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IN THIS ISSUE – “Will Jennifer Weigh In?”
LIFE IN THE CAPITAL OF A NATION-STATE
- New Games for California Politicians: Three-Dimensional Chess & Musical Chairs
- Governor’s Top Legislative Aide Departs
- Tech Challenges in the Tech Capital of the World
- Legislative Dems Take Another Run at Raising Millionaires Tax
NATURAL & HUMAN RESOURCES
- Sea-Level Rise Will Move the Coast Inland
- US Refiners Go Green
- Health Care Coverage Must Go Universal
FOR THE WEEK ENDING AUG. 14, 2020
Capital News & Notes (CN&N) harvests California legislative and regulatory insights from dozens of media and official sources for the past week, tailored to your business and advocacy interests. Please feel free to forward.
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New Game for California Politicians: Three-Dimensional Chess & Musical Chairs
First, from Politico…
GAVIN, KAMALA AND THREE-DIMENSIONAL CHESS: We’ve speculated on the top names in the “who could replace Kamala” parlor game, but insiders tell POLITICO to put money on a statewide official being tapped for the U.S. Senate, should Kamala and Joe Biden make the White House.
Why? Gavin gets a two-fer: He can appoint both Kamala’s replacement, and the statewide official’s replacement. So with the buzz that he may go for a historic Latino pick, that puts Secretary of State Alex Padilla high on the list, as well as AG Xavier Becerra, who first got his post by gubernatorial appointment.
BUT DON’T FAIL TO INCLUDE the three women who have already expressed ambition for higher office: Lt. Gov. Eleni Kounalakis, the first woman to hold that post, a good friend of Kamala’s, and former U.S. ambassador to Hungary; Treasurer Fiona Ma , the world’s fifth largest economy’s banking and investment overseer; and Controller Betty Yee, who topped all statewide officials among Democratic voters in the last election. Calculations already being heard like this: “If he appoints [Eleni/Fiona/Betty], he also make someone else happy by pledging support to [Fiona/Betty/Eleni] for their 2026 run for governor.”’ Political chess on a couple of levels.
WILL JENNIFER WEIGH IN? Don’t underrate the uniquely influential position that Jennifer Siebel Newsom — the founder of The Representation Project and director of the award-winning “Miss Representation” documentary — has with the governor as he makes this decision. The feminist icon — his wife and mother of his four children — has dedicated her life to the cause of female representation in the halls of power, media and the arts. So expect the first partner to push for a woman in the U.S. Senate, where female representation is just a little over one-fourth of the body.
Second, from CalMatters…
Joe Biden’s choice of California’s junior senator, Kamala Harris, as his running mate brings to a close the presidential campaign’s most frenetic guessing game. It also opens up a relatively rare thing in the Golden State: the prospect of an open Senate seat.
For career-minded Democrats, that holds the opportunity of a major promotion to the national stage and term-limitless job security, bolstered by the fact that California’s Democratic incumbent U.S. senators have a 28-year track record of winning.
And the one man who could bestow that on them is Democratic Gov. Gavin Newsom. Should a Biden-Harris ticket defeat President Donald Trump and Vice President Mike Pence in November, state law gives the governor the power to fill Harris’ empty seat for the duration of her term, which ends with the 2022 election.
And so, for politicos who enjoyed the spectacle of the veepstakes — the interpersonal drama, the last minute dark horse candidates, the feverish scrutiny by reporters of each possible nominee’s travel schedule — get ready for a fresh round as Newsom considers his options.
The scale of the bustle to come is in part thanks to a simple math problem.
California has nearly 40 million residents. A little over half of them vote. That’s more people than all but three states. But thanks to some last-minute haggling at the Constitutional Convention, all of those voters get just two statewide representatives in the U.S. Senate.
And because California’s electorate predictably and overwhelmingly votes for Democrats, there’s a very deep bench of Democratic mayors, state legislators, statewide officeholders, members of Congress and other could-be senators who would love to hold one of those two seats.
