Pauline Bartolone, California Healthline
California policymakers are facing a busy year, as a Republican-controlled Congress inches closer to rolling back key provisions of the Affordable Care Act and debate over high drug costs continues.
Assemblymember Jim Wood, D–Healdsburg, helps set priorities for health policymaking as chairman of the Assembly Health Committee. The former family dentist represents a 300-mile Northern California coastal stretch that spans from Sonoma County all the way up to the Oregon border.
“If you look at my district, it’s almost a microcosm of California,” said Wood, referring to the mix of rural, conservative communities and more progressive ones like the City of Santa Rosa. Half the medical providers in his district are clinics that have a hard time attracting physicians, he said. Some constituents must travel long distances for medical care.
Wood took on some of these rural health challenges during his first year as committee chair last year. He proposed measures that allowed small hospitals to directly hire doctors and clinics to bill Medi-Cal for mental health workers, which secures a funding stream for therapists working in underserved areas. Both were signed into law by Governor Brown.
Wood also held the first of three hearings on drug prices last October. The next two will be held in the coming months.
Wood said “alleviating the pain” from the potential repeal of the Affordable Care Act in California tops his priorities. California Healthline spoke with Wood about his 2017 goals. The interview was edited for length and clarity.
Q: California Healthline produced a county-by-county map of which California counties would lose the most in terms of health coverage from an ACA repeal. In terms of per share of population, Humboldt and Mendocino, two counties in your district, were the highest in the state. One in five residents in those counties had Obamacare. Does that surprise you?
No, it doesn’t surprise me. I have two of the top 10 counties that stand to lose the most. It’s very troubling. There is a lot of poverty in certain parts of my district. And the repeal will hit the people that can least afford it the most, and that’s really unfortunate.
Q: What can you do as a state lawmaker to protect health care in California amid the potential repeal of the Affordable Care Act?
The most important thing we can do is communicate. Ultimately, I can’t vote on it. What I want to do is everything I can to educate my colleagues. And try to find ways to educate our Congressional delegates. I don’t believe a lot of members really understand the issue that well … or know just how dramatic [a repeal] would be.
Q: Now that Democrats have a supermajority in the legislature again, would you support efforts to raise revenue either by taxing individuals or corporations to make up the potential loss of federal subsidies for Covered California or the Medi-Cal expansion?
I think it’s too early to say until we really understand how the federal government plans to dismantle this. There’s a potential to do that with the supermajority. But, anytime you look to do something complicated like that, there’s no guarantee that you’re going to get every Democrat to vote for that.
Q: Are you afraid that the Affordable Care Act is going to overshadow all other health policymaking in California this year, or do you see the legislature pushing ahead on other issues?
It will be the top of the list of things we work on, but I do believe there are other things we need to forge ahead with as well. Working on the opioid [overdose epidemic], and the other thing I’m concerned about is the rapidly rising cost of prescription medications. We need to try to understand the system better, and find ways to bring more transparency, and bring more clarity about how this system works … There are so many players, and so many variables; just throwing piecemeal plans at this problem isn’t going to help anyone.
Q: You convened the drug price hearing at the end of October last year. Did anything come of that in terms of sparking legislation?
We are looking at a couple of things internally that may surface as bills, but I’m still working through that. The biggest takeaway is it’s a very complicated system.
Q: Last year there was a big push around SB1010 [a bill that would have required advance notice about drug price increases]. Was there anything that you learned or saw during that process that made you think that we need to have a public hearing because people don’t know enough?
Absolutely. In the Assembly health committee, it was clear to me by the questions that the members of my committee just didn’t know as much about this subject as my colleagues in the Senate did. That’s why I committed to doing the hearings.
Q: What did you learn about drug pricing that you identified as problematic or that needs to be addressed by the California legislature?
We just fundamentally don’t understand how the money flows, quite frankly. There are rebates that go back and forth between manufacturers and pharmacy benefit managers and health plans. Where does the consumer benefit from that? We’re trying to understand some of that.
The supply chain and the distribution of medications, and the generics and how patents are arrived at. We just saw a U.S. Senate report released last month [about] the arbitrary price increases on generic medications that have been around for 30, 40, 50 years sometimes that are just opportunities for companies to make money without any real consumer benefit. There’s just a lot of things we don’t know, and it appears that certain aspects of the industry don’t want to tell us. So how do we get that information?
Q: What kind of policies would you like to see to address the opioid epidemic? Is that an issue in your district in particular?
It’s a huge issue in my district. One of my counties [Mendocino] has one of California’s highest mortality rates from opioid overdoses. There have to be some solutions. I think one of them is, ultimately, can we find a way of changing our prescribing patterns and be a little more in tune with what the patient’s needs might be? I don’t want to see anyone in any kind of pain, but I don’t also believe that for a simple procedure, someone needs to be prescribed 40 pain pills when six or eight could do. You wind up with all this extra medication floating around.
The goal at this point is to work with the California Department of Public Health with their existing task force. Hopefully, expanding that task force, and try to get some real policy deliverables that we can work on. The task force has been together for almost two years now. Two years is a fair amount of time. And I’d love to see some recommendations sooner rather than later. I’m waiting for those.