HERE WE GO. IT IS NOW 230. WE
WILL CALL THE ASSEMBLY BUDGET
SUB ONE COMMITTEE TO HEARING.
HEARING TO ORDER. WOULD YOU LIKE
TO CALL ROLL? PATTERSON. ALL
RIGHT. WELL, FIRST OF ALL, THANK
EVERYONE FOR COMING. EITHER IN
PERSON OR WATCHING US ON THE TV.
THIS IS PART TWO CONTINUATION
OF, ONE OF THE HEARINGS THAT WE
HAD BACK ON MARCH 11TH, WHICH
DEALT WITH HOSPITAL FINANCING.
TODAY WE WILL FOCUS ON THE
IMPACT OF HEALTH CARE PRICING ON
CONSUMERS. WE HAVE AN AMAZING
PANEL, OUR INFORMATIONAL HEARING
ON HEALTH CARE PRICING WILL
EXPLORE THE CHALLENGES THE
HEALTH CARE SYSTEM EXPERIENCES
FROM THE PERSPECTIVE OF
CONSUMERS AND WORKERS IN THE
INDUSTRY. I AM GOING TO INVITE
UP THE FIRST FOUR MEMBERS OF OUR
PANEL STARTING WITH LAUREL LUCIA
FROM èC BERKELEY LABOR CENTER,
BETH CAPELL FROM HEALTH ACCESS,
AND LOUIS FROM UNITE HERE AND
MATT LEGGETT FROM SERVICE
EMPLOYEES INTERNATIONAL UNION. I
THOUGHT I SAW HIM, OKAY. AND WE
WILL START WITH LAUREL. GOOD
AFTERNOON. THANK YOU FOR THE
OPPORTUNITY TO BE PART OF THIS
HEARING TODAY. I'M LARA LUCIA,
THE DIRECTOR OF THE HEALTH CARE
PROGRAM AT THE UC BERKELEY LABOR
CENTER, WHICH CONDUCTS RESEARCH
ON THE MOST PRESSING ECONOMIC
CHALLENGES AFFECTING WORKING
FAMILIES IN CALIFORNIA,
INCLUDING HEALTH CARE,
AFFORDABILITY IN JANUARY, MY
COLLEAGUE MIRANDA DIETZ AND I
PUBLISHED A REPORT LOOKING AT
THE HISTORICAL TRENDS FOR
AFFORDABILITY OF JOB BASED
COVERAGE FOR CALIFORNIANS OVER
THE LAST 20 YEARS. AND I'M GOING
TO SHARE SOME HIGHLIGHTS FROM
THAT REPORT TODAY. SOME OF THE
DATA I'LL MENTION IS IN THE
SLIDE DECK THAT WILL BE SHOWN UP
HERE. AND IT'S ALSO ON THE
COMMITTEE WEBSITE. FOR THE
AUDIENCE MEMBERS, CALIFORNIA
WORKER PREMIUMS AND DEDUCTIBLES
HAVE GROWN MORE THAN TWICE AS
FAST AS MEDIAN WAGES HAVE GROWN
OVER THE LAST TWO DECADES. THE
TOTAL ANNUAL PREMIUM FOR JOB
BASED FAMILY HEALTH PLAN, GREW
FROM APPROXIMATELY $88,400 IN
2002 TO MORE THAN $22,200 IN
2022. THAT'S FASTER GROWTH THAN
WE'VE SEEN IN WAGES AND
HOUSEHOLD INCOME. DEDUCTIBLES
HAVE BECOME INCREASINGLY COMMON
AMONG PRIVATE SECTOR WORKERS IN
CALIFORNIA. WHO HAVE JOB BASED
COVERAGE. 20 YEARS AGO,
APPROXIMATELY THREE OUT OF TEN
CALIFORNIA WORKERS HAD A
DEDUCTIBLE, BY 2022, IT WAS,
EIGHT OUT OF TEN WORKERS. WHEN
YOU COMBINE THESE TRENDS, IT
BECOMES CLEAR THAT HEALTH CARE
IS TAKING UP AN INCREASING SHARE
OF HOUSEHOLD BUDGETS, GROWING
FROM AROUND 4% OF INCOME FOR THE
TYPICAL CALIFORNIA WORKER WITH
JOB BASED COVERAGE IN 2002 TO
12% OF INCOME IN 2022. FOR A
FAMILY THAT SPENDS THEIR FULL
DEDUCTIBLE. THIS EROSION OF
HEALTH CARE AFFORDABILITY HAS
NEGATIVE CONSEQUENCES FOR ACCESS
TO CARE, FINANCIAL SECURITY, AND
EQUITY. A RECENT SURVEY FROM THE
CALIFORNIA HEALTH CARE
FOUNDATION FOUND THAT JUST OVER
HALF OF CALIFORNIA ADULTS SAY
THAT THEY, OR A FAMILY MEMBER
HAVE SKIPPED OR DELAYED CARE IN
THE PAST 12 MONTHS DUE TO COST.
OF THOSE WHO DELAYED CARE,
NEARLY HALF SAID THAT IT MADE
THEIR CONDITION WORSE, IN TERMS
OF FINANCIAL SECURITY, MORE THAN
1 IN 3 CALIFORNIANS REPORTED
HAVING SOME TYPE OF MEDICAL DEBT
IN 2023, AND MORE THAN 1 IN 4
REPORTED HAVING TROUBLE PAYING
FOR MEDICAL BILLS. HEALTH CARE
AFFORDABILITY IS AN EQUITY ISSUE
, THE SURVEY DATA SHOWS THAT
DELAYS IN CARE AND FINANCIAL
PROBLEMS RELATED TO HEALTH CARE
COSTS ARE MORE COMMON AMONG
BLACK AND LATINO CALIFORNIANS,
AND ALSO AMONG THOSE WITH LOW
INCOME. WHEN THINKING ABOUT
HOSPITAL PRICES, IT'S IMPORTANT
TO REMEMBER THAT CALIFORNIANS
PAY FOR NEARLY ALL OF THE HEALTH
CARE COSTS IN OUR STATE IN
DIRECT AND INDIRECT WAYS.
APPROXIMATELY 43% OF CALIFORNIA
HEALTH EXPENDITURES ARE PAID FOR
DIRECTLY BY HOUSEHOLDS AND
EMPLOYERS, AND MOST OF THE
REMAINDER IS PAID BY THE FEDERAL
AND STATE GOVERNMENTS. BUT THAT
IS ULTIMATELY FUNDED BY
TAXPAYERS. TYPICALLY, WHEN WE
THINK ABOUT SPENDING ON HEALTH
CARE, WE MIGHT THINK ABOUT THE
PORTION OF PREMIUM THAT COMES
OUT OF A WORKER'S PAYCHECK OR
THE CO-PAYMENT AT THE DOCTOR'S
OFFICE OR A PHARMACY, BUT THE
LARGE PORTION OF THE HEALTH CARE
PREMIUM THAT EMPLOYERS PAY IS
ALSO ULTIMATELY COMING OUT OF
WORKERS POCKETS UNDER ECONOMIC
THEORY, EMPLOYER CONTRIBUTIONS
TO HEALTH INSURANCE PREMIUMS ARE
ONE OF MULTIPLE PARTS OF
WORKER'S TOTAL COMPENSATION, AND
EMPLOYERS OFFER THE COMBINATION
OF WAGES AND BENEFITS THAT WILL
BEST HELP THEM ATTRACT AND
RETAIN EMPLOYEES. IF EMPLOYERS
WEREN'T CONTRIBUTING TO HEALTH
INSURANCE PREMIUMS, THOSE
DOLLARS WOULD GO TOWARDS WAGES
OR OTHER BENEFITS. BECAUSE OF
THIS, HIGH AND RISING HEALTH
CARE COSTS CAN BE AN IMPEDIMENT
TO WAGE GROWTH. ONE RECENT STUDY
IN THE JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION ESTIMATED
THAT OVER A 32 YEAR PERIOD, THE
AVERAGE CUMULATIVE CUMULATIVE
LOST EARNINGS DUE TO GROWTH IN
HEALTH CARE PREMIUMS WAS OVER
$125,000 FOR THE TYPICAL US
FAMILY WITH JOB BASED COVERAGE.
AND I THINK, YOU KNOW, WE CAN
ALL THINK OF OUR EXAMPLES OF HOW
A TYPICAL CALIFORNIA FAMILY
COULD PUT THAT, THAT, LOST
EARNINGS TO GOOD USE. ALL US
FAMILIES SAU THE PERCENTAGE OF
THEIR COMPENSATION THAT GOES
TOWARDS JOB BASED COVERAGE GROW
SIGNIFICANTLY OVER THIS TIME
PERIOD, BUT BLACK AND LATINO
FAMILIES DEDICATED A HIGHER
PERCENTAGE OF COMPENSATION TO
HEALTH COVERAGE THAN WHITE AND
ASIAN FAMILIES. AND THAT
DISPARITY WORSENED OVER TIME. SO
TODAY'S HEARING FOLLOWS A
HEARING ON HOSPITAL FINANCING,
WHILE THE TRENDS I'VE DESCRIBED
EARLIER FOR HEALTH CARE, OVERALL
HOSPITAL CARE, AND PARTICULARLY
HOSPITAL PRICES ARE AN IMPORTANT
CONTRIBUTOR TO THOSE TRENDS,
HOSPITAL CARE MADE UP
APPROXIMATELY 36% OF PRIVATE
HEALTH INSURANCE SPENDING IN THE
US IN 2022, AND THAT'S ROUGHLY
THE SAME AMOUNT THAT WE SPEND ON
PHYSICIAN AND CLINICAL CARE AND
RETAIL DRUGS COMBINED, THESE
EXPENDITURES ARE THE PRODUCT OF
HOW MUCH HOSPITAL CARE WE USE
AND HOSPITAL PRICES. OVER THE
LAST DECADE, PRICES HAVE BEEN A
BIGGER DRIVER OF HOSPITAL
SPENDING THAN UTILIZATION THÀNH,
WITH A COUPLE OF YEARS OF
PANDEMIC RELATED EXCEPTIONS,
ÓRDENES, THERE'S TREMENDOUS
VARIATION IN COMMERCIAL HOSPITAL
PRICES, THAT CAN'T BE FULLY
EXPLAINED, BY QUALITY
DIFFERENCES OR VARIATION IN
INPUT COSTS LIKE WAGES, IN ONE
FACTOR THAT RESEARCHERS HAVE
FOUND IS ASSOCIATED WITH HIGH
HOSPITAL PRICES IS HOW
CONSOLIDATE THE CONSOLIDATED THE
HEALTH CARE MARKET IS, MEANING
THAT HOSPITALS AND REGIONS WITH
LIMITED COMPETITION TEND TO HAVE
HIGHER PRICES. SO THE MARKET IS
FAILING TO REIN IN BOTH RAPID
GROWTH IN PRICES AND ALSO
VARIATION IN HOSPITAL PRICES.
BUT CALIFORNIA IS TAKING STEPS
TO ADDRESS AFFORDABILITY
PROBLEMS WITH THE NEWLY FORMED
OFFICE OF HEALTH CARE
AFFORDABILITY, OR OHCA. THE
OFFICE IS CHARGED WITH SLOWING
SPENDING GROWTH WHILE ALSO
PROMOTING HIGH VALUE HEALTH CARE
BY JUNE 1ST OF THIS YEAR, THE
BOARD WILL BE VOTING ON HOW MUCH
IT WANTS TO BEND THE SPENDING
CURVE. THE STAFF HAVE
RECOMMENDED SETTING A TARGET
SUCH THAT HEALTH CARE SPENDING
IN THE STATE GROWS NO FASTER
THAN MEDIAN HOUSEHOLD INCOME HAS
GROWN HISTORICALLY, WHICH WOULD
AIM TO ENSURE THAT THE CHALLENGE
THAT CHALLENGES I'VE DESCRIBED
DON'T GET WORSE. THE TRENDS IN
THE DATA THAT I'VE TALKED ABOUT
IN MY PRESENTATION REALLY
FURTHER REINFORCE THE STORIES
THAT MANY WORKERS AND CONSUMERS
HAVE SHARED AT OHCA BOARD
MEETINGS ABOUT HOW MUCH THEY ARE
STRUGGLING TO AFFORD HEALTH
CARE. I APPRECIATE THE
OPPORTUNITY I'VE HAD TO SHARE
THIS RESEARCH AND DATA WITH YOU
TODAY. THANK YOU. THANK YOU. AND
BEFORE YOU BEGIN, CAN YOU. THERE
WAS SOMETHING I DIDN'T CATCH.
THE LAST STATISTIC THAT YOU SAID
THAT WAS SPECIFIC TO BLACK AND
LATINO FAMILIES. CAN YOU STATE
THAT AGAIN? WAS IT RELATED TO.
IT WAS A VERY LAST ONE, I THINK
THE LAST ONE WAS THIS ISN'T WITH
REGARD TO THE NATIONAL STUDY IN
THE JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION THAT
ESTIMATED, YOU KNOW, HOW MUCH,
WORKERS HAVE SPENT ON JOB BASED
COVERAGE OVER THE LAST 30 YEARS
AND 30, YOU KNOW, FOR ALL
WORKERS OVER THE LAST 30 YEARS,
THE SHARE OF THEIR TOTAL
COMPENSATION THAT IS SPENT ON
JOB BASED COVERAGE PREMIUMS HAS
GROWN SIGNIFICANTLY. VÆ, BUT
BLACK AND LATINO, FAMILIES SPEND
A HIGHER PERCENTAGE OF THEIR
COMPENSATION ON ON HEALTH
INSURANCE PREMIUMS. AND THE GAP
BETWEEN THE PERCENTAGE OF INCOME
SPENT BY BLACK AND LATINO
FAMILIES AND WHITE AND ASIAN
FAMILIES HAS GROWN OVER TIME. SO
THERE'S A GREATER DISPARITY NOW.
