 Good evening and welcome to our second League of Women Voters Davis Area Health Forum. My name is Michelle Famula and I'll be the host for this moderated discussion titled Healthcare Reform Demystifying Future Healthcare Options. This forum is being recorded and streamed on YouTube live. Our League Healthcare Committee has invited the speakers and developed the format and moderated questions for tonight's forum. Our webinar host will receive your audience questions throughout the discussion. Please submit your questions directly to the host using the chat function at the bottom of your Zoom screen. A timekeeper will advise speakers of their time. Tonight's presentation is not a debate but rather a one-hour facilitated discussion to help voters better understand healthcare reform options and to compare a public option proposal with a universal care single payer system in time to better appreciate November 2020 candidate healthcare positions in debates and forums. Tonight, two nationally recognized experts, Jody Reed, Executive Director of California Alliance for Retired Americans and Anthony Wright, Executive Director of Health Access California will better acquaint us with the provisions of a public option expansion of the ACA, including some of its most popular variants and options expansion of Medicare eligibility and Medicaid enrollment by choice, and a universal care single payer health reform proposal, sometimes called Medicare for All or Health Care for All, including provisions for public funding and elimination of private health insurance. The discussion format will begin with speaker introductions, followed by four moderated questions that our speakers have been given in advance. Each speaker will have approximately three minutes to respond to the question, and then each will have two minutes for a follow-up response. Each speaker will then be offered a second opportunity of a one-minute comment, and if there are no further comments, we'll move on to the next question. We'll try and hold each discussion question to about 12 minutes. Following this moderated question portion, we'll ask our speakers to respond to your audience questions. In conclusion, we will ask each speaker to provide a two-minute closing statement on how voters can provide, excuse me, can improve their understanding and what they can do to address their health policy concerns. We'll begin now with speaker introductions from each of our speakers this evening, and we begin with Anthony. Is this my, do I just introduce myself, or is this an opening? Yes, I'm sorry, Anthony, yes. We will ask our speakers now to introduce themselves, first Anthony, and then Jodi. So we begin with Anthony. If you could just give us a minute to introduce yourself. Yes, great. Thank you. My name is Anthony Wright. I'm the Executive Director of Health Access California, the statewide healthcare consumer advocacy coalition, working for the goal of quality affordable healthcare for all Californians for over 30 years. We're proud to be a coalition organization that includes great organizations representing different constituencies, including Tara, the great organization led by Jodi Reid. And we, you know, we have fought for both the vision of a universal healthcare system, including single payer and Medicare for all, and also for the battles of the moment, whether it's fighting for the ACA for Medicaid expansion and variety of consumer protections and other issues. I'm proud to be a resident of Davis. I'm on the, I'm on the Yellow County Library Advisory Board, and so happy to be part of this event with the legal wing voters and Davis. Thank you, Jodi. Hi, everyone. I'm Jodi Reid. I'm the Executive Director of the California Alliance for Retired Americans. Otherwise known as Cora, it's a lot easier to say. We are a statewide grassroots senior advocacy organization. We're also a coalition of about now 300 organizations that represent seniors and senior issues from labor retiree organizations to senior housing, resident associations, mobile home communities, senior serving agencies. And we try to come together to focus on issues of concern to seniors and their families. Our primary focus is state legislation and state advocacy, but we are part of a national network of Alliance for Retired Americans organizations. There's 38 states that have a similar organization to ours. We're all very separate, but we come together through our national organization called the Alliance for Retired Americans on national issues like Medicare and Social Security and Medicaid and the Elder Americans Act. Thank you. So we begin this evening's discussion with the first question I'll ask Jodi to respond. Please review the challenges for consumers and care providers under our current healthcare system of the ACA Medicare, Medicaid and private insurance as you understand them. Okay. So in our current system, and I work with people who are primarily on Medicare and Medicaid and there is a huge misconception in California and in this country, said if you have Medicare, you've got it all, and that we all ascribe to someday turn 65 and have Medicare but the truth of the matter is that Medicare only covers hospitalization basically and some outpatient expenses and everyone needs to then have some supplemental insurance that is now privately provided with the exception of those who are low enough income who qualify for Medicaid or in California they're called dual eligible or many medis and their supplemental coverage is through Medicare. And so, so even though many people thought that seniors were going to be that impacted by the ACA the truth is that our supplemental coverage is provided by the private insurance industry just like people who are not yet on Medicare and have to get their health insurance through private plans that are offered. Unless of course they're eligible for medical and even most Medi-Cal recipients are assigned to a private managed care environment to receive their care. With that comes all kinds of challenges that the ACA includes Medicare includes that there are things you, you have to stay within network so you have to go to the providers that are part of the network