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California’s Chief Medical Officer, Monica Soni, has much in her plate and her mind in the face of potential federal spending cuts that threaten lower health insurance and childhood vaccination rates.
California’s Affordable Care Act Insurance Exchange covers approximately 2 million residents, 89% of whom are receiving federal grants to reduce premiums. Many middle-income households have received subsidies for the first time since Congress expanded them in 2021.
From the original and enhanced subsidies, California enrollees in California currently earn $563 per month, an average of $563 per month, with the average monthly out-of-pocket premium being reduced from $698 to $135, according to California data.
The 2021 grants are set to expire at the end of this year, unless Congress renews them. If they expire, subscribers will be hooked to pay a monthly $101 for health insurance, not counting premium hikes after 2026. And middle-income earners who were not previously eligible for the grant would lose all their financial aid – on average $384 a month – what Soni feared could have dropped them.
At the same time, vaccination rates for children under two fell from seven of California’s 10 eligible health plans, subject to new quality of care requirements. Soni, a native of Los Angeles who will cover California in May 2023, will oversee the program. In this program, health plans must meet performance goals for blood pressure control, diabetes management, colorectal cancer screening, and childhood vaccination.
Lack of access to such important aspects of care affects disproportionately underserved communities, and California’s efforts are equally one of health equity. A Harvard-trained primary care doctor who watches patients once a week at the emergency care clinic at the Los Angeles County Public Safety Net Health System, Soni is well-versed in the challenges faced by these communities.
Covered California reported last November that three of the program’s four measures had improved their health plans. However, pediatric vaccinations for people under the age of 2 fell by 4%. This decline is consistent with national trends stemming from post-pandemic mistrust of vaccines and “more skepticism about the healthcare industry as a whole.”
According to an April KFF poll, most parents have heard at least one untrue statement about measles and its vaccine, but many don’t know what to believe.
The health plan was improved with three other measures, but it was not sufficient to avoid penalties, resulting in $15 million. The exchange uses that money to fund another effort Soni manages. This helps 6,900 eligible California households buy groceries and contributes to more than 250 savings accounts for children getting routine testing and vaccines. Some of the penalty money is also used to support primary care practices around California.
In addition to his divergent professional duties, Soni is a mother of two children, ages 4 and 7.
Bernard J. Wolfson, senior correspondent at KFF Health News, spoke to Soni about the possible impact of federal cuts and the exchange’s initiative to improve the care of enrollees. This interview has been compiled for length and clarity.
Q: Compatible California has record registrations of nearly 2 million. This is boosted by the expansion of federal grants passed under the Biden administration, which ended this year. What if Congress doesn’t update them?
A: Our estimates are that we will soon approach 400,000 Californians who will lose coverage.
We hear from our people every day that they really live on the edge. They could not afford to provide compensation until they got some of those grants.
As a primary care physician, I am the one who treats people who appear and manifest themselves with preventable cancer. I don’t want to go back then.
Q: Congress is considering cutting Medicaid billions of dollars. Considering that more than one in three people in California are in Medi-Cal, the Medicaid version, how does it affect California and the state’s population?
A: They are our neighbors, our friends. Those are the people who work in restaurants where we eat.
Previous cancer screening, better chronic disease control, lower maternal mortality rates, and more substance use disorder treatment: we know that Medicaid saves lives. We know it helps people live longer and better lives.
As a doctor, I would have a hard time insisting on rolling back what saves life. It’s extremely painful to see you come to California.
Q: Why did Covered California take on a quality transformation initiative?
A: We have been very successful in covering nearly 2 million, but frankly we have not seen any quality improvements and continue to see a particular population gap in terms of outcomes. So I think the question has become much more important. Do we get the value of money from this report? Do we make sure people live longer and better?
Q: There are penalties for not meeting your targets, but there are no bonuses to meet them. Do you achieve your goals or is it?
A: We don’t say that like that, but that’s true. And we didn’t complicate it. It’s just four majors.
As a primary care physician, what I know is important and it is to take care of me when I see someone in myself.
Practice. Once you reach the 66th percentile with these four measures, there is no dollar you have to pay. If not, raise these funds.
Q: Use penalty money to fund grocery support and children’s savings accounts.
A: That’s exactly right. We had the opportunity to think about what we would spend these dollars on and how we could actually make a difference in people’s lives. So we calmly called out hundreds of people and sent thousands of people to investigate. The people are making trade-offs between food and transportation, childcare and food – just impossible decisions.
Q: You put $1,000 for your kids in those savings accounts, right?
A: That’s right. It is related to performing these healthy behaviors, visiting in order of children and obtaining the recommended vaccine. We looked at the literature, and once you reach just $500 on your account, the chances of your child going to school for two or four years is greatly increased. It’s because they actually have hope for their future, and that changes the path of upward mobility that they know to change the outcomes of their health.
Q: Given the rising vaccine skepticism, are you worried that the recent outbreak of measles will grow?
A: I’m very worried about that. I was actually reading a few posts from a doctor colleague who trained decades ago and talked about all the illnesses that doctors of my generation had never seen before. I don’t really know how to diagnose and care for many infectious diseases. Because they are mostly eradicated or actually contain an outbreak. So I’m worried. I’ve been brushing old textbooks.
Wolfson writes for KFF Health News. It is an independent source of Health Policy Research, Polling and Journalism, which creates detailed journalism on health issues and is one of KFF’s core operating programs.
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