THANK YOU. FOR HEALTH ACCESS,
CALIFORNIA, THE, FIRST TO SAY
HOW MUCH WE APPRECIATE THE
OPPORTUNITY THAT THIS HEARING
REPRESENTS TO PROVIDE THE
CONSUMER OUR PERSPECTIVE ON
HEALTH CARE COSTS. I THINK,
MADAM CHAIR, YOU KNOW, FROM YOUR
WORK ON HEALTH COMMITTEE THAT
HEALTH ACCESS IS THE STATEWIDE
HEALTH CARE CONSUMER ADVOCACY
COALITION COMMITTED TO QUALITY,
AFFORDABLE HEALTH CARE FOR ALL
CALIFORNIANS, AND THAT WE HAVE
WORKED FOR MANY DECADES IN ORDER
TO ASSURE THAT CALIFORNIANS GET
THE HEALTH CARE THEY NEED AT A
PRICE THEY CAN AFFORD. WE WANT
TO PUT THE QUESTION OF HEALTH
CARE COSTS AND PRICES IN A
CONSUMER CONTEXT, AS MISS LUCIA
JUST SAID, CONSUMERS PAY THE
COSTS OF HEALTH CARE WE PAY AS
TAXPAYERS FOR MEDICARE AND
MEDI-CAL AND COVERED CALIFORNIA
FOR WE PAY AS EMPLOYEES IN LOST
WAGES, $125,000. AND I THINK
YOU'LL HEAR SOME EXAMPLES OF
EVEN HIGHER LOST WAGES. AND AS
CONSUMERS, WE PAY FOR
DEDUCTIBLES, COPAYS AND
COINSURANCE. CGRTS MISS LUCIA
POINTED TO THE COST OF THE SHARE
OF PREMIUM AND DEDUCTIBLE IT
EXCEEDS IN CALIFORNIA. NOW
EXCEEDS $10,000. ALMOST $10,500
IN A STATE WHERE THE MEDIAN
INCOME IS 85 OR $86,000, YOU
KNOW YOUR OWN CONSTITUENTS
SPENDING ONE OUT OF $8 ON HEALTH
CARE COSTS IS HARD. IT'S PART OF
THE REASON CALIFORNIANS STRUGGLE
TO AFFORD DECENT HOUSING AND
FOOD AND THE OTHER NEEDS OF LIFE
. WE ARE ALREADY SEEING PEOPLE
DENIED ACCESS TO CARE, DENIED
QUALITY CARE, AND EQUITY
WORSENED BECAUSE OF HIGH HEALTH
CARE COSTS. TODAY, CONSUMERS
LACK ACCESS TO CARE BECAUSE OF
AFFORDABILITY. THEY CAN'T AFFORD
TO SEE A DOCTOR LIKE YOURSELF
BECAUSE THEY CAN'T AFFORD THE
DEDUCTIBLE OR THE CO-PAY OR THE
COINSURANCE. WE KNOW THIS HALF
OF CONSUMERS TELL US THEY CANNOT
AFFORD TO SEE THE DOCTOR. THEY
SKIP DOCTOR VISITS. THEY DON'T
TAKE THEIR PRESCRIPTIONS. THEY
DON'T GET THE LABS AND THE
TESTS. THEY KNOW THEY SHOULD
BECAUSE THEY CAN'T AFFORD IT
BECAUSE OF COSTS AND HALF AS
MISS LUCIA JUST SAID, HALF OF
THOSE CONSUMERS GET WORSE AS A
RESULT AND THEY KNOW IT QUALITY.
AND MOST OF THE QUALITY MEASURES
THAT WE USE DEPEND ON ACCESS TO
CARE, WHETHER IT'S MANAGING
ASTHMA OR DIABETES OR
HYPERTENSION OR PRENATAL CARE OR
CHILDHOOD IMMUNIZATIONS, THOSE
ALL DEPEND ON GOING TO THE
DOCTOR, TAKING YOUR MEDICATION
AND GETTING THE TESTS YOU NEED.
IF YOU CAN'T AFFORD TO DO THAT,
QUALITY IS WORSE. YOU'RE GOING
TO HEAR MORE. YOU JUST HEARD A
LITTLE BIT FROM MISS LUCIA ABOUT
THE IMPACT IMPACT ON EQUITY.
YOU'LL HEAR MORE FROM CPAN. PART
OF WHAT DRIVES US AT HEALTH
ACCESS IS THE RECOGNITION THAT
PEOPLE WHO MAKE IN THE BOTTOM 60
OR 70% OF THE INCOME SCALE AND
COMMUNITIES OF COLOR ARE HIT
HARDEST BY THE LACK OF
AFFORDABILITY TODAY IN OUR
HEALTH CARE SYSTEM. THE OFFICE
OF HEALTH CARE AFFORDABILITY IS
PREMISED ON THE CALIFORNIA
VERSION OF THE TRIPLE AIM THAT
WE WILL BE ABLE TO ACHIEVE LOWER
COSTS THROUGH BETTER AND BETTER
OUTCOMES, AND IMPROVED EQUITY
THROUGH DELIVERING CARE IN A
BETTER WAY. THAT'S WHAT THE HOPE
IS. THAT'S WHY THE OFFICE OF
HEALTH CARE AFFORDABILITY
INCLUDES NOT ONLY A SPENDING
TARGET, BUT ALTERNATIVE PAYMENT
METHODS, EMPHASIS ON PRIMARY
CARE, EMPHASIS ON BEHAVIORAL
HEALTH. WE WANT PEOPLE TO BE
HEALTHIER, AND WE WANT COST THE
MONEY THAT WE SPEND ON HEALTH
CARE TO BE SPENT IN AN EFFECTIVE
AND EFFICIENT WAY SO THAT PEOPLE
GET THE CARE THEY NEED. BUT
WE'RE NOT JUST SPENDING A LOT OF
MONEY FOR NOT MUCH BENEFIT. AND
I THINK I'LL LEAVE IT THERE AND
LEAVE IT TO MY COLLEAGUES OF
WHOM YOU HAVE A NUMBER BEFORE
YOU TODAY. SO THANK YOU, MADAM
CHAIR. I'M IAN LEWIS, I'M A
MEMBER AND STAFF PERSON WITH
UNITE HERE. WE'RE A UNION OF
50,000. IN CALIFORNIA, 50,000
HOTEL, RESTAURANT AND GAMING
EMPLOYEES, AND I OVER THE 25
YEARS I'VE BEEN WITH, WITH OUR
UNION, I'VE SPENT A HUGE AMOUNT
OF TIME ON HEALTH CARE. THE
POINTS THAT LAUREL AND BETH
SPOKE TO UNDER UNDERLINE WHY IT
IS THAT THE HOSPITALITY WORKERS
UNION MIGHT HAVE OPINIONS AND
MUCH TO SAY ABOUT ABOUT HEALTH
COSTS FOR EVERY UNION AND FOR
EVERY PRIVATE SECTOR EMPLOYER,
FOR THAT MATTER, COLLECTIVE
BARGAINING BOILS DOWN TO ONE
NUMBER, AND THAT'S HOW MUCH A
LABOR COSTS GOING UP NEXT YEAR
IN OUR INDUSTRY. THAT IS VERY
EXPLICIT. WE COMMONLY BARGAIN
WITH EMPLOYERS FOR A FIXED
AMOUNT BY WHICH LABOR COSTS WILL
GO UP. LET'S CALL IT A DOLLAR AN
HOUR FOR SAKE OF DISCUSSION TO
EMPLOYERS. IT DOESN'T MATTER
WHERE THAT DOLLAR GOES, WHETHER
IT GOES TO WAGES OR RETIREMENT
SECURITY, IMPROVED STAFFING
LEVELS OR HEALTH BENEFITS FOR
THEM, IT'S A MATTER OF CERTAINTY
ABOUT LABOR COSTS, FOR OUR
UNION'S MEMBERS, HEALTH CARE IS
THE YEAR AFTER YEAR IS THE
OVERWHELMING PRIORITY. IT IS THE
MOST IMPORTANT THING AND THE
BIGGEST SOURCE OF INSECURITY.
OVER THE LAST 20 YEARS, HEALTH
PREMIUMS HAVE GONE UP AT 2 TO 3
TIMES THE RATE OF INFLATION. AND
SO $0.47 OUT OF EVERY DOLLAR FOR
OUR UNION HAS HAD TO GO INTO
PAYING FOR THE INCREASED
PREMIUMS. AND EVERY PENNY OF
THAT $0.47 PER DOLLAR IS MONEY
THAT DID NOT GO INTO WAGES, IS
MONEY THAT DID NOT GO INTO
RETIREMENT SECURITY. WE, AS A
RESULT, THE TYPICAL UNION
DISHWASHER COOK, HOUSEKEEPER IN
THIS STATE, OVER THAT 20 YEAR
PERIOD WOULD HAVE BEEN OVER
$150,000, WOULD HAVE HAD
$150,000 MORE IN THEIR POCKETS
OR IN THEIR RETIREMENT ACCOUNTS
THAN THEY DO TODAY IN SAN
FRANCISCO. THAT NUMBER IS WELL
OVER $200,000. IN SAN FRANCISCO,
THE AVERAGE ROOM CLEANER
DISHWASHER. WHOM HAVE YOU WOULD
BE PAID $11.66 MORE PER HOUR
TODAY THAN THEY WOULD IF HEALTH
CARE COSTS HADN'T GONE UP AT 2
TO 3 TIMES THE RATE OF
INFLATION, THAT WOULD HAVE MORE
THAN PAID FOR THE INCREASED COST
OF RENT THAT HAS DRIVEN SO MANY
TO MOVE FURTHER AND FURTHER AWAY
FROM HOME. OUR UNION SPONSORS
HEALTH FUNDS THAT PAY FOR CARE,
EITHER PAY PROVIDERS DIRECTLY OR
MORE COMMONLY THROUGH HEALTH
PLANS. JUST TO GIVE YOU A SENSE
OF WHERE SOME OF THE COST
DRIVERS ARE IN MONTEREY COUNTY,
OUR FUND PAYS AS MUCH AS 521% OF
WHAT MEDICARE PAYS FOR HOSPITAL
STAY. THAT'S NOT BILLED CHARGES.
THAT'S THE COMMERCIALLY
CONTRACTED ALLOWABLE AMOUNT.
THAT'S FIVE TIMES WHAT THE
FEDERAL GOVERNMENT THINKS IS A
REASONABLE RATE, BASED ON THEIR
ANALYSIS OF HOSPITAL COSTS,
PRESCRIPTION DRUGS ARE ANOTHER
AREA, ESPECIALLY IN HOSPITALS,
WHERE COSTS ARE HIDDEN, BY WAY
OF EXAMPLE, AN IMPORTANT
CHEMOTHERAPY, FOR COLORECTAL
CANCER, WHICH WENT OFF PATENT
ABOUT A DOZEN YEARS AGO, OVER
THAT TIME PERIOD, THE PRICE TO
HOSPITALS WENT DOWN 99. TODAY,
MEDICARE PAYS $185 FOR A COURSE
OF TREATMENT. YET AS RECENTLY AS
LAST YEAR, ONE HOSPITAL IN
SALINAS WAS CHARGING NEARLY
$90,000 FOR THAT SAME COURSE OF
TREATMENT IN THE COMMERCIAL
MARKET. CONTRACTING WITH HEALTH
PLANS HAS NOT SOLVED THE
PROBLEM, EITHER, THROUGH A DATA
WAREHOUSE THAT OUR UNION AND
OTHERS HAVE BUILT THAT HAS, OVER
$7 BILLION WORTH OF EXPERIENCE,
PARTICULARLY WITH KAISER. WE
FOUND THAT WITHIN KAISER, FOR
INSTANCE, OVER THE LAST FOUR
YEARS THAT INTEGRATED CARE
SYSTEM HAS MANAGED TO KEEP
COSTS. THE ACTUAL SPENDING DOWN
BELOW 3. THIS IS BY THEIR
CALCULATION OF COSTS. AND YET,
FOR MANY OF OUR FUNDS JUST THIS
YEAR, RATES ARE GOING UP AS MUCH
AS 25% IN JUST ONE YEAR. THE
PREMIUMS ARE GOING 25. WE'VE
DONE EVERYTHING WE KNOW HOW TO
DO ON ON OUR END. WE'VE BUILT
HEALTHY LIVING PROGRAMS,
SPONSORED PROMOTORA TRAININGS
AMONG COWORKERS. WE'VE
DISINCENTIVIZED UNNECESSARY ER
CARE. WE'VE INCENTIVIZED THE
MOVING OF CARE TO APPROPRIATE
SITES OF SERVICE, BUT AT THE END
OF THE DAY, THERE'S ONLY SO MUCH
YOU CAN DO TO BY MANAGING
UTILIZATION, HEALTH CARE COSTS
ARE A MULTIPLICATION PROBLEM.
IT'S UTILIZATION TIMES PRICE,
AND PRICE IS THE PROBLEM IN
CALIFORNIA. IT'S A PROBLEM OF
CRISIS PROPORTIONS, WE CANNOT
KEEP TAKING $0.47 OUT OF EVERY
DOLLAR THAT WE GET, OFTEN
THROUGH BIG FIGHTS WITH
EMPLOYERS AND TURN AROUND AND
HAND IT OFF TO OTHER HEALTH CARE
CORPORATIONS, SOMETHING HAS TO
GIVE. AND THAT'S WHY I'M I WAS
HONORED AND AGREED TO BE THE
SPEAKER'S APPOINTEE TO THE
OFFICE OF HEALTH CARE
AFFORDABILITY.îM SO GLAD
YOU'RE FOCUSING ON ON THIS
QUESTION TODAY AND IN THE MONTHS
AND YEARS TO COME, I REALLY DO
BELIEVE THERE'S NO MORE CRITICAL
PROBLEM FACING OUR STATE. THANK
YOU. THANK YOU, MATT, HERE ON
BEHALF OF SEIU CALIFORNIA AND
OUR 700,000 MEMBERS, MANY OF
THEM HEALTH CARE WORKERS, MANY
OF THEM NOT HEALTH CARE WORKERS
WHO SHARE MANY OF THE SAME
ISSUES THAT MY PANELISTS IAN,
JUST MENTIONED. AND, APPRECIATE
HIS STEADFAST LEADERSHIP ON THE
OFFICE OF HEALTH CARE
AFFORDABILITY BOARD, IT'S A
MAJOR CONCERN IN BARGAINING.