that your insurance is in, you have certain formularies for services and for prescription drugs that are determined by that network that you're in. The costs are not really regulated they're supposed to be but but you know it's really market driven and even with the best plans there are still out of pocket costs and for many people whose healthcare is connected to their employment when they no longer have employment they no longer have healthcare and we have in this era of COVID have seen millions more people lose access to their healthcare during the time of a pandemic when we all should be comfortable with the fact that if we need care we'll have access to it and not go brain croaked because of the costs associated with it and even people who are covered by insurance or supplemental insurance still have out of pocket costs that sometimes are so exorbitant that they don't seek the care when they feel they need it because they can't absorb the cost. So in our very private insurance, private health care system, it leaves millions of people in California and our country out and now with COVID and the loss of jobs, millions more are without insurance. It's a very broken system that is based on what the insurance companies want to provide and not based on the healthcare that we need. It's not a person centered, it does not cover many of our body parts that need health just as much as the other body parts for Medicare, dental, vision, hearing, podiatry, and especially long term care are not covered benefits. It's very important for the populations I work with but for everybody because we're one person, we're not body parts. And so we have a lot to do to fix the system to control costs and to make sure everybody has access to one standard comprehensive benefit package at a cost that they can afford. Thank you. So, can you really question challenges for consumers and care providers under the current system? I mean, I would agree with what Jody says. I think that our healthcare system is fragmented is confusing and complex and almost Kafkaesque in how consumers have to experience it and to try to deal with it, there are many significant gaps. Let me break it down in a couple of different ways and also suggest ways that we've actually have seen the potential for progress as well as the peril of going backwards. In the issue of access, affordability, cost and quality. On access, we have a system that leaves a lot of people out. Half of us get coverage through employers about a third through public programs and then the rest of us have to buy it as individuals. And in California, we had as many as 7 million uninsured, nearly 20% of the state. The Affordable Care Act actually showed that we can make progress in this regard. We actually had the biggest drop of all 50 states going from 7 million down to about 3 million by both bolstering employer-based coverage, expanding public programs, and then basically totally redoing how people buy coverage as individuals for those people who fall through the cracks of those two systems. But that still leaves 3 million around less than 10% of our state uninsured, which means that they live sicker, they die younger, they're one emergency away from financial ruin. And of course, that doesn't include the millions more who are underinsured and find themselves facing the out-of-pocket costs that Jody was talking about. And the high cost of healthcare is something that's very significant for people who are paying out-of-pocket, but for any of us who are paying premiums. And we have a healthcare system unlike any place in the world where the prices that the healthcare industry charges is basically what they can charge rather than either negotiated or set by the public, by the government. And so that's something that we need to address going forward. And then finally, just this issue of quality, that at the end of the day we want a system that actually is focused on the patients rather than profits, that is focused on public health. And so we want to make sure that their incentives are aligned so that people do best when they are actually providing primary and preventive care, keeping people healthy rather than just taking care of them when they're sick. And right now that's not where the systems are aligned. The systems are aligned where if you grow bigger, you can charge more, and that costs all of us, either as out-of-pockets in our co-pays or deductibles or in our premiums. In my last 30 seconds I will say, you know, the debate in DC is unfortunately, we can't talk about the status quo without talking about the threat of going backwards. And, you know, right now we are in a cataclysmic debate at the federal level about whether we even make the progress that the good but incomplete progress that we have made over the last 10 years, and we undo it and blow that up and throw chaos in the healthcare system by repealing the Affordable Care Act. And that's something that is very much in the debate this year, especially now with the debate around the new Supreme Court justice, since the very constitutionality of the question of whether the Affordable Care Act will be struck down in its entirety is going in front of the Supreme Court, literally the week after the election. And so we have a debate, I know we're going to get into the debate about what's the path to move forward, but I want to make sure that people recognize that we could lose even the progress that we've made depending on how voters decide this, you know, in the next month. Thank you. So I'd like to give each of you an opportunity, if you would like, in a follow up statement, I know that you had a chance to speak Anthony after Jodi had first spoken and then I'd like to give Jodi a chance just to respond but if either one of you might pay a little bit of your answer to the challenges for care providers as you see them. We spoke a lot about consumers. Do you have any thoughts about challenges to care providers. Well, certainly in this moment. The concerns are are monumental. The fact that we were unable, or maybe unwilling, I don't know depending on your perspective to provide the necessary PPE for frontline healthcare workers who are