California Should Create Its Own Health Insurance Plan

More than 1 million Californians have gained health care under Covered California, the state’s health insurance marketplace, created under President Barack Obama’s Affordable Care Act.

President Trump’s effort to repeal and replace Obamacare may have failed in Congress, but it did succeed in reigniting discussion of how best to provide health care to all Americans. California should seize the opportunity

to create a unique, affordable, state-specific health insurance program best suited to meet the needs of its

diverse population.

Gov. Jerry Brown’s actions to strengthen the Medi-Cal program and build Covered California have helped millions of Californians gain health care. However, this system relies upon federal matching funds, without which the state would be on the hook for billions of dollars to keep the program sustainable. At least six obstacles stand in the way of the state coming up with those funds on its own:

1 California’s infrastructure (roads, highways, bridges) desperately needs funding. Potholes are often given Band-Aid repairs rather than substantial fixes because cities and counties don’t have the money to rebuild the roads on their own. With a renewed focus on California’s transportation needs, state leaders will feel more public pressure to use general-fund money on road repairs.

2 The call for more public education dollars from kindergarten through college will not stop, as the number of college-age students completing their degrees with substantial debt continues to grow.

3 Many middle-class Californians do not qualify for affordable health plans through Covered California, and the cost of private health insurance has grown increasingly out of reach. The Legislature cannot continue to help the poor while overlooking the middle class.

4 The mental health crisis facing California communities and schools, beginning as early as the elementary-school years, is slowly being unmasked. Over time, this will likely lead to increased pressure on budgets at the state and local levels.

5 A growing number of Californians rely upon high-cost specialty medications. While less than 2 percent of the U.S. population took these drugs in 2015, they represent 37 percent of the nation’s drug spending today. By 2018, the figure is expected to reach 50 percent.

6 California’s population is growing older. Lower-income seniors utilize far more services than all other age groups. Middle-income retirees are often desperate for help but lack access to affordable, community-based, long-term-care services. Elderly couples in which one spouse has a severe disability and/or Alzheimer’s disease often deplete their resources after decades of saving and paying their taxes.

These challenges place significant pressure on California’s state budget. But as the late Pennsylvania Sen. John Heinz often said, “every problem is an opportunity waiting to happen.” That is the view the Legislature and the governor should take.

If they don’t, California — like every other state in the nation — will remain on a collision course in which the primary-care needs of the poor will do battle with the long-term-care needs of the middle-class aged and disabled.

California has a unique opportunity to lead the nation in tackling this issue, beginning with a bipartisan dialogue committed to delivering outcomes that will improve Californians’ health and quality of life.

For example, our state leaders could negotiate a partnership with the federal government and the private sector — something no other state has attempted. The state could assume full fiscal responsibility for the primary-care needs of its residents, or for the long-term-care needs of disabled and/or of residents 65 and older. Attempting to care for both populations will not work. The needs are too great, the costs too high, and the demands for the same dollars are unsustainable.

Government has an important role to play: It must protect families from going broke as a result of rapidly escalating health care costs, help them care for aged and/or disabled relatives in their homes, and recognize that individuals who leave the workforce to care for an aging parent or relative deserve some type of tax relief for doing so.

If Congress cannot create a better health plan for America, then perhaps California can step up and find solutions of its own.

Jeffrey Lewis is the president and CEO of Legacy Health Endowment, which works to improve health and wellness in Stanislaus and Merced counties. The views expressed are his own.

Get involved:

Contact your state legislator, and say: The state must create a California long-term care commission to address the needs of every Californian, regardless of income, and say how the programs would be paid for.

To find your legislator, go to