Anthony Wright’s Top 10 Health Policy Accomplishments

As I depart from my role as Executive Director of Health Access California after serving in it for 22 years, I’ve been asked to reflect on what would be our top policy victories in that time. That’s a daunting task – like picking amongst your children – and impossible to rank. First, I must recognize that all these accomplishments were not done by any one person or organization, but instead by a whole coalition and community, with lots of people playing different roles—from policymakers to researchers to advocates and activists. That said, I am proud of the leadership role that Health Access played to win big health reforms, providing meaningful relief for Californians consumers who are now better able to access and afford care. And not only that but having a national impact on changing health policy.

In no particular order, here are some of those wins with the biggest impact for Californians, and toward an improved health system over the years:

1. The Affordable Care Act in California

Health Access led consumer advocacy efforts in California to pass, implement, improve, and then defend the federal Affordable Care Act (ACA), which is the biggest social policy reform in a generation. From that work, California had the biggest drop in the uninsured rate of all 50 states, providing more coverage to over six million more Californians, and new patient protections to millions more. California had tried to pass many state reforms in the years prior, but the ACA provided the foundation and funding for California to succeed and to build on, which we have done with successive reforms for the past dozen years and will continue into the future.

2. Covered California’s purchasing power

Before the ACA, Californians without employer health benefits or not enrolled in a public program were left at the mercy of the individual insurance market. People were able to be denied or discriminated against due to pre-existing conditions, they had no help in affording coverage, and many of the plans provided substandard if not illusory or junk benefits. Health Access championed the bill that set up the first state-based health care coverage exchange in the country, including the foundational decision that the new state entity be an “active purchaser” with the ability to bargain for the best cost and quality for consumers. While opposed by insurers, this power (which is unique among the other state exchanges) was the policy foundation for standardized benefits, easier comparison shopping, real price competition, and more accountability for quality and equity. As a result, Covered California is far more consumer friendly than the prior individual insurance market, or the marketplaces in other states.

3. Covered California affordability assistance

The ACA provided federal tax credits, but they cut off for anyone making above four times the poverty level. That means an individual making more than $50,000/year anywhere, much less in high-cost California, would be left without any affordability assistance, even though coverage is on average $10,000 a year, and for older folks, it could be $20,000 or more—and potentially 20%, 30% or more of their income. With our advocacy, Governor Newsom, legislative leaders and Covered California pioneered state-level subsidies to solve this “affordability cliff” problem, while also increasing help for those with lower incomes. Recently, federal legislation supplanted that help more generously, now providing a universal government guarantee that no one spends more than 8% of their income on coverage—and often much less. This guarantee also extends to those on employer-based coverage, who don’t pay more than 8% of their income on premiums, since they can shift into Covered California as well. The federal premium financial help now allows California to use the state subsidies to reduce cost-sharing and eliminate deductibles for all Silver plans, reducing those out-of-pocket cost barriers. The election this year will be a big factor if this federal affordability assistance gets extended or expires which would premiums spike $400/month or more on average.

4. Medi-Cal for all, regardless of immigration status

While ACA dramatically expanded coverage for the uninsured, especially Medi-Cal, it explicitly barred a huge portion of the population from accessing Medicaid benefits – those who are undocumented. Almost immediately after the federal law passed, California began its work to close this unjust gap in our state program (Medi-Cal) and truly get our state to universal health coverage.

The long-term work to expand Medi-Cal to include all income-eligible Californians regardless of immigration status is a recognition of the contribution of immigrants to our society and economy, and that the benefit of inclusion is to make our health system and overall public health stronger for everyone. This expansion helps prevention and primary care, as well as providing payment to the health care providers that we all rely on.

5. Defending, restoring, and improving Medi-Cal

Medi-Cal is a lifeline for the over 14 million Californians it covers—over a third of the state—and is the biggest single-program in the state budget. The Great Recession forced cuts to key benefits, like dental, vision, and ten other services, and it took a decade of advocacy to restore those benefits, but we did. At the same time, we supported and won a variety of other improvements in Medi-Cal eligibility, access, and benefits for seniors, children and families. We were also proud to support the new CalAIM reforms to provide specific new benefits and community supports for the unhoused, those coming out of the justice system, and other vulnerable populations.

