Large hospital systems in California — and the rest of the country — have been buying up independent physician offices under the guise of streamlined care. In reality, these acquisitions drive up fees and costs for patients without improving care at all.
The math does not work — not for physicians, and not for patients — until policymakers can fix the significant dangers associated with vertical integration.
Many doctors don’t see or don’t want to see Medi-Cal patients. It’s all about pay. In fact, the latest federal government adjustment reduced physician fees by 2.8 percent, exacerbating the problem. California voters passed Proposition 35 in November 2024, to increase pay to doctors treating Medi-Cal patients, but it hasn’t been implemented yet.
The payment pressure doesn’t just affect who gets seen, it also shapes how they’re seen.
I’ve spent my career protecting kids from Big Tobacco. But you don’t need to be an expert to understand that candy-flavored tobacco products were created to hook kids on nicotine.
Unfortunately, this isn’t stopping Big Tobacco. The industry is on a hot streak of weakening federal tobacco regulations, making it essential for California’s leaders to defend our flavor ban and keep our kids safe.
California closely monitors whether nursing home residents fall. Regulators track incidents, facilities report them and safety policies revolve around preventing them.
Yet a more fundamental question often goes unasked: Can residents walk?
When safety becomes the only measurable outcome, unintended consequences can follow.
Like most parents, my wife and I want our daughter to be kind, happy and safe — but what does safety really mean?
What kind of safety can we ensure in a society deeply rooted in sexism and patriarchal violence? How do we teach her to be safe — without instilling a fear of men or of people who’ve committed past harms? How do we show her to be strong without masking her vulnerability? To be assertive yet expansive in her compassion?
When California committed to “Medi-Cal for All Children” a decade ago, it made a powerful promise to families from all backgrounds: No child will go without health care. It was a defining moment and a strong example of California taking the lead on kids’ health and setting an example for the country.
Today, that promise is in danger of being broken.
Every Californian should have access to quality health care, no matter where they live. But today, that promise is slipping out of reach in rural communities. Without decisive action to support the academic medical centers that offer care and train the next generation of health professionals, the consequences will be felt across the entire state.
The budget that legislators must adopt by June 15 will set California on one of two courses: protecting the health coverage that millions rely on, or allowing federal cuts to decimate Medi-Cal, the insurance program covering 15 million Californians.
Without a strong response from lawmakers in the coming days, millions will be pushed out of coverage or lose critical health benefits, making California sicker and more unequal.
Without serious intervention, July 1 will usher in a new era for American health care, carrying dire consequences for decades to come.
These provisions are not neutral reforms. They are targeted policies that will decimate the nursing workforce while disproportionately undermining a profession dominated by women — particularly working mothers and women of color.
For the past two years, I’ve co-facilitated meetings in five counties and helped lead numerous projects across California to help these organizations cope with the state’s demands. In nearly every meeting, I observe the same pattern: Community-based organizations are financing California’s Medicaid transformation out of their own organizational capacity.
This dynamic has equity implications that deserve attention.