IT'S OFTEN LEADING TO LONGER
WORKER ACTIONS, LONGER STRIKES,
AND EVEN AT TIMES BECAUSE IT
MATTERS SO MUCH FOR WORKERS. IT
HAS ALLOWED EMPLOYERS TO UTILIZE
AS A TOOL TO THREATEN TO CANCEL
HEALTH INSURANCE, WHICH REALLY
SPEAKS TO THE NEED TO INVEST IN
THE STRIKING WORKER FUND IN
CALIFORNIA THAT I KNOW THIS
COMMITTEE HAS LOOKED AT THIS
YEAR AND REALLY JUST WANT TO
UNDERSCORE WHY THAT'S IMPORTANT,
BECAUSE THAT IS A CRITICAL TOOL
THAT WE'RE BARGAINING OVER THAT
COULD BE SORT OF TAKEN AWAY AND
UTILIZED. ONE OF THE MAJOR
DRIVERS THAT WE SEE THAT'S
DRIVING HEALTH CARE COSTS,
CANDIDLY, IS GREED. AND FOR
EXAMPLE, YOU KNOW, WE SEE THE
EXPANSION OF FOR PROFIT
COMPANIES AND PRIVATE EQUITY
COMPANIES AND VARIOUS PARTS OF
THE HEALTH CARE INDUSTRY DRIVING
CONSOLIDATION AND ELIMINATING
COMPETITION AND CHOICE,
SUPPRESSING WAGES FOR THE
WORKFORCE AND RESULTING IN
SIGNIFICANT PROFITS OVER TIME.
THIS HAS BEEN STUDIED BOTH IN
CALIFORNIA AND AT NATIONAL
LEVELS, AND IS SOMETHING THAT IS
DEFINITELY A FLAG AS WE'RE
LOOKING AT HOW TO CONTROL COSTS,
ONE EXAMPLE FOR IS THE DIALYSIS
INDUSTRY, WHERE TWO LARGE FOR
PROFIT ENTITIES ARE DRIVING UP
HEALTH CARE COSTS. THAT'S PRETTY
WELL DOCUMENTED, AND, YOU KNOW,
REALLY FORCED WORKERS TO CHOOSE
BETWEEN THE HIGH COST OF CARE OR
HIGHER PREMIUMS OR FORGOING
CARE. AND MANY OF THEM,
UNFORTUNATELY, ARE FORGOING
CARE, LEADING TO HIGHER COSTS IN
THE LONG TERME, WE'VE ALSO SEEN
AND THIS IS RECENTLY DOCUMENTED,
EXECUTIVE COMPENSATION IN THE
HEALTH CARE SPACE BEING A
PROBLEM WITH ONE RECENT ARTICLE
ON THE CEO OF VALLEY CHILDREN'S
HOSPITAL IN FRESNO RECEIVING
TOTAL COMPENSATION OF CLOSE TO
$5.5 MILLION IN 2022, THIS IS
FOR A HOSPITAL WHERE 90% OF
THEIR REVENUE COMES OR MORE
COMES FROM THE MEDI-CAL PROGRAM.
SO SOMETHING WHERE OUR PUBLIC
DOLLARS ARE GOING TO REALLY
SUPPORT, YOU KNOW, EXTENSIVE
COMPENSATION FOR EXECUTIVES,
WHILE AT THE SAME TIME, WE SEE
THE HEALTH CARE WORKFORCE AND WE
SEE A CRISIS WE SEE BEFORE THE
PANDEMIC, A SHORTAGE OF MORE
THAN 500,000 WORKERS, TO MEET
OUR GROWING CARE NEEDS,
PARTICULARLY AS OUR POPULATION
GETS OLDER AND MORE AND MORE
GOING TO MEDICARE, WHICH MEANS
MORE AND MORE ARE GOING TO HAVE
HIGHER UTILIZATION, WHICH MEANS
CALIFORNIA AND FEDERAL
GOVERNMENT AS A WHOLE IS GOING
TO HAVE TO DEAL WITH THIS, WE
KNOW THAT WITHOUT A SUFFICIENT
WORKFORCE, WE'RE GOING TO SEE
LONGER DELAYS, HARDER TO GET IN
AND SEE SOMEONE, WE'LL SEE
HIGHER RATES OF INFECTIONS AND
BED SORES WHEN YOU ARE IN THE
HOSPITAL AND UNFORTUNATELY,
POORLY COORDINATED CARE, IF WE
CONTINUE TO HAVE TURNOVER, WE
MUST HAVE SUSTAINED INVESTMENT
IN OUR HEALTH CARE WORKFORCE TO
MEET THIS NEED, BOTH IN THE
SHORT AND THE LONG TERME AND
ALSO MUST MAKE SURE THAT THESE
THIS WORKFORCE MEETS OUR
CULTURAL AND LINGUISTICALLY
NEEDS OF OUR POPULATION AS WE
CONTINUE TO DIVERSIFY AS A STATE
, INVESTING IN THE WORKFORCE
GOES HAND IN HAND WITH MEETING
OUR STATE'S, COST CONTAINMENT
GOALS BECAUSE BETTER STAFFING,
RETENTION AND TRAINING AND
HEALTH CARE WORKFORCE WILL
IMPROVE PATIENT CARE AND
OUTCOMES, UNFORTUNATELY, YOU
KNOW, FOR THE STATE OF THE
MEASUREMENT AND MONITORING OF
THE HEALTH CARE WORKFORCE AND
WORKFORCE STABILITY, WHICH IS
ONE OF THE ISSUES CURRENTLY
UNDER DISCUSSION WITH THE OFFICE
OF HEALTH CARE AFFORDABILITY, IS
REALLY DEPENDENT ON OUR ABILITY
TO GET DATA. AND OFTEN THE DATA
SOURCES WE'RE USING CURRENTLY
HAVE A LAG OF A YEAR OR MORE,
WHICH MEANS IT'S HARD TO REACT
IN REAL TIME WITH WHAT WE NEED.
AND UNFORTUNATELY, THERE'S NOT A
MAGIC WAND TO MAGICALLY CREATE
MORE HEALTH CARE WORKERS THAT
ARE EXPERIENCED AND BE ABLE TO
DELIVER THE CARE, AS BOTH OF YOU
KNOW. SO, YOU KNOW, FOR THAT, WE
REALLY WANT TO PUSH AND SEE THE
NEED FOR SITE LEVEL, DATA SO
THAT WE CAN SEE WHAT EACH
REGION, EACH INDIVIDUAL SITE
NEEDS, AS A STATE AND CONTINUE
TO WORK ON THAT INVESTMENT, WE
ALSO THINK THAT, THAT NEEDS TO
BE PUT TOGETHER AS A WHOLE SO WE
CAN LOOK AT A MACRO LEVEL, MAKE
SURE EVERYONE TAKING THE
APPROPRIATE CLINICAL PLACEMENT
SITES, INVESTING IN THOSE
TRAINING PROGRAMS, BECAUSE IT IS
GOING TO NEED AN ENTIRE INDUSTRY
EFFORT TO MEET OUR WORKFORCE
GOALS. SO JUST IN SUMMARY, I'LL
CLOSE QUICKLY. HEALTH CARE COSTS
ARE REALLY HURTING WORKERS AT
THE BARGAINING TABLE, WE SEE THE
GREED WITHIN THE INDUSTRY, AND
SOMETIMES IT'S NOT EVEN HEALTH
CARE PROVIDERS, BUT IT'S PEOPLE
FROM OUTSIDE THAT SEE THAT THIS
IS AN INDUSTRY WHERE YOU CAN
MAKE QUITE A BIT OF MONEY
DRIVING UP COSTS CGRTS. AND,
ADDITIONALLY, JUST THAT HAVING A
STRONG HEALTH CARE WORKFORCE
DOES REQUIRE THIS INVESTMENT.
AND CONTINUED COMMITMENT BY THE
INDUSTRY TO MAKE SURE THAT WE'RE
MEETING OUR OVERALL LONG TERME
CARE GOALS FOR BOTH QUALITY OF
CARE AND COST. THANK YOU FOR
YOUR TIME AND ATTENTION ON THIS
ISSUE. THANK YOU SO MUCH TO OUR
FIRST PANEL. I AM GOING TO
SWITCH IT OVER TO THE SECOND,
BUT I AM GOING TO ASK LAUREL,
STAY. SO WE'LL NOW HAVE, SARAH
FLAX FROM THE CALIFORNIA LABOR
FEDERATION. CARMEN, CUMPSTY FROM
CALIFORNIA NURSES ASSOCIATION,
KAREN SAVAGE SANGWAN FROM
CALIFORNIA, PAN ETHNIC HEALTH
NETWORK. THANK YOU, MADAM CHAIR,
ASSEMBLY MEMBER, THANK YOU SO
MUCH FOR THE INVITATION. I
ALMOST DON'T HAVE MUCH TO SAY.
THIS IS AN EXCELLENT, EXCELLENT
PANEL, AND PEOPLE THAT I HAVE
WORKED WITH AND LEARNED FROM FOR
MANY YEARS NOW, BUT I DO WANT TO
DRILL DOWN ON SOME OF THE, THE
POINTS THAT WERE MADE ON
AFFORDABILITY. WE HAVE SAID FOR
A LONG TIME AT THE LABOR
FEDERATION THAT EVERY DOLLAR
THAT GOES INTO THE HEALTH CARE
INDUSTRY IS A DOLLAR THAT COMES
OUT OF A WORKER'S POCKET, A
CONSUMER'S POCKET OR A
TAXPAYER'S POCKET. BUT WHAT I
THINK WE KNOW NOW AND WHAT IAN
ILLUSTRATED IS THAT THAT'S NOT
JUST A DOLLAR, THAT'S $11.66 IN
THEIR INDUSTRY. NOW TAKE THAT
AND MULTIPLY IT BY THE 2.2
MILLION UNION WORKERS THAT THE
LABOR FEDERATION REPRESENTS. AND
IN CERTAIN AREAS OF THE STATE
AND IN CERTAIN WORKFORCES THAT
NUMBER IS MUCH HIGHER. PEOPLE
ARE UNIONS ARE GOING TO THE
TABLE AND BEING ASKED TO GIVE UP
15, 16, $17 AN HOUR SO THAT THEY
CAN HAVE HEALTH CARE THAT THEIR
MEMBERS CAN AFFORD, BECAUSE
THAT'S THE BIG QUESTION. THAT'S
THE BIG ISSUE, THAT YOU CAN
REDUCE THE AMOUNT THAT'S PAID IN
A PREMIUM, BUT THEN YOU'RE GOING
TO HAVE A $10,000 DEDUCTIBLE
THAT A LOT OF OUR MEMBERS CANNOT
AFFORD, AND WE WANT THEM TO GET
THE CARE THAT THEY NEED. AND SO
THIS HUGE AMOUNT OF MONEY THAT
IS BASICALLY BEING SIPHONED AWAY
FROM WORKING PEOPLE AND THE
STATE BUDGET INTO THE HEALTH
CARE INDUSTRY IS EXACERBATING
THE AFFORDABILITY CRISIS IN THE
STATE. THIS IS NOT JUST A HEALTH
CARE ISSUE. IT'S NOT JUST A
PUBLIC HEALTH ISSUE. IT'S AN
ECONOMIC CRISIS. IT IS
CONTRIBUTING TO THE INEQUITIES
AND INCOME INEQUALITY IN THIS
STATE. AND FOR THAT REASON, IT'S
AN ISSUE THAT THE LABOR
FEDERATION HAS TRIED TO TACKLE
FOR MANY, MANY DECADES NOW AND
WILL CONTINUE IN THE FUTURE. AND
WE'VE DONE THAT IN SEVERAL WAYS.
ONE IS THROUGH POLICY, BUT ALSO
INTERNALLY, WHICH IAN ALSO
TALKED ABOUT. OUR TRUST FUNDS
ARE VERY SOPHISTICATED
PURCHASERS, AND THEY MANY OF
THEM THAT ARE SELF-INSURE AND
ARE ABLE TO LOOK AT WHAT THEY
ARE BEING CHARGED AND THEY ARE
ABLE TO TRY THEIR BEST THROUGH
ANY RESOURCE OR TOOL. THEY HAVE
TO TRY TO REDUCE THE COST, TO
TRY TO FIGURE OUT HIGH VALUE
NETWORKS, TO TRY TO MAKE SURE
PEOPLE GET HIGH QUALITY CARE.
THAT'S NOT AS EXPENSIVE AS
PERHAPS THE HOSPITAL NEXT TO
THEM. AND THEY'VE LOOKED INTO
EVERYTHING WE'VE TRIED TO FOLLOW
THE DOLLAR. AND LET ME TELL YOU,
FOLLOWING THE HEALTH CARE DOLLAR
IS VERY COMPLICATED BECAUSE
THERE'S HEALTH INSURERS, HEALTH
PLANS, INSURERS, THERE'S
HOSPITALS, PBMS, THERE'S PHARMA
DIALYSIS CLINICS, THERE'S MONEY
FLOATING IN AND OUT AND IT IS
VERY HARD TO TRACK. BUT
FUNDAMENTALLY, WHAT WE'VE
REALIZED, THE PROBLEM IS THE
PRICE. AND I'M JUST GOING TO SAY
THAT AGAIN, I'M GOING TO QUOTE
IAN, IT IS THE PRICE. WE ARE
BEING CHARGED TOO MUCH, AND WE
HAVE REACHED THE LIMIT OF WHAT
WE CAN DO INTERNALLY, BENEFIT
DESIGN IS NOT GETTING US THE
RESULTS THAT WE NEED. AND SO WE
ARE VERY EXCITED ABOUT THE
OFFICE OF HEALTH CARE
AFFORDABILITY BECAUSE IT'S THE
FIRST TIME THAT WE HAVE AN EYE
IN THE SKY. WE ARE ABLE TO LOOK
AT THE WHOLE INDUSTRY AND TRY TO
SET REASONABLE TARGETS, AND WE
REALLY HOPE THAT WE ALSO AND THE
BOARD WILL BE ABLE TO DRILL
DOWN. SO WE'LL START TO LOOK AT
SOME OF THOSE HOSPITALS THAT ARE
CHARGING 500, 400, 600% OF
MEDICARE AND TRY TO FIGURE OUT
WHY THEY'RE CHARGING SO MUCH
MORE THAN WHAT THE FEDERAL
MEDICARE PROGRAM THINKS THEY
SHOULD BE GETTING IN COMMERCIAL
PAYMENTS. AND HOPEFULLY, WHEN WE
IDENTIFY THAT THAT MONEY CAN BE
PUT BACK INTO THE WORKFORCE AND
INTO MAKING SURE THAT WE HAVE A
FULLY TRAINED, WELL PAID, STABLE
HEALTH CARE WORKFORCE THAT IS IN
MEDICALLY UNDERSERVED AREAS THAT
REFLECTS THE DIVERSITY OF OUR
STATE AND IS ABLE TO STAY IN THE
PROFESSION. AND SO WE REALLY
THINK OF WITH OKA THAT THAT
HOPEFULLY THIS WILL BE A
REDISTRIBUTION, A REDISTRIBUTION
OF SOME OF THE MONEY IN THE
HEALTH CARE INDUSTRY BACK TO
WORKERS IN WAGES AND BACK INTO
THE INDUSTRY. SO THAT THE HEALTH
CARE WORKFORCE HAS THE STABILITY
AND THE WAGES THEY NEED TO SERVE
THE PUBLIC. SO WE THANK YOU FOR
THIS HEARING AND LOOK FORWARD TO
WORKING WITH YOU IN THE FUTURE.