dealing with this pandemic is front and center in my mind and it's still a challenge not as much in an acute care settings now, but certainly in skilled nursing facilities where many rehab facilities where many people wind up going to recover from acute care procedures, the record on providing PPE is is dismal. The pay and staffing levels at some of these clinics and facilities is is horrendous. And so we have people, especially during you know an emergency situation like this who are working incredibly long hours, not having the kind of protections that they need, you know staffing standards is something we fought for and one and for nurses anyway in California but that is not reflected across the country, and certainly not in other kinds of healthcare settings hospitals barely do it so I feel like you know we need to do a lot more to to to protect our workforce but also we have a huge workforce challenge ahead of us. I mean, I work with seniors and we are the fastest growing part of California's population for sure and that's true in other states as well. But we're just not ready for this this this continuing boom and so we have very, we don't have the caregivers we don't have the people who can come into folks homes, one because it's not covered by most most insurance and to we just haven't trained the workforce to deal with some of the issues that as we age or maybe become disabled that is required so we need more primary care positions we need more nurses we need more nurse assistants we need more social workers we need more pharmacists we need a lot more of every kind of healthcare provider. And if we really want to go towards a system where we have access to care for everyone that is going to be compounded. But maybe we can move some of the people who are insurance claim adjusters and sales people into retraining them for a more direct hands on healthcare position but that's a huge challenge and I think one that is becoming clear and clear every day. Thank you Anthony thoughts about that. I mean, I think the question about you know providers I do think again we have a system that is focused on profit rather than on public health and prevention and everything else and so when a you know if it's if if decisions about spending resources are focused on market aspects, when the market changes like it did with the shelter in place order, then we're not prepared, we're not. And, and I think that's a real problem. The, you know, the fact is is that, you know, we had many providers, because of the shelter in place who lost a lot of revenue, because people weren't going to their doctor. And, and, and it was, and I think it raises the question, you know, we don't, we don't pay firefighters per fire, we don't pay librarians per book check, but we, but for many, you know, doctors and healthcare providers we pay them per visit per procedure per patient which is not. And, and I think, I think one of the reasons why I and others support a single payer system is at least it gives us the tools, but how do we actually pay both a fair amount, not one that's, that's too low as I was talking about, but also not too high, but also one that would actually incentive out better quality better outcomes reduced inequalities, etc. How do we have more global budgets that that both are mindful of cost containment but also, you know, focused on keeping a whole community healthy. And I think that's something that we can do. I think one other thing can I just add to my, Oh, absolutely. Um, even, but even before COVID. You know, Anthony is absolutely right. A lot of providers are not getting income because we're sheltering in place and services have really changed everything's going to tell a health. I'm not even sure how you reverse for that, but even before COVID. There's been a real growing challenge for healthcare providers who have had to in their, you know, small associations or networks or PPO's have had to to pay. So, especially in primary care, pay for enormous administrative costs because everybody comes in, or many people come in with different kinds of coverage, even within the same health plan you can have like the platinum version and the gold version and what that covers and how much it is a administrative and billing nightmare. And so many physicians and their offices spend as much time or too much time fighting with the insurance companies filling out forms, instead of providing care, and it has become, you know, I've heard stories after stories. I noticed that Hank Abrams and some folks from physicians for national health planner on in the chat and you know I've heard from many physicians that I know who have just like have left and retired from being a, especially a primary care provider because it's just, they're not doing the work of being a doctor they're doing the work of being a bureaucrat and a paper pusher in many ways and not being able to to to prescribe a treatment plan and medication plan that makes sense to them and to their to the patient as a partnership. But based on what the insurance company will pay for it takes, you know, people didn't study and pay all that money to go to medical school, and then be told what they can and cannot do by a company that really doesn't know anything about healthcare provision but is looking at the bottom line. So I really appreciate how the two of you have kind of set the stage with the answer to this first question and so we're going to go into the second question will start with Anthony and that is will you please share your vision for the path forward to a successful healthcare system that is patient centered, accessible and equitable for all persons needing care in our community. We ask that you address how the public option ACA expansion and the single payer universal healthcare proposals would each seek to achieve this goal. So I mean I would I would say that I think there is a vision of let's get to get to a universal unified healthcare system often called a single payer system often called Medicare for all that my organization supports that my I support that so both my organization I have supported that for over 30 years in terms of how to get to that to that vision of