Consider the list of Harris allies who reportedly lobbied Biden to make the case for Harris in late July. Among them were Secretary of State Alex Padilla, San Francisco Mayor London Breed and Lt. Gov. Eleni Kounalakis.
The governor will have until January to pick a replacement for Harris — if Trump loses the presidency. And as the last five months of pandemic, recession and civil unrest have shown, a lot can change in the meantime.
But as Newsom chooses Harris’ successor, he’s likely to keep a few things in mind.
First, there’s the state’s largest and thoroughly under-represented demographic group.
“I would be shocked if it were not a Latino or Latina, candidly,” said Mike Madrid, a Republican political consultant with a focus on Latino voting trends.
Nearly 40% of Californians are Latino — yet the state has never been represented by a Latino in the U.S. Senate.
Two women have represented California in the Senate since 1993, while Harris shattered a series of glass ceilings, serving as the state’s first Black and Asian American woman senator.
Newsom’s modus operandi — from allowing same sex couples to marry when he was mayor of San Francisco to imposing a death penalty moratorium as governor — is to “make history,” said Democratic strategist Garry South. “In this particular case the only way he can do that is to appoint a Latino.”
That’s in part why prognosticators often name both California Secretary of State Alex Padilla and Attorney General Xavier Becerra as among the most likely to be appointed.
And as a power bonus, naming either would give the governor the opportunity to choose their respective replacements as well.
In one fell swoop, Newsom would “build an ally in the U.S. Senate, and you also get an opportunity to appoint their replacements in the interim, so (he would) get a whole lot of chits,” Madrid said.
Former Labor Secretary and now Los Angeles County Supervisor Hilda Solis, state Sen. Maria Durazo and Long Beach Mayor Robert Garcia also appear on the guessing-game short lists of political consultants.
Padilla may be the most natural choice. Long before he became the state’s top elections chief, he got his start in politics working for California’s senior U.S. senator, Dianne Feinstein. Padilla also is a longtime ally of the governor — an early endorser in both of Newsom’s gubernatorial campaigns who also served as state chair of Newsom’s aborted run for governor a decade ago.
“They’re very close, they’re very much alike,” said Nathan Ballard, a political strategist who worked for Newsom when he was mayor of San Francisco.
Rep. Karen Bass, a Black congresswoman from Los Angeles who was circulated as a possible vice presidential choice for Biden, makes for another likely contender.
Although women have long represented California in the Senate, the governor will still be under pressure to choose a woman, said Ballard. With women making up just over a fourth of the Congress’ upper chamber for the first time in U.S. history, “you don’t want to be the one who diminishes the number of women who are in the Senate.”
And Assemblymember Lorena Gonzalez tweeted her suggestion for a twofer: Los Angeles state Sen. Maria Elena Durazo, who recently has been perhaps the Legislature’s strongest advocate for extending Medi-Cal health care to qualifying undocumented residents. The daughter of migrant workers, she was a trade official before entering politics.
Another consideration, said South: electability.
Governors have filled senatorial vacancies five times in California history. The last governor to get that opportunity was Pete Wilson, who jumped from the U.S. Senate to the governor’s office in 1990 and appointed his own successor, fellow Republican John Seymour. Seymour served for fewer than two years before losing to Feinstein.
Before that it was Democrat Pierre Salinger in 1964, who served only five months before losing to a Republican.
“It’s embarrassing for a governor to appoint a senator and then have that senator get their clock cleaned,” said South. Plus no governor wants to lose a loyal friend in Washington.
“It’s like how Gavin Newsom owes (former San Francisco mayor) Willie Brown gratitude forever because Willie Brown got him his start in politics by appointing him to a commission,” he said.