HI HI. GOOD AFTERNOON, CHAIR
WEBER, ASSEMBLY MEMBER BONTA I'M
CARMEN CÁC, LEAD REGULATORY
POLICY SPECIALIST WITH THE
CALIFORNIA NURSES ASSOCIATION,
AS YOU KNOW, THE LARGEST UNION
OF REGISTERED NURSES IN
CALIFORNIA REPRESENTING OVER
100,000 NURSES ACROSS THE STATE,
YOU KNOW, I KIND OF WANT TO STEP
BACK A LITTLE HERE, WHICH IS TO
SAY, TODAY, YOU KNOW, WE HAVE A
MARKET BASED SYSTEM OF HEALTH
CARE. AND I THINK WE NEED TO
REALIZE THAT. AND WHAT IS
DRIVING HEALTH CARE RIGHT NOW IS
A PROFIT DRIVEN INSURANCE SYSTEM
AND PROFIT DRIVEN HEALTH CARE
CORPORATIONS, HEALTH CARE
EMPLOYERS THAT THRIVE AT THE
EXPENSE OF PATIENTS AND HEALTH
CARE WORKERS, WITH HEALTH CARE
EMPLOYERS FIXATED ON SHORT TERMS
, PROFITS AND REDUCING COSTS.
WHAT WE GET IS THAT HEALTH CARE
EMPLOYERS UNION BUST. THEY
DEPRESS WAGES. THEY UNDERSTAFFED
TO CUT COSTS, EMPLOYERS SQUEEZE
HEALTH CARE WORKERS TO PROVIDE
MORE CARE WITH LESS, WHICH HARMS
OUR NURSES ABILITY TO PROVIDE
SAFE AND HIGH QUALITY PATIENT
CARE. SO THERE'S A CONNECTION
BETWEEN THE MECHANISM OF CUTTING
COSTS AND RAISING PRICES AND
HEALTH CARE QUALITY, WHEN
REVENUE IS TIGHT, WHAT WE SEE ON
THE CHOPPING BLOCK ARE SAFETY
NET HOSPITALS AND RURAL
HOSPITALS BECAUSE THEY'RE NOT
THEY'RE NOT MONEY MAKERS, HIGH
COST, LOW RETURN SERVICES LIKE
MATERNITY CARE, BEHAVIORAL
HEALTH CARE, PRIMARY CARE. THOSE
ARE ALSO PEGGED FOR CLOSURE.
WE'VE SEEN TODAY THERE'S A
HEALTH CARE SYSTEM, A FOR PROFIT
HEALTH CARE SYSTEM WHOSE CLOSING
TRAUMA CENTERS IN MAJOR
METROPOLITAN AREAS IN THE STATE,
YOU KNOW, AND TO EVEN FURTHER
FOCUS ON SHORT TERME, COST
CUTTING HOSPITALS IMPLEMENT, YOU
KNOW, THEY AVOID IMPLEMENTING
THINGS LIKE SEISMIC UPGRADES TO
THEIR HOSPITALS AT THE EXPENSE
OF HEALTH CARE WORKERS AND
PATIENTS IN THE LONG RUN,
EMPLOYERS FOCUS ON JUST IN TIME
STAFFING AND JUST IN TIME
SUPPLIES. AGAIN, SHORT TERME
COSTS, COST CUTTING AT THE
EXPENSE OF LONG TERME INVESTMENT
AND PREVENTION. NOW EMPLOYER
INDIFFERENCE AND DISREGARD FOR
HEALTH CARE, WORKER HEALTH AND
SAFETY HAS AND WE KNOW HAS
RESULTED IN HIGH LEVELS OF MORAL
DISTRESS FOR NURSES AND OTHER
HEALTH CARE WORKERS, AND HIGH
RATES OF WORKPLACE INJURY AND
ILLNESS. AS A RESULT. THIS LEADS
MANY NURSES AND OTHER HEALTH
CARE WORKERS TO LEAVE BEDSIDE
CARE OR THE PROFESSION
ALTOGETHER. THIS HARMS OUR
HEALTH CARE WORKFORCE. THESE
LEAN STAFFING MODELS AND SUPPLY
MODELS. THEY ULTIMATELY
CONTRIBUTE TO THE RISING COSTS
OF HEALTH CARE, IN 2023, IT
COSTS HOSPITALS ON AVERAGE
NATIONWIDE OVER $56,000 FOR EACH
STAFF TURNOVER AND THE AVERAGE
HOSPITAL NATIONWIDE IN IN ONE
YEAR ALONE LOST OVER $4.8
MILLION IN NURSE TURNOVER ALONE.
SO THIS IS JUST NURSES. JUST
IMAGINE ALL THE OTHER HEALTH
CARE WORKERS THAT WE'RE TALKING
ABOUT HERE TOO. BUT TO BE CLEAR,
THERE'S NO SHORTAGE OF
REGISTERED NURSES IN CALIFORNIA.
AND IN THE UNITED STATES.
THERE'S A SHORTAGE OF GOOD
NURSING JOBS. THERE ARE OVER
HALF A MILLION REGISTERED NURSES
WHO ARE ACTIVELY LICENSED IN
CALIFORNIA, BUT ONLY ABOUT TWO
THIRDS WORKING ACTIVELY AS
NURSES. HEALTH CARE EMPLOYERS
MUST INSTEAD INVEST IN THE
RECRUITMENT AND RETENTION OF
HEALTH CARE WORKERS AND NURSES,
AND PROVIDE GOOD UNION JOBS WITH
FAIR WAGES, SAFE STAFFING AND
SAFE WORKING CONDITIONS, AND
INSTEAD OF SHIFTING THE COST
ONTO WORKERS AND PATIENTS, WE
MUST FUNDAMENTALLY RESTRUCTURE
OUR HEALTH CARE SYSTEM. THIS IS
WHY HEALTH HEALTH CARE NURSES,
UNION NURSES OF CNA HAVE BEEN
FIGHTING FOR DECADES FOR
UNIVERSAL GUARANTEED HEALTH CARE
FOR ALL THROUGH A SINGLE PAYER
SYSTEM, HEALTH CARE CORPORATIONS
WASTE TENS OF BILLIONS OF
DOLLARS EACH YEAR ON PROFIT
MARGINS AND INSURANCE MIDDLEMEN,
THE NICKEL AND DIME PATIENTS AND
WORKERS. MEANWHILE, PATIENTS
FOREGO THE BASIC HEALTH CARE
NEEDS, BECAUSE THEY CAN'T AFFORD
IT. FOR NURSES, THIS IS
UNCONSCIOUS, ABLE TO ADDRESS THE
RISING PRICES OF HEALTH CARE. WE
WANT TO MOVE TO A SYSTEM THAT
TREATS PATIENTS CGRTS, WITH
DIGNITY AND PROVIDES THE CARE
THAT THEY NEED. OUR HEALTH CARE
SYSTEM IS FUNDAMENTALLY BROKEN
AND UNDER A SINGLE PAYER SYSTEM,
WE KNOW THAT WE CAN USE OUR
COLLECTIVE BUYING POWER TO
REDUCE PRICES ACROSS THE BOARD
FOR EVERYONE. AND BY
GUARANTEEING HEALTH CARE FOR
ALL, WE'RE TAKING HEALTH CARE
OFF THE BARGAINING TABLE FOR
HEALTH CARE WORKERS. SO THAT WE
CAN BARGAIN FOR HIGHER WAGES,
BETTER WORKING CONDITIONS, AND
BETTER COMPENSATION. OVERALL SO
WE CAN RETAIN THEM IN OUR HEALTH
CARE SYSTEM. NOW CONFIRMING
STUDIES OVER THE DECADES, THE
HEALTH OF CALIFORNIA FOR ALL
COMMISSION FOUND THAT IT COSTS
CALIFORNIA HOSPITALS, DOCTORS
AND OTHER PROVIDERS ABOUT 85
BILLION WITH A B EACH YEAR IN
INSURANCE RELATED ADMINISTRATIVE
COSTS. AND THE COMMISSION FOUND
THAT A DIRECT PAYMENTS OR SINGLE
PAYER MODEL WITH NO COST SHARING
AND LONG TERME CARE FOR ALL
WOULD SAVE BETWEEN 32 BILLION
WITH A, B, A TO UP TO $213
BILLION OVER TEN YEARS. IF WE
IMPLEMENTED, A SINGLE PAYER
SYSTEM COMPARED TO OUR CURRENT
SYSTEM, BY ELIMINATING THIS
FRAGMENTATION IN OUR CURRENT
HEALTH CARE SYSTEM, CALIFORNIA
WOULD SAVE BILLIONS THAT COULD
BE INSTEAD INVESTED INTO OUR
HEALTH CARE INFRASTRUCTURE, TO
OUR HOSPITALS, TO GOOD JOBS, TO
SAFE STAFFING, TO OPTIMAL
RESOURCING SO THAT WE CAN
ACTUALLY HAVE A HEALTH CARE
SYSTEM THAT THAT CAN PROVIDE
CARE TO EVERYONE. AND SO, YOU
KNOW, WE LOOK FORWARD TO WORKING
WITH YOU ALL ON, ON THESE REALLY
IMPORTANT ISSUES. THANKS GREAT.
THANK YOU SO MUCH, GOOD
AFTERNOON AND THANK YOU SO MUCH
FOR HOLDING THIS HEARING. I'M
HERE ON BEHALF OF THE CALIFORNIA
PANETHNIC HEALTH NETWORK, OR
CPN. WE ARE A STATEWIDE
MULTICULTURAL HEALTH ADVOCACY
ORGANIZATION, AND WE WORK WITH A
LARGE NETWORK OF COMMUNITY BASED
ORGANIZATIONS AND COMMUNITY
LEADERS, ALL OF WHOM ARE DEEPLY
EMBEDDED IN COMMUNITIES OF COLOR
ACROSS THE STATE. OUR GOAL IS TO
ELIMINATE RACIAL HEALTH
DISPARITIES IN CALIFORNIA AND
THE CURRENT AND EVER RISING COST
OF HEALTH CARE IS A SIGNIFICANT
BARRIER TO REACHING THIS GOAL.
APPROXIMATELY 40% OF BLACK,
LATINO, AND MULTIRACIAL
CALIFORNIANS OR THEIR FAMILY
MEMBERS HAVE HAD DIFFICULTY
PAYING MEDICAL BILLS IN THE LAST
12 MONTHS. AS A RESULT, HALF OF
ALL BLACK AND LATINO
CALIFORNIANS CURRENTLY HAVE
MEDICAL DEBT, THE MOST COMMON
SOURCE OF WHICH IS HOSPITAL
CARE. OTHERS HAVE SPOKEN ABOUT
THE NUMBER OF CONSUMERS WHO
SKIPPED NEEDED MEDICAL CARE
BECAUSE OF CONCERNS WITH COST OR
AFFORDABILITY. I WANT TO NOTE
THAT THE IMPACTS OF HEALTH CARE
COSTS, PARTICULARLY THE
ACCUMULATION OF MEDICAL DEBT, GO
BEYOND THAT. A 2016 STUDY CITED
BY THE CONSUMER FINANCIAL
PROTECTION BUREAU FOUND THAT
LARGER DEBT LOADS ARE CORRELATED
WITH A HIGHER RISK OF DYING.
EARLIER, PEOPLE WITH DEBT HAVE
TRIPLED THE INCIDENCE OF MENTAL
HEALTH CONDITIONS SUCH AS
ANXIETY, STRESS, OR DEPRESSION,
AND A 2021 STUDY PUBLISHED IN
THE JOURNAL OF CLINICAL
PSYCHIATRY, Kò FOUND THAT DEBT
BURDEN IS STRONGLY ASSOCIATED
WITH AN INCREASED LIKELIHOOD OF
SUICIDE ATTEMPTS. QUITE
LITERALLY, UNAFFORDABLE HEALTH
CARE COSTS MAKE US SICKER, AND
THIS IS PARTICULARLY TRUE FOR
PEOPLE OF COLOR. HIGH HEALTH
CARE COSTS ALSO HAVE IMPACTS ON
THE ABILITY OF CONSUMERS TO
AFFORD OTHER ESSENTIALS,
PARTICULARLY HOUSING IN THE
STATE OF CALIFORNIA. MORE
MULTIPLE STUDIES HAVE FOUND HIGH
HEALTH CARE COSTS AND DEBT
IMPACT THE ABILITY OF CONSUMERS
TO PAY FOR FOOD AND HOUSING. TWO
CRITICAL COMPONENTS OF HEALTH.
HEALTH CARE COSTS CONTRIBUTE TO
CALIFORNIA'S HOMELESSNESS
CRISIS, BOTH CAUSING AND
PROLONGING HOMELESSNESS, WHICH
AGAIN, IS DISPROPORTIONATELY
EXPERIENCED BY BLACK AND LATINO
CALIFORNIANS. HEALTH CARE COSTS
PUSH PEOPLE OUT OF HOUSING AND
ONTO THE STREET, AND IN FACT, ON
MY WAY HERE TODAY, I PASSED A
WOMAN. SHE WAS ON THE STREET.
