Anthony Wright’s Top 10 Personal Favorite Health Access Campaigns, Programs and Experiences

As I finalize my transition from Health Access California to a new national role, I am proud of the progress that California has made toward a more universal, affordable, equitable health system for all. I have previously posted my own top ten list of policy victories, from the biggest drop of the uninsured rate in the nation under the Affordable Care Act, to a suite of nation-leading patient protections and public health investments. 

I’m particularly pleased that this momentum has continued in the past several months: 

  • The nation’s most comprehensive effort to contain health care costs, with the setting of a cost growth target by the new Office of Health Care Affordability, with a 3% goal so Californians don’t see health costs rise higher than the median income. 
  • The securing of additional affordability assistance in Covered California, to further reduce cost sharing, and to zero out deductibles in all Silver plans. 
  • The full removal of exclusions in Medi-Cal due to immigration status, allowing another 700,000 Californians to have primary and preventive care, and as importantly, the work of our #Health4All campaign to successfully beat back bill and budget proposals to go backwards, and other budget cuts, firming up political support for the #Health4All framework into the future. 

There’s much more to do, and the Health Access team have more victories to win, including this year—on ensuring accurate provider directories, preventing medical debt impacts to credit scores and families’ financial futures, and putting public oversight on private equity takeovers of health providers.  

Yet co-equal to this mission of winning tangible improvements in our health system, and in Californian’s lives, is to empower and engage patients and the public. How we achieve those wins matters, by helping elevate and magnify the voices of individual consumers, patients, organizations, and communities. We seek to do this in our organizing, coalition work, communications, and much more. 

Continuing on a more personal note, here’s my top ten list of favorite campaigns, programs, and experiences during my time at Heath Access: 

  1. Health Care for America Now:
    The campaign to pass the ACA started well before the election of President Obama, building from state-based efforts for employer mandates or single-payer or other efforts like the It’s Our Healthcare! Campaign during the Schwarzenegger era that didn’t get enacted but built our policy and organizing capacity. We launched the HCAN campaign in California in July 2008 with events with then Lt. Gov. Garamendi in Los Angeles and with Mayor Gavin Newsom in San Francisco, which had just piloted a local reform, Healthy San Francisco. With our community and labor organizing partners, we got dozens of California Congressional Representatives to sign a “What Side Are You On?” pledge and ran a campaign of events and actions that lasted over a year of twists and turns, from countering tea party protests and highlighting health plan rate hikes to resurrect the bill multiple times, and eventually getting unanimous support from the Democratic members. 
  2. Fight for Our Health:
    Our work to defend the ACA was ongoing, from annual birthday celebrations (with cake) to the hard work of implementation and showing the benefits, to even getting MC Hammer to help us with memes saying that the ACA was “2 Legit 2 Quit” when up in front of the Supreme Court and facing multiple Congressional votes to undo the law. Those threats because very real with the election of Donald Trump, and despite everyone thinking that repeal was inevitable, we got out a story collection form the day after the election and held the first in the nation resistance rally against repeal and replace in Los Angeles on Thanksgiving, with new Senator Kamala Harris. That was the first of over 150 events and actions over the next year that we helped with, often with local partners, some that had turnout in the hundreds or even thousands. Detailing the devastating impact to their districts, we put a spotlight on those who eventually voted for repeal. Voters took note: seven of them lost re-election the next year.
     
  3. CA LGBTQ HHS Network:
    The Network started in 2006 to ensure a LGBTQ voice in state health policy debates, but was looking for a new home in 2010, when the Network vetted, interviewed, and agreed to be hosted by Health Access. The synergy made sense as an extension of Health Access’ work to empower groups like the LGBTQ-serving organizations in the Network to be actively part of the implementation of the ACA, to highlight key issues like family definition and benefit design. The Network went on to help host a million-dollar grant for many of its members to do culturally competent outreach and enrollment work to the LGBTQ community, and eventually to take on programs around tobacco control, mental health, Mpox, and more. I’m so proud of the Network’s accomplishments, including its ongoing alignment with Health Access’ work on public health and health equity. Among other benefits, the Network has fostered new leadership in local organizations, and at Health Access: On a personally gratifying note, Amanda McAllister
    Wallner started as the Network Director before becoming Deputy Director, and now interim Executive Director for Health Access. 
  4. MergerWatch:
    On behalf of patients and the public interest, Health Access worked to intervene in the many cases that health plans and providers sought to merge, vertically, horizontally, and even diagonally. In some cases, we outright opposed deals, and other times we raised concerns about a company’s track record or impact on access or cost. For some, if the regulator wasn’t going to block the deal, we demanded and won key conditions—ensuring that key services stay open, that prices wouldn’t spike, that corporate behavior would improve, that charity care was maintained, and investments made to ameliorate the negative impacts. Working with local communities, we stopped bad actors from taking over community institutions, and prevented mini monopolies from growing bigger that surely would have increased prices. 
     
  5. Care Not Cuts: 
    For a good long decade of budget crises, Health Access and others highlighted the impacts of awful cuts to health and human services, including to cut off hundreds of thousands of Californians from coverage and benefits, and the need for revenues to prevent such cuts—some of which were won on successive ballots. We led multiple multi-issue coalitions, with names like Together for California’s Future, the HHS Network, and Commit to Equity. The release of a Governor’s budget was sometimes met with simultaneous press conferences at four or more locations around the state, with speakers to respond, describe the cuts and their impact. During bad budget times, it helped to avoid messaging that was implicitly “don’t cut us, cut them,” but rather to stress the need for a balanced solution than included revenues, not just cuts. Health Access actively worked on those revenue campaigns, including ballot measures, whether to raise the income tax for the budget overall, or the tobacco tax to specifically benefit Medi-Cal. Given how much money matters, if you care about health care, you care about budget and tax policy.
     