This won’t be the first time that Harris’ advancement has set off a statewide frenzy to replace her. After Harris won her first Senate race in 2016, then-Gov. Jerry Brown was given the opportunity to pick her replacement as attorney general. Brown ultimately blindsided political prognosticators by appointing Xavier Becerra — a Los Angeles congressman who, despite a powerful position in Congress’ Democratic caucus, had little home-state name ID.
https://calmatters.org/politics/2020/08/kamala-harris-replacement-newsom-california-senate/
Governor’s Top Legislative Aide Departs
Sacramento Bee
Legislative Secretary Anthony Williams, a top aide to Gov. Gavin Newsom who led his office’s engagement with lawmakers, is leaving his post at the end of the month, chief of staff Ann O’Leary announced Thursday.
In an email to staff announcing the departure, O’Leary praised Williams for his work during the Newsom administration’s first two-year legislative session.
“He played an integral part in passing landmark police use-of-force and renter relief laws, as well as wildfire protections, affordable housing starts, charter school reforms, and two responsible, on-time budgets,” she wrote. “The Governor and I have relied on Anthony’s leadership and intelligent counsel to help navigate through these challenging times.”
In her email, she said Williams had taken the job, which involved commuting to Sacramento from his home in Southern California, with the intention of leaving after two years. She said his departure was partly motivated by the start of his children’s school year.
“Anthony also has always been a colleague who is quick to laugh, tell a silly Dad joke (‘What did the fish say when it hit the concrete wall? …. Oh Dam!!’), offer a smile, an inspirational moment or a reassuring word just when any one of us needs it,” she wrote.
His resignation coincides with the end of the legislative session on August 30. After he leaves, O’Leary said special adviser Angie Wei and Chief Deputy Legislative Secretaries Joey Freeman and Stuart Thompson will oversee the bill signing period, when Newsom must take final action on all the bills lawmakers sent him over the year.
The pandemic has strained Newsom’s relationship with the Legislature, which bristled at the governor’s use of executive power while lawmakers were away from the Capitol during stay-at-home orders.
https://www.sacbee.com/article244955335.html#storylink=cpy
Legislative Dems Take Another Run at Raising Millionaires Tax
California Democrats on Thursday announced a second union-backed plan to raise taxes on the state’s millionaires as a way to generate revenue for schools and government services a week after their first attempt failed to earn a vote during a committee hearing.
As California’s economy reels from the coronavirus — with unemployment numbers skyrocketing to nearly 15% in June — the Legislature’s more liberal Democrats and the state’s most powerful public employee unions have argued millionaires should help shoulder the financial burden of COVID-19.
“We had folks who were barely hanging on who can no longer hang on. We’ve had people who were teetering on the edge who have fallen over. And we need to be there to catch them,” Assemblyman Rob Bonta, D-Alameda, and author of the latest tax bill, Assembly Bill 2088, said during a Thursday Zoom conference. “This is an approach that is a progressive approach.”
California’s seven-figure earners already pay the highest state income tax rate in the country — 13.3% — according to the Tax Foundation.
The Democrats’ most recent plan would levy a 0.4% tax on Californians with a net worth of $30 million or more. The legislation would affect about 30,000 residents, less than 1% of Californians, Bonta said, and generate $7.5 billion for schools and the state’s social safety net.
Earlier this month, lawmakers also announced Assembly Bill 1253, which would bump income tax rates by imposing three new surcharges on the state’s wealthiest households: 1% for taxable income over $1 million, 3% for income over $2 million and 3.5% for income over $5 million.
That meaning California’s wealthiest could pay 16.8% on income earned over $5 million.
The billions in projected revenue could help the state fill an estimated $20 billion gap to K-12 and community college education system, according to labor groups like the California Teachers Association and the Service Employees International Union.
“We are seeing families who are desperate,” said Denise Solis, Northern California Director for the SEIU-United Services Workers West. “It’s needless in a state where we have so many resources.”
Lawmakers only have 18 days to pass bills until the Aug. 31 session deadline and it’s unclear whether either proposal will get a vote.