SHE WAS ASKING FOR CHANGE, AND
SHE WASN'T ASKING FOR MONEY FOR
FOOD OR FOR HOUSING. SHE WAS
ASKING FOR MONEY FOR A LIFE
SAVING MEDICAL PROCEDURE FOR A
FAMILY MEMBER. FINALLY, AND
PERHAPS MOST IMPORTANTLY, ALL
THIS HEALTH CARE SPENDING DOES
NOT LEAD TO GOOD HEALTH
OUTCOMES. WHILE SUFFICIENT
FUNDING IS OF COURSE A
PREREQUISITE, INCLUDING FOR OUR
MEDI-CAL PROGRAM, THE UNITED
STATES SPENDS FAR MORE ON HEALTH
CARE THAN OTHER HIGH INCOME
COUNTRIES. BUT ACCORDING TO THE
COMMONWEALTH FOUNDATION, RANKS
LAST ABSOLUTELY LAST IN CRITICAL
DOMAINS, INCLUDING ACCESS TO
CARE, ADMINISTRATIVE EFFICIENCY,
EQUITY AND HEALTH OUTCOMES. MORE
SPENDING DOESN'T LEAD TO BETTER
CARE. KHN SUPPORTS THE OFFICE
OF HEALTH CARE AFFORDABILITY,
NOT ONLY BECAUSE WE BELIEVE
CONTROLLING COSTS ITSELF IS
CRITICAL TO ADVANCING HEALTH AND
RACIAL EQUITY, BUT MORE
IMPORTANTLY, BECAUSE WE WANT A
MORE EFFECTIVE AND MORE
EQUITABLE HEALTH CARE SYSTEM,
THE OFFICE OF HEALTH CARE
AFFORDABILITY MANDATE ENSURES
THAT WE DO NOT SACRIFICE ACCESS,
QUALITY OR EQUITY IN THE PROCESS
OF REINING IN COSTS. IT REQUIRES
US TO INVEST ADEQUATELY IN
PRIMARY AND BEHAVIORAL HEALTH,
WHICH HAS BEEN SHOWN TO IMPROVE
HEALTH OUTCOMES, AND IT ENSURES
THAT THE HEALTH WORKFORCE
REMAINS INTACT. WE CAN AND MUST
BUILD A BETTER HEALTH CARE
DELIVERY SYSTEM IN CALIFORNIA.
ONE WHICH IS NOT ONLY FOR THOSE
WHO CAN PAY, BUT FOR ALL OF US.
THANK YOU. THANK YOU SO MUCH.
AND I WANT TO THANK ALL OF THE
PANELISTS FOR YOUR PRESENTATIONS
TODAY. I'M GOING TO TURN OVER TO
MY COLLEAGUE, ASSEMBLY MEMBER,
TO SEE IF SHE HAS ANY QUESTIONS.
AND BEFORE SHE DOES, I
APOLOGIZE, IF ALL OF THE
PANELISTS WHO AREN'T SITTING, IF
YOU'RE SITTING THERE, STAY. BUT
IF YOU'RE NOT, IF YOU CAN COME
UP TO THE FIRST ROW JUST IN
CASE, YOU NEED TO QUICKLY SWAP
OUT, I APOLOGIZE. I DIDN'T
MENTION THAT EARLIER, AND I WILL
NOW, TURN IT OVER TO
ASSEMBLYMEMBER BONTA. THANK YOU
TO ALL OF THE PANELISTS FOR YOUR
PRESENTATION. AND, DOCTOR WEBER
FOR MAKING SURE THAT WE HAVE A
VERY ROBUST CONVERSATION ABOUT
THIS. I, AM PRIMARILY INTERESTED
IN WANTING TO DIVE A LITTLE BIT
MORE DEEPER INTO THE
CONVERSATION AROUND VERTICAL
CONSOLIDATION AND THE IMPACTS OF
VERTICAL CONSOLIDATION, AND TO
YOUR POINT, KIND OF THE
INTRODUCTION OF OR THE OR THE
REMOVAL OF COMPETITION IN THE
MARKET, AND WHAT THAT MEANS FOR
PEOPLE WHO ARE STRUGGLING TO
MEET THEIR BASIC NEEDS IN HEALTH
CARE. SO I JUST WANTED TO JUST,
HAVE A LITTLE BIT MORE OF A
DISCUSSION AROUND THE IMPACTS OF
VERTICAL CONSOLIDATION AND WHAT
WE AS A LEGISLATURE ARE ALREADY
DOING AROUND THAT LEGISLATIVELY,
AND WHETHER THERE ARE ANY
OPPORTUNITIES FOR US TO BE ABLE
TO ADDRESS THAT.
EPISCOPAL, ON BEHALF OF HEALTH
ACCESS, THANK YOU SO MUCH FOR
THAT QUESTION. THERE HAS ALREADY
BEEN A SUBSTANTIAL AMOUNT OF
CONSOLIDATION WITHIN HEALTH CARE
IN CALIFORNIA JUST IN THE LAST
FEW DAYS, I WAS LOOKING AT, THE
DEGREE OF CONSOLIDATION IN THE
COMMERCIAL MARKET. WE HAVE THREE
MAJOR INSURERS THAT REPRESENT
SOMETHING LIKE 75 OR 80% OF THE
HEALTH CARE MARKET. WHEN WE
LOOK, REACH IN BY REGION, WE
FIND A HANDFUL OF HEALTH SYSTEMS
THAT ARE IN THE COMMERCIAL
MARKET. I THINK ABOUT SAN DIEGO
WITH SCRIPPS AND SHARP AND UC
DAVIS AND OR UC. SORRY WE TO
MANY TO MANY UCS, NOT ENOUGH
TIME, UC SAN DIEGO AND KAISER,
SOME ORPHALI IN THE EAST BAY.
FUNCTIONALLY IN THE COMMERCIAL
MARKET, IT'S SUTTER AND KAISER,
AND SO THAT'S A DEGREE OF
CONSOLIDATION. THAT MEANS IF YOU
WANT TO GO TO A NON KAISER
HOSPITAL OR DOCTOR, YOU'RE GOING
TO SUTTER. AND THAT'S A HIGH
DEGREE OF CONSOLIDATION IN
MONTEREY WHICH YOU HEARD ABOUT.
THERE ARE THREE HOSPITAL SYSTEMS
, ONE OF THEM A STANDALONE
HOSPITAL, IS PART OF A HEALTH
SYSTEM THAT IS USING ITS
RESERVES TO BUY UP PHYSICIAN
PRACTICES. THEY HAVE $1 BILLION
IN RESERVES. THAT'S THE ONE
THAT'S CHARGING BETWEEN 550% AND
600% OF WHAT MEDICARE CHARGES
THEY'RE NOT IN. MISS LUCIA HAS
DONE SOME OF THE HOMEWORK HERE.
THEY'RE NOT PAYING THEIR HEALTH
CARE WORKERS BETTER. THEY'RE
COMPARABLE TO OTHER BAY AREA
WAGES, WHICH ARE GOOD WAGES
RELATIVELY. BUT THEY'RE NOT
THEY'RE NOT PAYING BETTER. THE
OTHER TWO HOSPITALS IN THE AREA
ARE NOW PRICING IN A SIMILAR
WAY, WHAT AN ECONOMIST MIGHT
CALL SHADOW PRICING OFF OF THE
FIRST ONE. THIS IS A CHALLENGE
THAT THE OFFICE OF HEALTH CARE
AFFORDABILITY HAS ALSO HÌ
EQUIPPED TO IDENTIFY, BUT NOT TO
ACT ON. SO I WANT TO DISTINGUISH
HERE THE OFFICE OF HEALTH CARE
AFFORDABILITY HAS THE AUTHORITY
TO DO WHAT ARE CALLED COST AND
MARKET IMPACT. REVIEWS OF BOTH
TRANSACTIONS, AND ALSO MARKETS.
AND I KNOW MY FRIENDS IN
MONTEREY HAVE ALREADY ASKED THEM
TO LOOK AT MONTEREY COUNTY FOR
OBVIOUS REASONS. GIVEN WHAT
YOU'VE HEARD TODAY, WHAT THEY
CAN'T DO, WHAT THE ATTORNEY
GENERAL DOES AND HAS DONE FOR 30
YEARS WITH NONPROFIT HOSPITALS
IS TO SAY YES, NO, OR YES WITH
CONDITIONS. AND LET ME BE CLEAR,
80 OR 90% OF THE TIME, ATTORNEYS
GENERAL OF BOTH PARTIES GOING
BACK ALL THE WAY TO DAN LUNGREN,
WHO, YES, I KNOW, HAVE SAID YES
WITH CONDITIONS AND THEY'RE
CONDITIONS THAT I THINK WE ALL
SUPPORT KEEPING THE EMERGENCY
ROOM OPEN, KEEPING LABOR AND
DELIVERY, KEEPING CARDIAC CARE,
THE KINDS OF THINGS CONSUMERS
ACTUALLY NEED, SO THAT'S BEEN A
VERY IMPORTANT PROTECTION. YOU
HAVE LEGISLATION PENDING BEFORE
YOU. SORRY I CAN'T REMEMBER
WHERE THIS BILL IS NOW, ON
PRIVATE EQUITY. YOU YOU ALREADY
GOT. YEAH, ON PRIVATE EQUITY,
WHICH WILL, YOU WILL SEE AGAIN
ON THE FLOOR, WHICH IS GOING TO
JUDICIARY COMMITTEE AND THEIR
ROLE IN TAKING OVER PARTS OF
HEALTH CARE IN CALIFORNIA. SO
AND THERE HAVE BEEN OTHER
EFFORTS TO TRY AND EXPAND THE
AUTHORITY OF THE ATTORNEY
GENERAL, TO HAVE OVERSIGHT AND
TO BE ABLE TO PROTECT THE PUBLIC
INTEREST, WHICH IS WHAT THEY DO.
SORRY THAT WAS A VERY LONG
QUESTION. ANSWER TO A VERY SHORT
QUESTION. BUT IT TOUCHED A LOT
OF AREAS OF INTEREST TO I KNOW
TO BOTH OF YOU, I APPRECIATE IT.
AND MY SECOND QUESTION KIND OF
HIT ON WHERE YOU WERE GOING
ALREADY WITH THE RESPONSE, WHICH
IS KIND OF THE PROMISE OF OKA
AND ALSO THE, LIMITATIONS OF OKA
MOVING FORWARD. SO, YOU KNOW, IN
OUR WILDEST DREAMS, IF ALL WE'RE
ABLE TO GET FROM OKA IS AN
UNDERSTANDING WITH DATA TO
SUPPORT, THAT, WE ARE OFFERING
LOWER QUALITY CARE AT A HIGHER
PRICE. IT'S WONDERFUL TO HAVE
THAT DATA. WHAT IN THE WORLD,
THEN? DO WE DO ABOUT THAT? SO I
WANTED TO KIND OF FIRST TALK
ABOUT THE LIMITATIONS OF OKA AND
, AND ALSO THE POTENTIAL EVEN
OUTSIDE OF THE MECHANISM OF THE
OFFICE OF ATTORNEY GENERAL, TO
BE ABLE TO TRULY ADDRESS THE
IMPACTS OF, WHAT ULTIMATELY
MIGHT BE REFERRED TO AS PRICE
FIXING WITHIN OUR MEDICAL
INDUSTRY, PRICE FIXING IS A
STRONG FIRM IN THE WORLD OF
ANTITRUST. SO, YOU NOTICED I
DIDN'T QUITE SAY THAT. RIGHT,
LAYMAN'S PERSON, IT SO THE
OFFICE OF HEALTH CARE
AFFORDABILITY IS, I THINK YOU
BOTH KNOW, IS GOING TO BE
SETTING A TARGET, ON SPENDING.
THEY WILL ALSO BE SETTING
STANDARDS FOR PRIMARY CARE,
BEHAVIORAL HEALTH, ALTERNATIVE
PAYMENT MODEL, USE OF
ALTERNATIVE PAYMENT MODELS. ONE
OF THE CONVERSATIONS THAT I
THINK WILL COME TO YOU AT SOME
POINT IS, DO WE KNOW ENOUGH
ABOUT WHAT WE SHOULD BE DOING IN
TERMS OF PRIMARY CARE AND
BEHAVIORAL HEALTH AND
ALTERNATIVE PAYMENT MODELS THAT
THOSE STANDARDS OR GUIDELINES
SHOULD PERHAPS BE A LITTLE BIT
MORE BE ENFORCEABLE, THAT WE
SHOULD BE SAYING, YES, WE WANT
WE ARE SERIOUS AS A STATE IN
PRIORITIZING PRIMARY CARE, AND
WE WANT TO GET TO A CERTAIN
THRESHOLD. YES WE ARE SERIOUS
ABOUT ACCESS TO BEHAVIORAL
HEALTH AND WE THIS LEGISLATURE
HAS ALREADY DONE A LOT, BUT I
DON'T THINK ANY OF US THINK IT'S
ENOUGH, AND THE SAME WITH
ALTERNATIVE PAYMENT MODELS. WE
ARE. AND I'M GOING TO DEFER TO
IAN, WHO'S ACTUALLY ON THE OKA
BOARD. WE YOU KNOW, THE EFFORT
BEHIND OKA IS SERIOUS ABOUT THE
AIM OF LOWER COSTS, IMPROVED
OUTCOMES AND REDUCE DISPARITIES.
AND THAT'S PART OF WHAT YOU'VE
HEARD FROM ALL THE PANELISTS.
