When it comes to health -- as with many things -- California has its own unique brand.
While most of the nation was drawing partisan battle lines and taking sides in the aftermath of the 2010 passage of Obamacare, California governors of both parties successively led an aggressive effort over several years to lead the nation in the law’s implementation.
While the nation spent the next several years in divisive partisan warfare, California's successful expansion of coverage to millions became a source of state pride with broad popular support.
California's unflinching and bipartisan implementation of Obamacare is rooted in our cultural identity as a state of health and well-being. Our devotion to the outdoors, fitness, health food and self-care are quintessentially Californian. We pioneered anti-tobacco awareness and policies, leading the nation in reducing smoking and the illnesses it causes. This historic commitment to personal health is a core contextual component of California's ecosystem when it comes to health policy.
California approach also reveals a commitment to an inclusive vision of health. While others were debating Obamacare's coverage expansion, Californians were asking why the expansion hadn't gone further. Specifically, a grassroots push to include undocumented Californians -- excluded by Obamacare -- resulted in most counties moving in that direction and undocumented children added to our Medicaid program..
Now we are witness to California's divisive past of immigrant scapegoating and exclusion replaced with a vision of health for all. Today, California's single-payer enthusiasts and skeptics alike agree on the value of universal coverage.
Californians also share an appreciation of the ways health is determined beyond the walls of hospitals or doctors’ offices. There is a growing understanding of the way day-to-day settings like schools and neighborhood streets determine health outcomes for better and for worse.
The fact that a person's zip code is likely to have more impact on their health than their genetic code is changing people's perspectives on health and health policy. This awareness leads to more support for a preventive approach that’s built upon the underlying influence of equity and disparity.
Addressing those disparities in health outcomes requires hearing more directly from residents with the most at stake. Again, California's history is instructive. A popular uprising among HMO patients in the late 90s brought about the creation of the nation's first ever state department dedicated to defending patient rights, California's Department of Managed Healthcare. More recently, Californians across the state packed congressional town hall meetings demanding answers to questions about plans in Washington D.C. to repeal Obamacare.
Understanding California's health ecosystem means understanding the role of patient power, the history of wellness and prevention beyond traditional care, a growing commitment to equity and inclusion, and most of all California’s history of boldly forging ahead.