Bonta said the coalition plans to pursue both options, “perhaps both to be implemented,” next year at the start of session.
The bills could divide the more left-leaning faction of the Legislature and moderate Democrats who’ve said they’d like to avoid raising taxes as a solution to the recession brought on by the coronavirus outbreak.
During an Aug. 3 informational hearing on the first tax plan, both Republicans and Democrats raised concerns.
State. Sen. Bob Hertzberg, D-Van Nuys, said he was “worried about creating a system that’s highly volatile” during economic downturns, while Republican state Sen. John Moorlach of Costa Mesa warned against another tax he said would encourage entrepreneurs to flee California in search of more business-friendly territory.
“We already have the highest personal income tax rate in the nation,” Moorlach said.
https://www.sacbee.com/article244933337.html#storylink=cpy
Tech Challenges in the Tech Capital of the World
Sacramento Bee
Before he became California governor last year, Gavin Newsom built his reputation as a tech-savvy Bay Area politician, who wrote a book arguing government should follow Silicon Valley’s lead and embrace new technology.
But five months into the biggest crisis of his governorship, technology problems have become major stumbling blocks to his coronavirus strategy.
The state’s unemployment system has been mired in delays, leaving thousands of people desperate for aid checks in limbo.
California’s health insurance program for low-income residents has dropped coverage for thousands of people due to computer errors.
And last week state officials announced they had vastly undercounted coronavirus case data due to a series of human mistakes and IT glitches.
None of the problems have easy fixes.
“The magnitude of challenges with IT here in the state require a stubborn, long-term effort,” Newsom said at a press conference this week. “It took us decades to get into this place, but we’re now accountable.”
The technology breakdowns Newsom faces in the midst of a global public health crisis follow California’s well-documented history of disappointing results from its tech investments. Those include a $1 billion accounting program that took 16 years to implement and a $90 million payroll upgrade the state abandoned as unworkable.
Newsom called attention to the state’s tech record soon after his inauguration, when he lamented at a press conference that the Department of Motor Vehicles in 2019 didn’t accept credit card payments at its field offices.
“In the private sector, you’re used to having these upgrades to the latest and greatest, and that’s just not the case in government,” said Elizabeth Ashford, who served as an adviser to former governors Arnold Schwarzenegger and Jerry Brown.
Newsom has long capitalized on his connections to California’s technology industry and promoted initiatives to modernize government. In 2019, he created a new Office of Digital Innovation.
When COVID-19 struck, he promised data would drive his decisions and eventually made the state’s data publicly available on coding website GitHub.
But the recent COVID-19 setbacks show the state’s IT problems are deeply entrenched.
“California’s interesting, because they are the world’s leader in innovation in the private sector in a lot of ways,” said Matt Lira, special assistant to President Donald Trump for innovation. “But that doesn’t mean that they’re immune to these kinds of challenges in the public sector.”
Lira was among the experts Newsom spoke with for his 2013 book “Citizenville: How to Take the Town Square Digital and Reinvent Government,” which advocated for a more technology-focused mindset in government. Lira recalled speaking “at length” with Newsom for the book.
“He has a fairly intuitive understanding of the nature of the problem,” Lira said. “It’s something he’s definitely passionate about.”
Here are the main challenges in front of Newsom in the coronavirus outbreak.
Last week, nearly 300,000 coronavirus test results were blocked from reaching the state’s infectious disease database after a series of technology glitches and human errors. Without complete data, no one knew how many Californians were testing positive or who many of the infected people were.
For days, county officials didn’t know how much data was missing, although they suspected it could be as much as half. That hampered already struggling contact tracing efforts and stymied decisions about reopening schools and businesses. State officials decided they didn’t have enough information to move counties on and off the state’s monitoring list, which determines which businesses a county must shut down.