YEAH. AND IF I MAY AND BEFORE I
SAY ANYTHING, I SHOULD MAKE
CLEAR I'M SPEAKING ON BEHALF OF
MYSELF AND NOT THE OFFICE OR ANY
OTHER BOARD MEMBERS. BUT BUT I
WILL BORROW FROM, A FELLOW BOARD
MEMBER, DOCTOR KRONICK, WHO'S
WHO DESCRIBED PART OF THE GOAL
OF THE TARGET SETTING IN VERY
CONCISE WAY, WHICH IS TO SHIFT
THE INCENTIVES IN THE HEALTH
CARE MARKET AWAY FROM REVENUE
MAXIMIZATION, IT'S A VERY
AMBITIOUS GOAL, AND IT'S VERY
MUCH AN EXPERIMENT. THIS THIS
LEGISLATURE, PREVIOUS
LEGISLATURES HAVE GRAPPLED WITH
THE QUESTION OF WHETHER
INTERCEDING DIRECTLY ON PRICING,
IN THEIR WISDOM, AT THE TIME,
THEY DECIDED NOT READY TO DO
THAT YET. THE TARGETS ARE NOT
PRICE TARGETS. THEY'RE SPENDING
TARGETS. AND SO, THE CHARGE OF
THE OFFICE OF HEALTH CARE
AFFORDABILITY IS TO SET AND
ENFORCE, SPENDING TARGETS WITH
THE GOAL OF REDUCING SPENDING IN
SUCH A WAY THAT THE BENEFIT OF
REDUCED SPENDING ACCRUES TO
CONSUMERS AND PURCHASERS, VERY
MUCH AN EXPERIMENT. AND IN A
VERY COMPLICATED CHALLENGE, I
WILL SAY THE DISCUSSION AT THE
BOARD HAS BEEN VERY ROBUST. WE
ARE VERY BE MINDFUL OF OUR OF
THE CHALLENGE OF ACCOMPLISHING
THAT, GOAL WITHOUT COMPROMISING
IN ANY WAY, THE, THE WORKFORCE
AND SO FORTH. AND JUST BRIEFLY
ON PRIMARY AND BEHAVIORAL CARE,
THERE ARE SECTORS WHERE WE
UNDERSTAND THE VAST GAP BETWEEN
PRIMARY AND SPECIALTY SPECIALIST
PHYSICIAN PAYMENTS, FINANCIALLY
OR PLAN REIMBURSE BEHAVIORAL
HEALTH CARE AND PRIVATELY
REIMBURSED HEALTH CARE, THOSE
ARE BIG GAPS IN AREAS WHERE WE
MIGHT NEED TO MAKE MORE
INVESTMENT. AND I WOULD JUST ADD
THAT THE PRESENTATION THAT YOU
HEARD TODAY, THAT THE RESEARCH
FROM THE UC BERKELEY LABOR
CENTER HAS ALSO BEEN MADE TO THE
BOARD BECAUSE PART OF THE CHARGE
THAT THEY'RE TAKING VERY
SERIOUSLY IS TO TRACK THE IMPACT
ON CONSUMER AFFORDABILITY THAT
HAS REALLY, FOR THE LAST YEAR,
DOMINATED THEIR CONVERSATION.
THÀNH. SO A LOT OF WHAT YOU'VE
HEARD TODAY IS WHAT THE
CONVERSATION HAS BEEN THERE, AND
THEY'RE TRYING TO FIGURE OUT.
AND NO OTHER STATE HAS EVER DONE
THIS, WHAT THE METRICS ARE THAT
WE TRACK AND PART OF THE
CHALLENGE IS, AS YOU HEARD, IT'S
NOT JUST ONE THING. IF YOU JUST
TRACK COPAYS, THOSE MIGHT COME
DOWN, BUT DEDUCTIBLES WOULD GO
UP. WHAT GOOD WOULD THAT DO IF
YOU LOWERED DEDUCTIBLES AND
CO-PAYS? BUT THE SHARE OF
PREMIUM WENT UP THAT REAL
CONSUMERS CALL IT PAYING TWICE.
I PAID PAID ONCE FOR MY SHARE OF
PREMIUM, THAT I PAID A
DEDUCTIBLE, AND NOW I STILL HAVE
TO PAY A CO-PAY. AND WHAT'S, YOU
KNOW, LIKE I PAY EVERY TIME I
TURN AROUND. NO WONDER I CAN'T
AFFORD TO GO TO THE DOCTOR. SO
TRYING TO LOOK AT ALL THOSE
THINGS. BUT PART OF IT GOES HAND
IN HAND WITH LOWERING THE RATE
OF SPENDING GROWTH AND WHAT I
WANT TO BE CLEAR, THE LAW DOES
NOT ALLOW THE BOARD TO CUT
SPENDING. IT ALLOWS THEM TO SLOW
THE RATE OF GROWTH. THOSE ARE
TWO VERY DIFFERENT THINGS. SOME
PEOPLE MIGHT HAVE LIKED TO SEE
CUTS, BUT THAT'S NOT WHAT THE
LAW SAYS. THE WISDOM OF THE
LEGISLATURE WAS THAT SLOWING THE
RATE OF GROWTH WOULD BE A WOULD
BE QUITE AN ACCOMPLISHMENT IF WE
COULD. SO THAT'S WHAT THE LAW
PROVIDES. IF I COULD, IF I MAY,
SO I KIND OF WANTED TO ADD TO
WHAT IAN AND BETH WERE, WERE
SAYING HERE, WHICH IS ONE OF
THE, THE, THE QUESTIONS THAT AND
I'M ON THE ADVISORY COMMITTEE TO
THE ACA BOARD AS WELL AS KAREN.
SO YOU KNOW, SPEAKING SPEAKING
FOR MYSELF AND CNA ONLY HERE,
YOU KNOW, ONE OF THE THINGS THAT
HAS COME UP A LOT IS THAT
THERE'S A LOT OF DIFFICULTY
TRACKING, YOU KNOW, AS THE, THE
SPENDING TARGETS, PRESUMABLY
WILL BE, PROVIDERS AND, AND
PLANS WILL TRY TO MEET THE
SPENDING TARGETS, THAT, YOU
KNOW, THAT WILL BE PLACED AND
SHIFTED. THE COST WILL BE
SHIFTED ONTO EITHER PATIENTS
THROUGH HIGHER DEDUCTIBLES AND
CO-PAYMENTS OR PREMIUMS OR ONTO
WORKERS BY EITHER CUTS IN, IN
WORKERS BENEFITS, WAGES. AND
THOSE THINGS ARE REALLY HARD FOR
AND TO GRASP BECAUSE
PARTICULARLY ON THE CONSUMER
SIDE, IT'S VERY DIFFICULT. YOU
KNOW, A LOT OF US HAVE TRIED TO
SAY LIKE, LET'S COLLECT DATA ON
ON WHAT THE OUT-OF-POCKET SPEND
IS AND IT'S A LITTLE BIT MUSHY.
WHAT THAT THAT DOLLAR FIGURE IS.
SO LIKE, HOW ARE WE SUPPOSED TO
IN THE LONG RUN, TRACK ALL THOSE
THINGS AND IT'S GOING TO BE VERY
DIFFICULT IS KIND OF WHERE WE'RE
AT RIGHT NOW WITH OCA. SO LIKE
IT'S AMBITIOUS IN TERMS OF
TRACKING, BUT HOW IT ACTUALLY
GETS IMPLEMENTED IS THERE'S IT'S
AN OPEN ENDED QUESTION. AND THEN
ON THE INTEGRATION AND
CONSOLIDATION SIDE, I THINK
THERE THERE ALSO WAS A LARGE
DISCUSSION WHEN THE COST AND
MARKET IMPACT REVIEW REGULATIONS
WERE BEING DEVELOPED AS TO WHAT
NEXT IT WENT, WENT AFTER OCA
GETS THE INFORMATION ABOUT LARGE
TRANSACTION INS, WHAT HAPPENS?
THERE WAS SOME INDICATION THAT
THAT OCA WOULD PROVIDE, YOU
KNOW, IF THERE WAS SOME CONCERN
ON THE IMPACT OF A TRANSACTION,
THAT THAT INFORMATION WOULD BE
GIVEN TO THE ATTORNEY GENERAL,
BUT THEN THE ATTORNEY GENERAL
DOESN'T NECESSARILY HAVE ANY
AUTHORITY TO DO ANYTHING WITH
THAT INFORMATION. SO I THINK
THERE'S QUESTIONS ABOUT WE HAVE
IF WE'RE BUILDING THIS DATABASE
AND THE ANALYSIS OF MARKETS AND
PRICES AND INTEGRATION ON OCA,
WHAT HAPPENS TO THAT. AND I
THINK, YOU KNOW, WE ALL WANT
MORE TO HAPPEN. WHEN THE
INFORMATION IS THERE AND WE WANT
BETTER INFORMATION ON, AND
OBVIOUSLY THESE WOULD LEAD US TO
POTENTIALLY HAVING FURTHER, YOU
KNOW, CODE CHANGES TO GIVE
EITHER THE ATTORNEY GENERAL MORE
AUTHORITY OR OCA OR SOME
COMBINATION OF THAT. SO THAT'S
THAT'S THE LARGER SCOPE OF
WHAT'S HAPPENING. AND, AND YES,
WE, WE SHOULD LOOK MORE IN
VERTICAL INTEGRATION. I THINK
ONE OF THE THINGS WE DIDN'T TALK
ABOUT WAS HOW VERTICAL
INTEGRATION CAN LEAD TO
CLOSURES, AND, YOU KNOW, IT'S
PRIVATE EQUITY LIGHT JUST
BECAUSE YOU'RE NOT TECHNICALLY A
PRIVATE EQUITY FIRM DOESN'T MEAN
THAT THEY DON'T DO THE SAME
BEHAVIORS OF BUYING UP A LARGE
SWATH OF, OF HEALTH CARE
PROVIDERS AND THEN CLOSING THE
LOWEST COST OR THE LOWEST,
PROFITABLE CENTERS OF, OF THE
CORPORATION. SO, YEAH, JUST MY
LAST QUESTION, CHAIR, I ALSO
WANTED TO THANK MISS CHOMSKY FOR
, FRAMING IT AROUND THE
OPPORTUNITY COST, ESSENTIALLY,
OR THE REAL LIFE COSTS OF, WHAT
IT MEANS 85 BILLION IN INSURANCE
RELATED HEALTH CARE COSTS. I
THINK YOU SAID 32 BILLION TO
$213 BILLION OF LOST SAVINGS,
ESSENTIALLY TO MANAGE THE
FRAGMENTATION, I THINK ABOUT THE
INDIVIDUAL, YOU KNOW, IN THE
FRAME OF WHAT WE'RE TALKING
ABOUT, THE WORKER CONSUMER
PATIENT WHO'S SEEKING CARE AND
THE FACT THAT ESSENTIALLY WE, WE
RISK THE QUALITY OF CARE AND
CREATE A LOT OF CHURN FOR THE
INDIVIDUAL BY NOT NECESSARILY
PROVIDING THE LOWEST COST
PREVENTATIVE OPPORTUNITY,
BECAUSE WE ARE LOOKING FOR,
THINGS THAT COST MORE TO BE ABLE
TO ADDRESS THEIR CONCERNS, AND I
THINK IT'S HARD IN, IN, IN
BUDGET, ESPECIALLY BECAUSE WE
ALWAYS, FRAME THINGS AROUND HOW
MUCH WE ARE SPENDING. AND IT'S
VERY CHALLENGING FOR US TO BE
ABLE TO QUANTIFY HOW MUCH WE
COULD BE SAVING AND THE
OPPORTUNITY COSTS ASSOCIATED FOR
CONSUMERS WHEN WE TAKE
PARTICULAR ACTION ON THE BUDGET
SIDE. AND, IF I HAD TO WAVE A
MAGIC WAND ON BEHALF OF THE
STATE OF CALIFORNIA, THAT WOULD
BE MY HOPE FOR MY WISH. REALIZED
FOR THE STATE OF CALIFORNIA IN
OUR BUDGETING PROCESS. AND SO
THANK THE AUTHOR. THANK THE
CHAIR FOR BRINGING FORWARD THIS
CRITICAL ISSUE AND TRYING TO
HELP ME WEAVE THAT ONE. WELL, I
WANT TO, ALSO THANK ALL OF THE
PANELISTS. ONCE AGAIN, THIS IS A
VERY COMPLICATED ISSUE HERE, AND
UNFORTUNATELY, IT IS, YOU KNOW,
IMPACTING SOME MORE THAN OTHERS,
USUALLY ALONG THE SAME RACIAL
AND SOCIOECONOMIC LINES THAT WE
SEE IN, IN ALL SPACES WITHIN OUR
SOCIAL NETWORK, AND WHEN I WAS
LOOKING THROUGH YOUR SLIDES AND
I WISH WE COULD HAVE BEEN
ADVANCING THEM DURING YOUR
PRESENTATION, BUT, YOU KNOW,
WHEN YOU WERE TALKING ABOUT WHAT
HAPPENED OVER THE LAST 20 YEARS,
IT REALLY KIND OF TOOK ME BACK
TO WHAT HAS HAPPENED WITHIN THE
HEALTH CARE INDUSTRY OVER THE
LAST 20 YEARS. HOW MANY ADVANCES
WE HAVE MADE OVER THE LAST 20
YEARS THAT ARE VERY EXPENSIVE,
20 YEARS AGO, I WAS, A YEAH, I
WAS TOO. EXACTLY. I WAS TWO
YEARS OLD. I WAS A BRILLIANT
GENIUS, YOU KNOW, JUST, STARTING
OUT MY RESIDENCY PROGRAM IN
OB-GYN, AND, IVF WAS NOT
SOMETHING THAT WAS AS COMMON AS
IT IS TODAY, WE ESPECIALLY AT
MY, COUNTY HOSPITAL, RARELY DID
LAPAROSCOPY. WE PRETTY MUCH
OPENED EVERYBODY UP FOR SURGERY,
AND DEFINITELY DID NOT HAVE THE
DA VINCI ROBOT. THAT WAS NOT A
THING WHICH IS OUT AND EXTREMELY
EXPENSIVE, WE WEREN'T TALKING
ABOUT GENE THERAPY. WE WEREN'T
TALKING ABOUT ALL OF THESE
THINGS THAT WE ARE TALKING ABOUT
NOW. THANKFULLY BUT BUT IT'S
ALSO EXTREMELY EXPENSIVE. AND
AND A LOT OF TIMES WHEN I'VE,
WHEN PEOPLE HAVE THESE
CONVERSATIONS ABOUT HEALTH CARE,
THEY LIKE TO COMPARE US TO OTHER
COUNTRIES, WHICH I OFTENTIMES
THINK IS A LITTLE UNREALISTIC
BECAUSE THE UNITED STATES IS A
VERY UNIQUE, COUNTRY WITH A VERY
DIFFERENT KIND OF FOUNDATION.