6. Stopping Surprise Medical Bills

In 2017, Californians got new patient protections that prevented them from surprise out-of-network medical bills, which could be hundreds or thousands of dollars even when the patient was insured and using an in-network facility. Under Assembly Bill 72, sponsored by Health Access and the California Labor Federation, patients in state-regulated health plans are barred from paying any more than their pre-established cost-sharing benefit—no matter who they are seen by—and a process was put in place for the plan to pay the provider a fair but not inflationary price. This California model was a central case study in the debate around the passage of the federal No Surprises Act a few years later, which extended those protections to those in federally regulated plans. Even more gaps were filled in with legislation in 2023, again sponsored by Health Access, that passed to prevent surprise ground ambulance bills.

7. Office of Health Care Affordability

In light of ever-increasing health care costs where patients, purchasers, nor the public have the ability to say no, California created a new Office, at our urging, to set and enforce a cost growth target for the industry. For the first time ever, the Office of Health Care Affordability (OHCA) gives the health industry a goal to meet on their cost growth, with the flexibility, information, models, and tools to meet that goal—and accountability if they don’t. Unique among the other eight other states with cost targets, the Office can enforce penalties if an entity or segment doesn’t meet the goal. This new state Office is perhaps the most comprehensive approach to cost containment in the nation, and set a 3% growth target earlier this year, aligned with the growth of median income—and important signal that our health care bills shouldn’t grow at a rate higher than an average family’s paycheck.

8. Hospital Fair Pricing Act

Going to the hospital while uninsured often means getting the largest bill someone will get in their lives. Their bill will also be much larger than anyone else since they are charged the unnegotiated sticker price which is typically 3-5 times more than what an insurance company or public program pays for the same service. The Hospital Fair Pricing Act, which we passed in 2006, protects uninsured patients from being sent to collections too early, ensures they are informed of their rights and financial options, including charity care, and caps most of their bills at the Medicare or Medicaid rate. Its passage was a five-year fight, and we are still refining and improving it two decades later.

9. HMO Patients’ Bill of Rights

The multi-year campaign to pass patient protections for those in managed care involved gubernatorial vetoes and commissions, dozens of bills, competing ballot measures, and more. I arrived at Health Access right after passage (having worked on similar legislation in New Jersey), just as the new Department of Managed Health Care was being set up. I got to work to implement these new protections, including the new right to appeal denials of care through independent medical review. Over the years, we have continued to work to beef up this oversight, on timely access to care, language access, and to ensure key benefits are covered. The ACA provided a new spate of protections, from rejecting rescissions of coverage to rate review.

10. Public health improvements

Recognizing that our health is impacted by many societal and environmental factors beyond the care we need after we get sick, Health Access has supported and led a variety of public health efforts, and doubled-down on that during the pandemic and the need for vaccine equity. These efforts include leading in the work to raise the tobacco tax to fund Medi-Cal as well as supporting a package of tobacco control laws, from raising the smoking age to regulating E-cigarettes. This crucial work has been continued by our CA LGBTQ HHS Network.

These are big and bold policy changes toward a more universal, affordable, quality, equitable health system. They were often not easy to win and required taking on major health industry players.

But co-equal to winning meaningful improvements in people’s lives is how we achieve those wins: by helping empower individuals and organizations to engage in the health policy process itself. We do this by providing timely information about the policy process, what the current debates are, how to weigh in effectively, and how to push the politics of the possible. This is done through our communications, and in our coalition work, and in our organizing, co-designing events and meetings and campaigns that organizations and Californians can plug into. With that in mind, I would be remiss if I didn’t also compile a list of favorite campaigns and programs for my last few decades as well…stay tuned for that blog next!

I am proud of these decades of work and am confident on the continued progress Health Access will make in the years ahead as the respected voice of health care consumers in these policy-making spaces.


Anthony Wright
Executive Director
Health Access California