The Newsom administration has created temporary fixes, Health and Human Services Secretary Dr. Mark Ghaly announced Friday. But the underlying issue, that the state’s disease tracking system wasn’t built to handle a pandemic’s worth of data, remains.
To fix that, the state will build a whole new system with greater capacity, Ghaly said.
“It’s extremely frustrating for the governor,” said Nate Ballard, a Democratic consultant and Newsom confidant who worked in Newsom’s San Francisco mayoral office. “Gavin Newsom has a 21st Century outlook on how technology should serve his constituents, and he has inherited a 20th Century state government technology apparatus.”
During the pandemic, a tsunami of unemployment claims has overwhelmed California’s Employment Development Department.
Although the department has processed more than 9 million claims, many Californians who lost jobs have spent countless hours trying unsuccessfully to call the department’s hotlines. Many are still waiting for their money.
The program relies on a 60-year-old computer language so archaic most engineers who know how to work with it are retired, Chiu said. At a recent hearing on the system’s problems, Chiu read a decade-old report describing the same problems — outstripped capacity, jammed phone lines, staffers unable to answer specific questions — plaguing the department during the Great Recession.
Newsom has said the unemployment delays are unacceptable. He directed the department to hire thousands more workers to help respond more quickly. He also launched a “strike team” to modernize the department’s systems.
In the meantime, computer system errors have dis-enrolled tens of thousands of people from Medi-Cal, the state’s health insurance program for low-income residents.
California’s Department of Health Care Services recently sent notices to about 200,000 people informing them that they may have been incorrectly dropped from the program, department spokesman Anthony Cava said.
Some of those discontinuances were appropriate because the beneficiary died, left California or asked to be removed, Cava said. But other cases were mistakes, and the state is actively working “to quickly identify and restore all remaining beneficiaries who may have been erroneously discontinued,” Cava wrote in an email.
The state notified some counties about the errors in late June, according to a copy of the memo obtained by The Bee. Despite the governor’s executive order, the state wasn’t able to stop its computer system from automatically disenrolling some Medi-Cal recipients, according to the memo.
The state is still working to determine how many people were affected, Cava said.
Lawyers who work with low-income clients continue to hear from people who have lost coverage even after the counties were notified, said David Kane, a lawyer who works for the Western Center on Law and Poverty. The state should be working harder to fix the problem, which is leaving vulnerable people without coverage in the middle of the pandemic, Kane said.
“It’s August, and they still haven’t completely fixed it,” Kane said.
https://www.sacbee.com/article244842457.html#storylink=cpy
Sea-Level Rise Will Move the Coast Inland
Legislative Analyst’s Office
Sea level off California could rise 6 feet or more by the end of the century, and submerge $8 billion to $10 billion worth of property by 2050, a report by the California State Legislative Analyst’s office warns.
The report details the hazards the state faces from sea level rise in coming decades, and urges local and state authorities to take action now, even though the pandemic currently claims first priority in public policy.
“While the coronavirus disease 2019 (COVID‑19) pandemic and resulting economic impacts have rightly drawn the focus of the Legislature’s and public’s attention since March 2020, other statewide challenges continue to approach on the horizon,” the report stated. “Among these are the impending impacts of climate change, including the hazards that rising seas pose to California’s coast.”
With 3 to 6 feet of sea level rise, up to two-thirds of Southern California’s beaches could be completely eroded by 2100, the report states. In San Diego County, it states, that endangers rail lines, the port, airport and tourism industry, as rising water inundates infrastructure and erodes bluffs and beaches.
Research on the economic impacts of climate change in San Diego County found that 3 feet of sea level rise, combined with a 100-year storm, could harm 830 businesses and threaten 15,000 jobs and $2 billion in property sales. At 6 feet of sea level rise, a 100‑year storm could damage 2,600 businesses, and affect 49,000 jobs and $8 billion in sales.