AND WHAT YOU FIND IN OTHER
COUNTRIES IS, AND WHEN YOU LOOK
AT THEM, THOSE OTHER COUNTRIES,
THEIR HEALTH CARE SYSTEM, YOU
HAVE LONGER WAITS AND NOT
NECESSARILY THE SAME KIND OF
ACCESS THAT WE HAVE HERE. BUT
ONE OF THE THINGS THAT YOU SAID
IN YOUR PRESENTATION, THÀNH,
THAT REALLY KIND OF STUCK OUT TO
ME, IS THAT HERE IN CALIFORNIA,
AS TAXPAYERS WERE ULTIMATELY
PAYING LIKE THE ENTIRE PRICE FOR
HEALTH CARE. WHAT DO YOU SEE IN
OTHER STATES HERE IN THE IN THE
UNITED STATES? I DON'T HAVE THE
NUMBERS FOR OTHER STATES, BUT I
SUSPECT THAT THEY'RE SIMILAR IN
TERMS OF, THE SHARE OF HEALTH
EXPENDITURES THAT ARE SPENT ON,
BY EMPLOYERS AND HOUSEHOLDS, YOU
KNOW, THROUGH JOB BASED
COVERAGE, THROUGH THE INDIVIDUAL
MARKET, THROUGH MEDIGAP
COVERAGE, THROUGH DEDUCTIBLES
AND CO-PAYMENTS, AS COMPARED TO
THE PERCENTAGE PAID BY
TAXPAYERS, THERE MAY BE SOME
DIFFERENCES BECAUSE OF, YOU
KNOW, HOW COMMON JOB BASED
COVERAGE IS IN CALIFORNIA VERSUS
OTHER STATES, AND ALSO WE HAVE,
YOU KNOW, NOW, A BETTER COVERAGE
RATE THAN A LOT OF OTHER STATES
BECAUSE WE'VE DONE THE MEDICAID
EXPANSION UNDER THE AFFORDABLE
CARE ACT. AND WE'VE TAKEN STEPS
TO MAKE MEDICAID MORE INCLUSIVE
OF IMMIGRANTS, SO THE NUMBERS
MIGHT DIFFER SLIGHTLY, BUT I
THINK, OTHER OTHER STATES WOULD
SEE A SIMILAR STORY THAT THE
VAST MAJORITY OF COSTS ARE PAID
BY, WORKERS, CONSUMERS AND
TAXPAYERS. AND IF I MAY, IN, IN
PURE DOLLAR TERMS, CALIFORNIA IS
DEPENDING ON THE YEAR, SOMEWHERE
BETWEEN THE MOST EXPENSIVE AND
THE FOURTH MOST EXPENSIVE STATE
IN THE COUNTRY. THERE'S A REAL
DIFFERENCE BY MARKET AS WELL.
MONTEREY, I'VE SPOKEN ABOUT AND
OTHER VARIOUS NORTHERN
CALIFORNIA MARKETS ARE THE MOST
EXPENSIVE IN THE COUNTRY, WHICH
MEANS THAT FOR A MULTI-EMPLOYER
PLANS LIKE SOME OF SOME OF THOSE
ASSOCIATED WITH WITH MY UNION,
OTHER STATES ARE HAVING TO
SUBSIDIZE THE CARE OF
CALIFORNIANS BECAUSE, BECAUSE
ALL THE MONEY GOES INTO ONE
POOL. AND YET AT THE SAME TIME,
IT'S CALIFORNIA, OFTEN
CALIFORNIA BASED COMPANIES THAT
ARE BUYING UP, OTHER COMPANIES
ELSEWHERE IN THE COUNTRY. SO
IT'S A REAL IT'S A REAL
CHALLENGE. OUR EMPLOYERS ARE
LOOKING AT CALIFORNIA AND
WONDERING WHAT ON EARTH IS GOING
WRONG HERE. AND BECAUSE YOU
RAISED OTHER COUNTRIES, I WILL
SAY, YOU KNOW, I'VE BARGAINED
CONTRACTS IN BRITISH COLUMBIA
AND IN TORONTO AS WELL,
OPERATING UNDER VERY DIFFERENT
HEALTH SYSTEMS. AND I CANNOT
BEGIN TO DESCRIBE HOW DIFFERENT
BARGAINING IS IN THOSE STATES
WHERE YOU NEED TO NEGOTIATE 2 OR
$0.03 PER HOUR PER YEAR
ADDITIONAL INTO HEALTH CARE,
INSTEAD OF 75, 80, $0.90 PER
HOUR PER YEAR, SO WHAT DO YOU
THINK IT IS ABOUT CALIFORNIA VÀ
THAT THE COST, IN YOUR OPINION,
IS SO MUCH HIGHER HERE THAT
OTHER STATES ARE HAVING TO
SUPPLEMENT? I MEAN, CERTAINLY
THERE ARE BASELINE COSTS THAT
ARE MORE EXPENSIVE THAT WE ALL
WILL EXPERIENCE. THAT AFFECT THE
COMPANIES. BUT I DO PUT MY
FINGER ON THE CONSOLIDATION, THE
DEGREE OF CONSOLIDATE OPTION,
PARTICULARLY IN THE HOSPITAL
INDUSTRY, BUT INCREASINGLY OTHER
PARTS OF, OF THE HEALTH SECTOR.
YEAH. AND THERE'S, THERE'S A LOT
OF RESEARCH THAT BACKS THAT UP,
OUR UC BERKELEY COLLEAGUES AT
THE PETRA CENTER HAVE DONE A LOT
OF GOOD RESEARCH ON THE IMPACT
OF HEALTH CARE CONSOLIDATION AND
PRICES, AND HAVE ESPECIALLY
FOCUSED ON THE DIFFERENCE
BETWEEN NORTHERN AND SOUTHERN
CALIFORNIA. AND EVEN AFTER
TAKING INTO ACCOUNT WAGES AS,
WAGE DIFFERENCES BETWEEN THE TWO
PARTS OF THE STATE, HAVE FOUND
AN IMPACT OF CONSOLIDATION ON
PRICES. THANK YOU. AND I WANT TO
GO BACK TO WHAT I HAD HAD ASKED
FOR YOU TO CLARIFY WITH ME. SO
WITH THE IMPACT, ON BLACK AND
LATINO FAMILIES THAT THEIR JOB
BASED SHARE, THAT THEY SPEND A
HIGHER PERCENT, RIGHT? YEAH. AND
I CAN SEND YOU THE SPECIFIC DATA
WHICH I HAVE HERE IN FRONT OF
ME. BUT IN A, IN A GRAPH THAT'S
NOT LABELED WITH NUMBERS. SO I'M
GOING TO HAVE TO KIND OF EYEBALL
IT. BUT, IF FOR EXAMPLE, YOU
TAKE BLACK AMERICANS IN 1988
WERE PAYING AROUND ROUGHLY 8% OF
THEIR INCOME ON PREMIUMS, AND
THAT'S THE TOTAL PREMIUM, BOTH
PAID BY THE EMPLOYER AND THE
WORKER, BECAUSE, YOU KNOW, AS AS
MANY OF US HAVE TALKED ABOUT,
THE WHOLE THING IS ESSENTIALLY
COMING OUT OF THE WORKER'S
POCKET, BY 2019, BLACK AMERICANS
ON AVERAGE WERE PAYING AROUND,
18 OR 19% OF THEIR TOTAL
COMPENSATION TOWARDS HEALTH
INSURANCE PREMIUMS. OVER THAT
SAME TIME PERIOD, THE PERCENTAGE
OF COMPENSATION THÀNH GREW FOR,
FOR WHITE AMERICANS FROM ABOUT
6% TO, 13 OR 14, IN 2019. SO YOU
CAN'T SEE IT FROM HERE. BUT THE,
THE GAP, WIDENS OVER TIME. AND
THE PERCENTAGE OF COMPENSATION
OAN SPENT ON ON PREMIUMS IS
GROWING FOR EVERYONE. AND WHY
WHAT IS WHAT IS THE REASON FOR
THIS? DO WE KNOW? IS IT JUST THE
TYPES OF JOBS THAT YOU SEE MORE
PRIMARILY FOR AFRICAN AMERICANS?
I MEAN, PART OF PART OF THE
EXPLANATION IS, IS INCOME
INEQUALITY, BUT I GUESS MY
QUESTION IS, IS IT THE PERCENT
OF THEIR INCOME? SO IT WOULDN'T
MATTER. LIKE HOW MUCH YOU MAKE,
IT'S EITHER LIKE 5, 10, RIGHT?
REGARDLESS OF HOW MUCH YOU MAKE.
SO IS IT AGAIN LIKE THE JOBS
THAT THEY HAVE OR AS I RECALL,
THE JAMA STUDY, IT IS THAT THOSE
THAT THE AFRICAN AMERICAN
WORKFORCE IS DISPROPORTIONATELY
LOWER IN THE LOWER HALF OF THE
INCOME SCALE. SO THE SAME HEALTH
BENEFITS THAT COST $24,000 A
YEAR FOR FAMILY COVERAGE IS A
BIGGER SHARE OF INCOME FOR
PEOPLE IN THE BOTTOM HALF OF THE
INCOME SCALE THAN FOR PEOPLE IN
THE TOP 10 OR 20. LARA WILL
CORRECT ME, WHICH SHE OFTEN DOES
, BUT THE 80TH PERCENTILE OF
INCOME IN CALIFORNIA IS
SOMETHING LIKE $190,000 A YEAR.
SO FAMILY THAT MAKES LESS THAN
THAT IN CALIFORNIA IS IN THE
BOTTOM 80. THE MEDIAN INCOME IS
$86,000. SO WHEN YOU PUT 24,000
OR $25,000 IN COVERAGE ON TOP OF
THOSE WAGES, IT'S JUST A LOT OF
MONEY TO USE A TECHNICAL NON
NUMERIC TERMS. OKAY. SO IT'S NOT
THAT, THEIR PERCENTAGE THAT
THEY'RE PAYING IS HIGHER. IT'S
THE PERCENTAGE OF THEIR OVERALL
INCOME. THAT'S WHAT YOU'RE
SAYING. SORRY I SEE THE
QUESTION. YEAH YEAH, THE
PERCENTAGE THAT THE WORKER PAYS
VERSUS THE EMPLOYER PAYS THE
WORKERS PERCENTAGE HAS GROWN
OVER TIME FOR WORKERS IN
GENERAL. I HAVEN'T SEEN THAT
DATA BY RACE ETHNICITY, BUT THIS
IS ALL ABOUT THE PERCENTAGE OF
COMPENSATION. THÀNH. OKAY, AND I
CAN SEND YOU THE, THE SPECIFIC
STUDY. SO IT'S NOT AN ISSUE OF
CERTAIN PEOPLE GETTING CHARGED
HIGHER. BUT IF SORRY, JUST TO
BUILD ON THAT THOUGH, IT IS THE
CASE THOUGH, THAT THERE IS A
DISPARITY IN THE OVERALL AMOUNT
THAT, BLACK AMERICANS VERSUS AND
LATINO AMERICANS PAY FOR, THE
COST OF CARE LIKE IN TERMS OF
THE SERVICES. SO, SO BLACK
AMERICANS HAVE MORE COMING OUT
OF THEIR POCKET FOR, FOR
PARTICULAR PROCEDURES AND THE
TYPE OF HEALTH CARE THAT THEY
ARE RECEIVING. SO IT'S KIND OF A
DOUBLE WHAMMY. SO NOT ONLY DO
THEY NOT HAVE THE PROPORTIONATE
GROWTH IN INCOME TO SUPPORT
THEIR RELATIVE AMOUNT OF,
PAYMENT TOWARDS THEIR HEALTH
INSURANCE COVERAGE, BUT WHAT
THEY HAVE TO PAY FOR IS ALSO
MORE AS WELL. THIS IS ACTUALLY
AN AREA WHERE THERE'S NOT GREAT
DATA. WE HAVE. WE HAVE A GAP IN
THE RESEARCH THAT I'VE BEEN
INCREASINGLY NOTICING, IN TERMS
OF, YEAH. HOW MUCH, CALIFORNIANS
OR EVEN AMERICANS ARE SPENDING
OUT OF POCKET, WE DON'T HAVE A
LOT OF GREAT DATA IN GENERAL,
AND WE SPECIFICALLY DON'T HAVE,
GOOD DATA BY RACE AND ETHNICITY.
AND I AM HOPEFUL THAT'S ONE OF
THE GAPS THAT CAN CAN HELP TO
ADDRESS IN ADDITION TO THE
HEALTH. WELL, NO, I'LL STOP
THERE. I THINK, TWO KEY
DIMENSIONS I'D TEASE OUT OF THIS
, CERTAINLY AS A PERCENT OF
THEIR INCOME, BLACK AND LATINO
WORKERS ARE PAYING HUGELY MORE,
THAN THOSE OF OTHER RACES OR
ETHNICITIES, THE BARRIERS TO
ACCESS LEAD TO WORSE HEALTH
OUTCOMES, WHICH RAISES THE COST
TO THOSE COMMUNITIES AS WELL. IN
ABSOLUTE TERMS, THE OTHER NUANCE
HERE IS THAT WHILE WE'VE DONE
EXTRAORDINARY WORK EXPANDING
MEDICAID AND MEDI-CAL AND, TO A
DEGREE WITH THE COVERED
CALIFORNIA, COVERAGE, THERE IS A
HUGE SWATH OF WORKERS IN THAT,
YOU KNOW, JUST ABOVE THE RANGES
THAT THOSE PROGRAMS COVER. AND
AS, PANDEMIC ERA, SUPPORTS ARE
WOUND DOWN, ARE MORE EXPOSED TO
THE HEALTH, THE HEALTH MARKETS
HERE THAT CATEGORY OF WORKERS,
HOSPITALITY INDUSTRY WORKERS ARE
KEY AMONG THEM, 90% OF OUR
MEMBERS ARE PEOPLE OF COLOR, BIG
MAJORITY ARE WOMEN, SAME IN FOOD
AND COMMERCIAL SECTORS, THAT'S
THE CATEGORY OF WORKERS WHO ARE
ON THE CUSP, YOU KNOW, ON THE
BRINK OF LOSING COVERAGE THROUGH
THE EMPLOYMENT BASED SYSTEM
ALTOGETHER. IF THINGS DON'T
SHIFT IN THE COMING YEARS. AND
THAT'S SOMETHING WE'RE CERTAINLY
MINDFUL OF, AND I HOPE THE
LEGISLATURE WILL KEEP FOREFRONT
IN, IN YOUR MINDS. WELL, THANK
YOU FOR THAT, AND I DEFINITELY
LOOK FORWARD TO SEEING THE DATA
THAT COMES OUT OF. OKAY. AND AND
HOPEFULLY WE CAN GET SOME BETTER
DATA TO SEE IF THERE ARE ANY
SPECIFIC, DISPARITIES IN RACE
THAT, THAT WE'RE TALKING ABOUT
HERE. BECAUSE WE DO KNOW THAT IT
HAS EXISTED IN OTHER AREAS, YOU
KNOW, A, A BLACK FAMILY MAY GET
QUOTED A CERTAIN, YOU KNOW,
INSURANCE PRICE AND, YOU KNOW, A
NON-BLACK FAMILY WOULD GET
QUOTED SOMETHING DIFFERENT. SO
IT I WAS WONDERING IF THAT'S
WHAT YOU WERE GETTING AT WITH,
WITH YOUR PERCENTAGE. AND SO
WE'LL SEE WHAT THE DATA,
ELUCIDATES WITH THAT. DO YOU
HAVE ANY QUESTIONS, I REALLY
WANT TO THANK YOU ALL FOR, FOR
ENGAGING IN THIS, VERY IMPORTANT
CONVERSATION WITH US AS WE
TACKLE NOT ONLY, BUDGETARY
ISSUES AND AFFORDABILITY ISSUES,
BUT ALSO, STARTING TO ALSO THINK
FROM A POLICY STANDPOINT, WHAT
KIND OF THINGS WE IN THE
LEGISLATURE SHOULD BE PUTTING
FORWARD IN TERMS OF BILLS AND
SUPPORTING TO IMPROVE HEALTH
CARE, AFFORDABILITY AND HEALTH
CARE ACCESS FOR ALL
CALIFORNIANS? AT THIS POINT, I
AM GOING TO OPEN IT UP FOR
PUBLIC COMMENT. YOU WILL HAVE
ONE MINUTE AND PLEASE COME TO
THE MIC IF YOU HAVE ANYTHING
YOU'D LIKE TO SAY. THANK YOU.
