” with the federal government if it attempted to sabotage enrollment gains made under the Affordable Care Act, or if it tried to cut Medicare funding.
To combat the high price of prescription drugs, Newsom said, he would reduce patient copays and harness the state’s massive purchasing power to get drug discounts. He did not offer details on his approach.
He also pledged to ensure that health insurance regulators scrutinize mergers among hospital systems and insurance companies to prevent medical costs from skyrocketing.
He said California has made headway in the opioid addiction crisis by reducing the number of prescriptions and improving access to treatment. He expects treatment to improve further because of an influx of money provided under the recreational marijuana law, passed in 2016. Newsom stumped for the ballot measure early in his campaign, and said the law grew out of a policy initiative he spearheaded.
Name: John Cox
Residence: Rancho Santa Fe
Businessman John Cox wants the government out of health care. If he were elected governor, the millionaire accountant and property manager said, he’d use the free market to make health care less expensive and more responsive to patients.
But he didn’t say exactly how he’d do it. The 62-year-old Rancho Santa Fe resident acknowledged that he doesn’t “have all the answers,” but would hire experts to help him craft policies to reduce “government interference” in health care.
Though he has never held elected office, Cox is not entirely new to politics. He was a California campaign finance adviser to Gingrich during the former House speaker’s U.S. presidential bid in 2012, and is leading an initiative campaign to repeal California’s gas tax increase.
As governor, Cox said, he would bring more technology into health care, which would make it easier for rural patients to see doctors via telehealth appointments. He said he also would foster competition among drugmakers and encourage broader use of generic drugs to bring down the prices of pharmaceuticals, although he said government efforts to lower prescription drug costs should take place at the federal, not state, level.
Regarding a government-run, single-payer program, Cox said, “God, no.” The candidate said recent legislative proposals to expand coverage — such as creating state-based subsidies to help people buy private insurance — exemplifies how Democrats try to exert “control over people.”
Using taxpayer funds to expand health care to unauthorized immigrants in California would be a nonstarter, he added.
“People who are illegal … are not supposed to be in this country,” he said.
Cox said he thinks the best way to cover more people is to boost the economy so that more Californians can afford to buy their own health insurance.
Unlike his Democratic opponents and the heavily Democratic state legislature, Cox isn’t interested in defending steps California has already taken to expand coverage to people under the Affordable Care Act. The roughly 5 million Californians who have gained coverage under the law since 2014 could go into high-risk insurance pools if the Affordable Care Act is scrapped, he said.
Cox finds one aspect of the free market problematic for health care: market consolidation. He said regulators should enforce antitrust regulations when health systems gobble up competitors and drive up prices.
Name: Travis Allen
City of Residence: Huntington Beach
Simply put, Travis Allen believes government is ruining health care.
“No Californian wants to go to the DMV to get their medical care,” said Allen, summing up his opposition to single-payer, government-run health care, an idea that has taken center stage in the gubernatorial race.
The Republican state assemblyman instead touts the free-market principles of competition and deregulation as the cure for California’s ailing health care system.
If he were governor, Allen said, he would lobby for ballot initiatives to undo laws that he believes discourage out-of-state insurers from setting up shop in California. He would also target a requirement that health plans offer a certain set of benefits, which he argues would lead to lower premiums and more choices for consumers.
In his ideal marketplace, people could buy health coverage with benefits that suit them, such as policies without maternity coverage, he said.
“Everybody who wants health care in California should have the opportunity to get it,” he said, but to get there, “more government is not the answer, more competition is.”
The Huntington Beach resident borrows rhetoric from President Donald Trump, who has championed the idea of selling insurance across state lines. Health insurers already sell policies across state lines, but Allen said he would work to cut “stifling” regulations that prevent new players from coming in.
Undoing regulations would also help prevent hospital consolidation, Allen said, because new health care businesses would emerge and compete. That would drive down prices, too.
Citing “an intentional lack of transparency” in health care, Allen said he would champion legislation requiring doctors, hospitals and drugmakers to disclose their prices before providing services, so that patients could shop around for the best deal.
The lack of transparency “makes it very difficult for Californians to understand exactly what they’re paying for,” said Allen, 44.
He also “100 percent” supports scrapping the Affordable Care Act, and would use his clout as governor to push for a repeal at the federal level. The 5 million Californians who have coverage through the law now could either go into high-risk pools or buy their own health insurance. He acknowledged they might face higher prices if they have preexisting illnesses.
When it comes to the opioid epidemic, Allen wants anti-addiction drugs such as naltrexone to be more easily accessible through Medi-Cal, the state’s Medicaid program for low-income residents.
As governor, Allen said, he would work to repeal Proposition 47, passed by voters in 2014, which reduced criminal penalties for drug possession. Allen said the law has condoned drug use and fueled addiction.
Name: Antonio Villaraigosa
City of Residence: Los Angeles
When Antonio Villaraigosa was a teenager, he was temporarily paralyzed by a benign tumor in his back, and needed a complicated surgery to get him on his feet again.
“I remember my mother thanking God we had health insurance,” Villaraigosa, 65, said in a written statement provided by his campaign.
The former mayor of Los Angeles and Democratic speaker of the state assembly said he was able to recover because of his access to doctors, giving rise to his belief that health care should be a right for all Californians.