Increasingly severe storms, exceptionally high “King Tides” and El Nino events could raise sea level even higher during certain periods, it concluded. And these scenarios don’t account for possible melting of the West Antarctic Ice Sheet; if that occurs, sea level could swell by 10 feet off California by 2100. The rising seas could damage both public infrastructure and private property, threaten human lives and natural resources, contaminate drinking and agricultural water, and expose raw sewage and toxic contaminants currently contained underground.
Although the pandemic poses an immediate threat, the report urges state lawmakers and local communities to start planning for sea level rise now to reduce the magnitude of problems later.
“The state and its coastal communities cannot afford to defer all preparation efforts until economic conditions have fully rebounded from the recent crisis,” it states. “The state and local governments can undertake some essential near‑term preparation activities—such as planning, establishing relationships and forums for regional coordination, and sharing information—with relatively minor upfront investments.”
https://lao.ca.gov/Publications/Report/4261
US Refiners Go Green
Wall Street Journal
U.S. fuel makers see economic opportunity in getting greener as consumption remains depressed during the coronavirus pandemic and the prospect of more government regulations increases.
Phillips 66 PSX -1.10% said it is planning to transform a San Francisco-area oil refinery into a plant that produces fuels from products such as vegetable oil and animal fat, which generate less soot and fewer greenhouse gases.
The conversion, slated for completion in 2024, is expected to require around $800 million in capital investment and is one of several similar projects proposed in recent months, as U.S. refiners re-evaluate their businesses in light of Covid-19 and tightening environmental regulations.
The coronavirus pandemic has crushed demand for fuels such as gasoline and jet fuel, and many expect global oil consumption to remain depressed for years. But appetite for so-called renewable fuel is poised to grow because of government regulations in places such as California that are designed to reduce greenhouse gas emissions.
“The economic conditions are ripe for it,” Bob Herman, Phillips 66’s refining chief, said of the refinery conversion. He added that the company’s San Francisco-area facility isn’t making money as a traditional refinery.
Phillips 66’s converted facility would largely produce a biofuel known as renewable diesel that is interchangeable with conventional diesel. Other types of biofuels, such as biodiesel and ethanol, must be blended with conventional refined products.
Renewable diesel generally isn’t economical to produce without government incentives, and demand is small, said John Auers, an executive vice president at consulting firm Turner, Mason & Co. The fuel makes up around 1% of U.S. diesel consumption, largely driven by fuel regulations in California. The state aims by 2030 to reduce the carbon intensity of its transportation fuels by 20% compared with 2010 levels.
As California’s rules become stricter and other states consider adopting similar rules, U.S. renewable-diesel consumption is projected to roughly double over the next decade to around 1.1 billion gallons a year, according to Turner Mason.
Mr. Herman said over the next decade, as California’s fuel standards ramp up, the need for renewable fuels would become onerous if Phillips 66 weren’t producing its own biofuel and instead had to buy credits.
Other fuel makers including Marathon Petroleum Corp. MPC -0.73%and a smaller rival, HollyFrontier Corp., HFC -5.01% see similar opportunities. Marathon said last week it is considering converting a California refinery it closed this spring to a renewable-diesel facility. HollyFrontier said in June it plans to close a Wyoming refinery and transition it to renewable-diesel production, as well as build additional capacity in New Mexico to process the materials used in renewable diesel.
HollyFrontier Chief Executive Michael Jennings attributed the decision to convert the Wyoming refinery in part to reduced margins on traditional oil refining because of the pandemic.
“Demand for renewable diesel as well as other low-carbon fuels is growing and taking market share, based on both consumer preference and support from substantial federal and state government incentive programs,” Mr. Jennings said in a recent call with investors.
Exxon Mobil Corp., XOM -1.54% meanwhile, said this week it had signed a deal to buy 2.5 million barrels, or around 100 million gallons, of renewable diesel a year for five years from a California facility that is being converted from a traditional oil refinery.