GOOD AFTERNOON, LINDA HèA WITH
WESTERN CENTER ON LAW AND
POVERTY. WE ALIGN OUR COMMENTS
WITH HEALTH ACCESS AND KHN,
PARTICULARLY NOTING LOW WAGE
WORKERS, PARTICULARLY WORKERS OF
COLOR, ARE EXPECTED TO
CONTRIBUTE MORE OF THEIR WAGES
TO HEALTH COVERAGE, HIGHLIGHTING
THE NEED TO REIN IN COSTS.
THERE'S ALSO VERY REAL ACCESS
CONCERNS, AS SEEN FROM DELAYS IN
CARE, NOTING THAT HOSPITAL DEBT
MAKES OVER 70% OF MEDICAL DEBT
AND THAT 12 COUNTIES LACK A
SINGLE HOSPITAL WITH A MATERNITY
WARD. THANK YOU. HI, CHAIR AND
MEMBERS MARK FAROOQ WITH THE
CALIFORNIA HOSPITAL ASSOCIATION.
WE APPRECIATE THE CONVERSATION.
THIS AFTERNOON, RELATED TO
AFFORDABILITY, I JUST WANTED TO
POINT OUT A FEW THINGS THAT, YOU
KNOW, THIS FOLLOWS A HEARING
THAT WAS HELD ON MARCH 11TH
ABOUT THE FINANCIAL INSTABILITY
OF MANY OF OUR HOSPITALS, THAT,
YOU KNOW, OVER 50% OF
CALIFORNIA'S HOSPITALS STILL
OPERATE IN THE RED AND CARING
FOR PATIENTS, CALIFORNIA'S
HOSPITALS NONETHELESS STAND
READY TO RESPOND TO THE NEXT,
HEALTH CARE CRISIS. WOULD THAT
BE THE COVID 19 PANDEMIC OR
SOMETHING ELSE, AND SO LAST
YEAR, THE LEGISLATURE
ACKNOWLEDGED MANY OF THESE
CHALLENGES WITH THE
AUTHORIZATION, THE DISTRESSED
HOSPITAL LOAN PROGRAM AND THE
REAUTHORIZATION OF THE MANAGED
CARE ORGANIZATION TAX TO
CRITICAL, IMPORTANT INVESTMENTS
TO STABILIZE NOT ONLY HOSPITALS,
BUT OTHER HEALTH CARE PROVIDERS,
BUT I'D BE REMISS IF I ALSO
DIDN'T POINT OUT THE CHALLENGES
FACED BY OUR RURAL HOSPITALS AND
RURAL COMMUNITIES WHERE TWO
THIRDS OPERATE IN THE RED AND
WHERE THE CLOSURE OF THE SERVICE
. THE CLOSURE OF A HOSPITAL CAN
FORCE SOMEONE TO DRIVE AN EXTRA
HOUR UP TO TWO HOURS TO FIND
THAT SAME SERVICE, JUST A FEW
POINTS RELATED TO THE OFFICE OF
HEALTH CARE AFFORDABILITY, WHICH
WAS MENTIONED EARLIER. WE
SUPPORT THE OVERALL GOAL OF THE
OFFICE TO MAKE HEALTH CARE MORE
AFFORDABLE, MORE AFFORDABLE, BUT
WE DO REMAIN CONCERNED ABOUT
SOME OF THE PROPOSED BILLS,
SPECIFICALLY THE EXISTING 3%
SPENDING TARGET PROPOSAL, I
THINK WE HAVE TO BE MINDFUL OF
MANAGING THE CHALLENGE OF
BALANCING COST GROWTH REDUCTIONS
AND THE NEED TO INVEST IN
IMPROVEMENTS IN ACCESS TO CARE.
MAKING HEALTH CARE AFFORDABLE,
MORE AFFORDABLE, AND MEETING THE
NEEDS OF 40 MILLION PEOPLE HAS
NEVER BEEN ATTEMPTED ON THIS
SCALE. SO IT'S QUITE A SERIOUS
UNDERTAKING, I THINK, IS
EVERYONE WOULD AGREE, AND WE
THINK IT IS ESSENTIAL THAT THIS
BE DONE WITH AN UNDERSTANDING OF
THE DIFFERENCE BETWEEN GOOD
SPENDING AND WHAT WOULD BE
TERMED WASTEFUL SPENDING. THE
PROPOSED 3% SPENDING TARGET
WOULD CAUSE AN ABRUPT 40%
REDUCTION IN GROWTH OF HEALTH
CARE SPENDING, REPRESENTING A
$13 BILLION CUT IN RESOURCES FOR
PATIENT CARE AND ADVANCEMENTS IN
HEALTH EQUITY. ALSO POINT OUT
THAT THERE HASN'T BEEN AN
ANALYSIS YET AT THE OFFICE
RELATED TO SPENDING TARGET AND
WHAT THAT WOULD MEAN FOR ACCESS,
QUALITY, EQUITY OR WORKFORCE
STABILITY. THANK YOU, THANK YOU,
MADAM CHAIR. AND MEMBERS,
AIRBRIDGE, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS, WE
REPRESENT THE 77 HEALTHCARE
DISTRICTS THROUGHOUT THE STATE
OF CALIFORNIA. THESE ARE LOCAL
GOVERNMENT ENTITIES. I JUST WANT
TO MAKE A COUPLE OF BRIEF
COMMENTS BASED ON THE PANELISTS
THAT PRESENTED HERE TODAY. THE
FIRST BEING THAT HEALTH CARE
DISTRICTS SHARE IN ALL OF THE
CONCERNS THAT WERE MENTIONED
TODAY. WE WANT TO MAKE SURE THAT
HEALTH CARE IS AFFORDABLE FOR
OUR WORKERS. CONSUMERS PATIENTS
THAT WE SERVE AND LEAD WITH THAT
FIRST, HOWEVER, I WANT TO BE
REALLY CONSIDERATE THAT WE DON'T
APPLY A BLUNT INSTRUMENT TO
THESE PROBLEMS. AS WE LOOK AT
THINGS LIKE CONSOLIDATION AND
SEISMIC AND OTHER AND THE OFFICE
OF HEALTH CARE, AFFORDABILITY
AND COST AND SPENDING TARGETS,
PUBLIC ENTITIES ARE MUCH
DIFFERENT. WE'RE NOT OPERATING
WITH LARGE MARGINS. IN FACT,
MOST DISTRICT HOSPITALS ARE IN
THE RED. IN FACT, OVER HALF OF
THEM WERE THOSE TO RECEIVE THE
DISTRESSED HOSPITAL LOANS IN
THIS MOST RECENT GO AROUND, WHAT
HAPPENS WHEN A DISTRICT HOSPITAL
FAILS IS WE OFTEN HAVE TO
AFFILIATE OR MERGE WITH LARGER
ENTITIES, WHICH SPEAKS TO THE
CONSOLIDATION ISSUE. THAT'S NOT
SOMETHING THAT HEALTH CARE
DISTRICTS WANT TO DO. IT'S NOT
THEIR FIRST CHOICE. IT'S OFTEN
NOT THEIR SECOND CHOICE, BUT
THEY'RE FORCED TO DO IT. AND
THAT DOES IN FACT CONSOLIDATE
THE MARKETS. WHEN WE LOOK AT
AFFORDABILITY AND WE HAVE THESE
REALLY IMPORTANT CONVERSATIONS
AND THE CONVERSATIONS AROUND
THINGS LIKE SEISMIC AND OTHER
MANDATES PASSED BY THE STATE, WE
JUST HAVE TO UNDERSTAND THAT
IT'S A FINITE POOL OF RESOURCES.
AND WHEN WE'RE, YOU KNOW, FORCED
TO MEET OTHER MANDATES OR COMPLY
WITH NEW REGULATIONS, OFTEN THAT
TAKES AWAY THE ABILITY TO FOR US
TO FUND NEW PROJECTS AND
PROGRAMS FOR OUR WORKERS AND
PATIENTS. SO THANK YOU. GOOD
AFTERNOON. THANK YOU. CHAIR
WEBER, ASSEMBLY MEMBER BONTA,
FOR HOLDING THIS HEARING TODAY.
MY NAME IS KATIE LAYTON AND I'M
HERE ON BEHALF OF THE CHILDREN'S
SPECIALTY CARE COALITION. WE
REPRESENT OVER 3000 PEDIATRIC
SPECIALTY PHYSICIANS THAT TREAT
CHILDREN WITH COMPLEX HEALTH
CARE NEEDS LIKE CANCER, HEART
DISEASE, CYSTIC FIBROSIS, AND
MANY OTHERS, WE APPRECIATE THE
CONVERSATIONS HERE TODAY AND THE
DELIBERATIONS THAT ARE TAKING
PLACE WITHIN THE OFFICE OF
HEALTH CARE AFFORDABILITY Kò
COST MUST NOT BE A BARRIER TO
CARE, BUT WE ALSO MUST PROCEED
CAUTIOUSLY WHEN IT COMES TO A
SPENDING TARGET, TO AVOID
UNINTENDED CONSEQUENCES THAT
COULD FURTHER WORSEN ACCESS
CHALLENGES THAT ARE ALREADY
ACUTE IN CERTAIN REGIONS OF THE
STATE AND WITHIN CERTAIN
PROVIDER NETWORKS. FOR THE
PEDIATRIC SPECIALTY CARE
NETWORK, SPECIFICALLY, THERE'S A
GROWING SHORTAGE OF PROVIDERS
AND A NUMBER OF PEDIATRIC
SUBSPECIALTY FELLOWSHIPS ARE
GOING UNFILLED. IN SOME CASES UP
TO 50, MOST PEDIATRIC SPECIALTY
MEDICAL GROUPS ALREADY SEE
SOMEWHERE BETWEEN 50 AND 70%
MEDI-CAL PATIENTS. AND THE
CHRONIC UNDERFUNDING OF THE
MEDI-CAL AND CS PROGRAM IS
LEADING TO CRISIS LEVEL CONCERNS
WHEN IT COMES TO ACCESS.
ADDITIONALLY, PATIENTS THAT
THESE PHYSICIANS CARE FOR ARE
OFTEN COSTLY TO TREAT AND RELY
ON EXTREMELY HIGH COST DRUGS TO
MANAGE THEIR CONDITIONS. SO
WHILE WE AGREE THAT ESCALATING
COSTS OF CARE FOR CONSUMERS NEED
TO BE ADDRESSED, WE WOULD JUST
URGE A BALANCED AND MEASURED
APPROACH WHEN IT COMES TO COST
CONTAINMENT STRATEGIES THAT
RECOGNIZES THE CURRENT WORKFORCE
CHALLENGES AND HIGH COST NEEDS
OF CERTAIN POPULATIONS. THANK
YOU. THANK YOU, MADAM CHAIR, AND
MEMBERS. DAVID GONZALEZ, ON
BEHALF OF THE AMERICAS PHYSICIAN
GROUPS, I APPRECIATE THE
OPPORTUNITY TO PROVIDE SOME
COMMENTS. SO ÁP IS ONE OF THE
EARLY SUPPORTERS OF SENATE BILL
884, WHICH IS ACTUALLY
ESTABLISHING THE FRAMEWORK FOR
THE OFFICE OF HEALTH CARE
AFFORDABILITY. AND WE'RE WORKING
WITH THE OHCA STAFF RIGHT NOW ON
DEVELOPING SOME ALTERNATIVE
PAYMENT STANDARDS FOR PROVIDERS,
HOPEFULLY CREATING A MORE
COORDINATED SYSTEM THAT'S MORE
ACCOUNTABLE TO PATIENTS. AND ONE
THAT THEY CAN AFFORD. BUT WE
LOOK FORWARD TO WORKING WITH THE
ADMINISTRATION. THE BOARD AND
THE LEGISLATURE IN THIS VERY
IMPORTANT POLICY THAT'S OFTEN
UNKNOWN. A LOT OF PEOPLE IN
STATE POLITICS THAT DON'T KNOW
THAT WILK EXISTS, BUT WE'RE
HOPING TO MAKE THIS PROGRAM A
VIBRANT ONE AND ONE THAT CAN
WORK. THANK YOU. ALL RIGHT.
WELL, THANK YOU AGAIN. AND THIS
HEARING IS ADJOURNED.
BECAUSE CHANCES ARE. I GOTTA
CALL YOU AGAIN. SO THIS IS MY
DOING SOME HEAVY DRINKING WHILE
YOU'RE TAKING CLASS. THIS IS
SELTZER, BUT, THESE ARE ALL MY
NOTES. DUDE, I'M SO ORGANIZED.
ALL RIGHT, OFF TO TRANSPORTATION
. THE FUN NEVER ENDS. NEVER ENDS
. SO.