  6. Video Medical Interpretation:
    The VMI projects was the brainchild of my predecessor, Melinda Paras, who saw a way to use teleconferencing technology to better serve the many Californians that speak languages other than English, and who have trouble communicating with their doctors. Recognizing the problems with relying on support staff or even the children of patients to do translation about complex and confidential conditions, some hospitals hired medical interpreters, but the logistical issues of scheduling them to be in-person at the right time and place on a major hospital campus was daunting. At a time that was decades before Zoom, video conferencing provided a solution to have interpreters on call for any physician in a health system, allowing both the more efficient use of existing translators. The projects at Health Access allowed public hospitals to use the economies of scale to link together, to have more access to existing Spanish translators and to have critical mass to be able to have translators in a range of other languages as well. I was happy to continue this project for a decade, and to use it to demonstrate to state regulators that language access standards were workable and worthy of their approval, even taking the head of the Department of Managed Health Care on a tour of one public hospital system. The projects spun off successfully, but it was a great example of our policy advocacy and direct implementation work informing each other.
  7. Hospital Pricing:
    The Hospital Fair Pricing Act required a five-year campaign, as the hospital association went through multiple stages of opposition: they first denied that patients were getting overcharged. In return, we flooded the legislature and media with “Stories of the Week.” When the hospitals attempt to respond to the concern with “voluntary guidelines,” we engaged in “secret shopper” surveys to see if hospitals were complying with that. The hospitals’ stages also included bargaining, and ultimately resignation that these new patient protections would be passed. The Hospital Fair Pricing Act is a great example of a five-year campaign that required a range of tactics, from patients with their inflated hospital bills telling their “Story of the Week,” to “secret shopper” surveys to see if they agreed to “voluntary guidelines”
     
  8. #Health4All:
    The campaign had a simple vision, from legislative leaders and from activist
    s: all Californians should have access to the same coverage and assistance as anyone else in the same income, regardless of immigration status. While we had long worked with our board partner California Immigrant Policy Center, having this campaign co-chaired by our organizations helped channel the energy and momentum from both the California’s health reform movement, which has just won the implementation of the Affordable Care Act, and the immigrant rights movement, which had won its victories on driver’s licenses and more. With the broader Steering Committee, the collaboration has been impactful, bringing together groups with different styles and tactics and skills, from health policy expertise with the voices of those impacted, Sacramento savvy with grassroots militancy, and more. Beyond our statewide success, Health Access also worked locally, partnering with local groups to get counties to extend their indigent care programs to broader eligibility based on income and immigration status, given that many of their previous enrollees were covered by the Medicaid expansion. I was proud to testify before the Sacramento, Contra Costa, and Monterey County Supervisors, and the County Medical Services Program, as these counties took this local steps to #Health4All as well. 
  9. OuRx Coalition:
    Americans paying out-of-pocket for prescription drugs pay more than anyone else in the world. Our fight for lower prescription drug prices culminated in a whole package of bills, and ultimately dueling ballot measures in 2005. Prop 79 sponsored by Health Access garnered a record-breaking $80 million in opposition from PHRMA, as well as a competing initiative in Prop 78 designed to confuse voters. We campaigned in an ambulance and a prescription drug bottle costume across the state and dealt with dirty tricks. But while we lost at the ballot box, we never gave up, and we eventually won the policy in the legislature and with Governor Schwarzenegger,
    only to have implementation stymied by the budget crisis. After a few years, we picked up this work with the California Labor Federation on a major campaign to pass SB 17 on prescription drug price transparency. The drug companies went all out, with CEOs flying in to lobby, buying full page newspaper ads on a daily basis—and for a long time we didn’t have the votes—but once we finally got 41 votes, the vote count suddenly jumped to 66 votes, showing that legislators didn’t want to be on the wrong side of this issue with the public. Since then, Governor Newsom led a new spate of reforms that we led in supporting, from stopping pay-for-delay practices, to the state combining its purchasing power in Medi-Cal, to the CalRx effort to directly contract to manufacture generics for insulin, naloxone, and more. 
  10. Care4All California:
    After President Trump’s attempts to repeal and replace the ACA thankfully faltered in 2017, many in our coalition were not just satisfied with defending the ACA
    but wanted a positive agenda on how to improve upon it, and how to move toward a universal, affordable, equitable health system. The #Care4AllCA campaign of over 70 organizations came together to detail and package together actionable steps, that could be taken toward this goal, without needing federal approval. Some were existing proposals and campaigns, like #Health4All, and others were novel efforts, showed how they worked together toward a better health system overall, and is a great organizing example of how the package together is more than the sum of its parts. Each year, the Care4AllCA package often has around a dozen bills, with over ten authors and sometimes over a dozen organizations as a sponsor of a participating proposal. Over the last six years, over 30 bills and budget items have been highlighted and passed by this coalition, to stop the sabotage of the ACA from a hostile Trump Administration, and to expand coverage, increase affordability and advance equity. Care4AllCA was explicitly designed to be complementary, rather than competing, to other campaigns, like those advocating for a single-payer health system that had a longer time frame and process. It was gratifying that the Healthy California for All Commission, on which I served, did highlight some of the sequential steps that were on the Care4AllCA agenda. 

One of the lessons from these campaigns is the power of persistence: big and bold changes take time, but if you never give up, you are never defeated, only delayed. Passing a policy often takes years, and then more time to have it go into effect and implemented correctly.  

I hope these examples show that these wins aren’t just of one leader, but of a coalition and community of consumer advocates and may others who are continually organizing, aren’t just another stakeholder in the health system: in fact, patients are the point of the health system, and should be at the center of health policy discussions about it.   

Onward, 

Anthony Wright

Former Executive Director

Health Access California