Renewable diesel typically generates less soot than its petroleum-based counterpart and less than 40% of the greenhouse-gas emissions per unit of energy, measuring from production through consumption, said Robert McCormick, a senior research fellow with the National Renewable Energy Laboratory.
“They’re not getting to transportation decarbonization yet, but they’re taking a really massive step in that direction,” Mr. McCormick said, referring to a zero carbon-emissions scenario.
Phillips 66’s plant would produce around 800 million gallons a year of fuels derived from cooking oil, grease or other byproducts, making it one of the world’s largest renewable fuel plants announced to-date. The fuel maker plans to continue operating the facility as a traditional refinery while it pursues the conversion.
Phillips 66 and a partner called off plans earlier this year to build a renewable-diesel plant in Washington state, but Mr. Herman said he expects a smoother permitting process for this project because Phillips 66 is converting an existing facility rather than constructing a new one.
Health Care Coverage Must Go Universal
CalMatters commentary
The COVID-19 pandemic has laid bare racial inequities, health inequalities and health injustices for all to see, and challenges the very structure and delivery of our health care system.
As president and CEO of California’s largest health foundation, the California Endowment, we have championed universal coverage since our founding nearly 25 years ago. At the same time, we understand that “coverage” is insufficient to improve the health of all Californians.
We know from research that the most significant contributors to health are largely found outside of the medical system and are the conditions within which people are born, grow, live, work and play. Further, these conditions are shaped by issues of money, power, resources and race. And we’ve known this for decades – that social determinants drive health status.
Having the privilege to serve on Gov. Gavin Newsom’s Healthy California For All Commission, and in light of the COVID-19 pandemic, it is timely and appropriate to share my – and the California Endowment’s – perspective on the health system we need for our state and nation.
The California Endowment’s vision includes five essential elements for a transformed system that:
- Provides 100% coverage, everybody all in, regardless of immigration status;
- Embodies a unified financing mechanism with appropriate incentives to achieve other essential elements and ensure affordability;
- Advanceshealth equity by addressing racial equity;
- Optimizes prevention by linking to and supporting the social determinants of health;
- Possesses ahealth workforce that is culturally representative and proficient in serving California’s diverse landscape.
There is more than one policy option that can embrace all of these elements. For example, a single-payer system and Medicare for All offer unified financing approaches that cover all Californians, which would be terrific. However, even an all-in, government-sponsored health insurance system is simply not enough.
The prize is not insurance coverage – the prize, as our commission is aptly named and tasked to present to the governor, is to create a Healthy California For All, which should include all of the above elements.
California, along with other states, offers innovations to bridge health care, public health and social services, such as coordinated care organizations and accountable communities for health. These are promising intermediaries that also focus on equity and root causes of poor health. Such innovations are especially critical at this moment in our state and nation’s history. As colleagues have noted, without fundamentally transforming the delivery system, we are merely moving dollars around in a broken system.
In addition to the “what” of reform, there is an important set of “how” questions as we make decisions for our large and diverse state.
Specifically, how do we assure that, in the course of our deliberations, we are hearing from communities and families most directly impacted by the inequalities and inequities of our current system? We need that input, and we need to be excellent listeners. This was well done under Peter Lee’s leadership in the formative stages of Covered California, where I served as one of the founding board members.
Further, we need to develop a winnable roadmap to a transformed system. Do we lay out a roadmap for the governor that involves one bold stroke? Or, rather, should we put forth a series of “boldly incremental” steps? What implications will the outcome of the November presidential election have for the needed roadmap? Finally, what can we learn from other states, like Vermont’s valiant but failed attempt to enact a single-payer system?
For sure, whatever our commission agrees upon as the roadmap to system transformation will have the support of The California Endowment. While achieving the momentous task of implementation is daunting, I remain optimistic that with the input of my colleagues, and the leadership of our governor and secretary of Health and Human Services agency, California can once again be in the lead on health reform.
Dr. Robert Ross is the long-time CEO of The California Endowment