If he were elected governor, Villaraigosa said, he would “stand up to Donald Trump” and fight to keep Californians insured under the Affordable Care Act. It would be “a disaster” if Republicans in Washington, D.C., slashed the funding that keeps roughly 5 million people covered.
“We need to fight hard to protect and strengthen what we have,” he said.
Villaraigosa, who recently has slipped in the polls, advocates a piecemeal approach to closing the gaps in health coverage among Californians, rather than overhauling and scrapping the current insurance-based system.
Villaraigosa said the $200 billion price tag for single-payer is unrealistic, and boasts that he’s the first Democratic gubernatorial candidate to admit that.
“I was not afraid to pay a political price for doing what was right,” he said of speaking out against the CNA-backed single-payer bill and forfeiting the labor movement’s support for his candidacy.
Villaraigosa said he would instead champion a “public” health insurance option, which would allow uninsured Californians to buy into a public program like Medi-Cal, the state’s Medicaid program, regardless of their income.
To combat the opioid epidemic, Villaraigosa said, he would increase funding for substance abuse prevention and treatment. Because addiction is often rampant in poor neighborhoods, he said, investments in high-wage jobs would also dampen the epidemic.
Villaraigosa said he wants to promote the use of preventive care and raise the reimbursement rates for doctors who treat Medi-Cal patients. He also plans to tackle issues that would indirectly lead to better health for Californians, such as cleaning the air and water and improving people’s economic status, he said.
Name: John Chiang
City of Residence: Torrance
As a longtime steward of the state budget, John Chiang has already dabbled in health care policymaking.
During the height of Republican-led congressional efforts to repeal the Affordable Care Act last summer, Chiang, a Democrat who was elected state treasurer in 2014, created a $20 million dollar emergency fund to keep clinics such as Planned Parenthood open.
Last fall, he and treasurers from three other states sent opioid manufacturers a stern missive: Take action to stop the epidemic, such as helping communities that have been ravaged by opioid addiction, or cut executive pay.
“We want to challenge them and their compensation packages if they’re not going to be serious about the opioid epidemic,” said Chiang, 55, of Torrance.
Chiang also takes a hard line on pharmaceutical companies that he said inflate the prices of lifesaving drugs.
“We have to make sure that that’s not even permissible,” Chiang said during a telephone interview with California Healthline. He added that he would support price controls and programs that reward doctors who prescribe cost-effective drugs.
He also would like to bring together state agencies like CalPERS, Covered California and, ideally, Medi-Cal, to increase the state’s drug-purchasing power and get the best deals. But he acknowledged that changing Medi-Cal’s policies could require federal approval.
As governor, Chiang has said, his health care priority would be to implement a single-payer, government-run health care system during his first term. But he would want to build the system responsibly, he said, so that it covers everyone without bankrupting the state.
“I have a history of coming up with funding and financing ideas,” said Chiang, boasting that he’s the only Californian to have held all three elected statewide financial offices. Before he was state treasurer, he served on the Board of Equalization, then was state controller.
But he didn’t offer any specific ideas for bankrolling a single-payer system.
Chiang, the son of immigrants from Taiwan, said he supports offering full Medi-Cal benefits to low-income adult immigrants who are in the country illegally, which the state would have to fund without federal help. (Children already are eligible.) “Everybody should be covered,” Chiang said. “I believe health care is a right.”
Name: Delaine Eastin
City of Residence: Davis
Delaine Eastin believes Americans could learn a thing or two about health care from their European counterparts.
European countries pay less for health care and offer their residents better coverage, said the former Democratic assemblywoman and state superintendent of Public Instruction.
In the United States, “we’re paying top dollar and we [have] less coverage,” she said.
As governor, Eastin said, she would embrace European-style policies to prevent hospital consolidation, manage the opioid epidemic and bring down drug prices.
For instance, Switzerland reduced drug abuse by treating addiction as a mental health condition rather than a criminal justice problem, she said.
To cut pharmaceutical costs, Eastin would promote the use of generic drugs, and explore how Californians could get the same discounted prices on medications that Europeans receive.
She would also study what Europeans do to prevent “greedy” businessmen from amassing health care monopolies and driving up prices for patients, she said.
Placing sixth in the poll, Eastin would need a significant boost in popularity to make it to the November election.
She said her health care priority would be to get more people covered — and quickly.
“I’m tired of waiting,” she said. “We have to do something with some sense of urgency.”
Eastin supports single-payer health care. If that model isn’t possible, she said, she would consider a different nonprofit health care model, such as Medicare-for-All, which would cover everybody — but, she said, she wouldn’t bankrupt the state. (Medicare enrollees contribute to the overall cost of the program by paying premiums and out-of-pocket costs, and insurers — not the government — administer claims.)
In the meantime, Eastin said, she would defend the benefits of the roughly 5 million Californians who gained coverage under the Affordable Care Act against Republican moves to cut Medicaid and weaken the individual insurance market. She said she also would support efforts to expand comprehensive Medi-Cal coverage to eligible adult immigrants who are in the country illegally.
It’s “dangerous” to have people without insurance, she said, especially in light of recent disease outbreaks, such as hepatitis A last year.
Ultimately, Eastin said, she would be able to meet the health care needs of Californians not only because she comes from a family of modest means who have had their share of health problems, but because she calls herself a “can-do” person who brings people together to find solutions.
“I’ve prided myself on always doing my homework and being well-read … and being a person committed to fairness and justice,” she said.