a unified healthcare system. I think the the I think that there is a debate that happened in both the Democratic primaries of you know in the presidential debate and others about the path forward to get from here to there and does does that require some steps along the way, building on the progress that we have made under things like the Affordable Care Act where we have proven that progress is possible, sort of trying to address some of the voters justifiable criticism about whether anything is doable where whether progress is even possible. I think we have shown that in fact we can make real strides and help millions of people with new consumer protections new oversight over over parts of the industry new new coverage options that people have and how do you take those additional steps forward. And, and so I do think that, for example, if President Biden were to be elected and a Congress that was willing. They would be able to do a number of things to both build upon the Affordable Care Act some of those are, you know, basically fixes and improvements on the existing systems expanding further expanding medic, medical, improving the affordability assistance in in exchanges like covered California, putting putting in place greater consumer protection, like that against whether it's surprise medical you know directly addressing the issue of prescription drug negotiation. It both in Medicare and other programs to get better prices for prescription drugs, those types of issues. And then there's a another set of even more ambitious proposals that would be that are called sort of the And a lot of things are called the public option proposals, but some of those include everything from taking the Medicare program that exists and lowering the eligibility age to from 65 to 60 or, or, or 55 or 50 that is one of the things that's in sort of Biden Sanders agreement, you know common unity pack that that that they negotiated a public option that people that no matter who you are you can choose to go into to that, and that could be a mechanism by which we do set some rates that are fair for providers but that don't ice gouge us in a specific way and actually try to get more public acceptance with the notion of the book in a government run health care, which is one of the arguments that have been used against the notion of a single payer Medicare for all system. I do think that at the end of the day we can get to that goal of of a fully universal health care system on every other industrialized country in the world does it every industrialized country does it in a different way. And you know whether it's, you know, Canada, Britain, Germany, Switzerland, you know you name it they're they're different and America's is going to be American and a little bit different to but it is it is but I do think that the goals of having a system that is unified that where we pay through our taxes based on how much we can afford rather than how sick we are how old we are is a really important principle of, you know something that's progressive something that's universal that everybody's included because we're all our system is stronger when everybody's included something where the government actually negotiates or sets the prices, something where again the focus is on prevention and and and public health rather than profit and that and I think we can make real progress progress toward that goal while also having the vision of how do we get there. The last thing I'll say is that here at the state of California, we're trying to do that and, you know, take take both of these efforts, these complimentary efforts at the same time. I'm, you know, in the legislature I'm very much advocating against budgets and for these expansions and for these efforts. At the same time, I'm proud to be on this healthy California for all commission that is actively trying to figure out what is the path what is the plan of what we're trying to get to and what is the path to get there in terms of what kind of federal waivers and approvals do we need what kind of financing do we need what kind of, you know, to figure out all the sort of details that you need to do to be able to take the step when that window of opportunity opens, whether it's in two months or two years. You know, to really develop that plan so I'm, you know, excited to do that obviously the COVID crisis has put in, you know, made it with more urgent but also less time and focused by the people who are the policymakers to to focus on this. And so we are continuing to push to try to move as far as possible, especially with maybe the opportunity that might arise at the federal Thank you, Jody, would you share your vision for the pathway forward to a successful health care system for our communities. Yes. So, I do not think that a public option is a step forward. I think, you know, there's a lot of different definitions of it but but from from. So this is my limited view of what what that means. I think it is seen as a way to drive down costs by offering competition to private insurers but not having the expense of having the administrative costs that marketing costs the high executive salary costs that private insurance companies and so that it can compete. But the problem with that is, is that part part of the reason so people who would be able to enter and purchase into this public option and choose that unfortunately are going to be the people who don't have access to any other kind of coverage through their employer through they're not Medicare eligible they're not medical eligible. And so their, their, their income and their way in is going to be lower. And because that's the status their health, their, their built up health issues may be larger. And so the beauty of Medicare. And the reason why the Medicare for all model is one that we promote is because everybody's it is age specific and ability, you know disability specific but everybody's in all putting their money into this one system. And so in but in a public option, the risk pool becomes and the people who enter it become those who are are less financially wealthy, and also have help they can't get healthcare anywhere else because they don't have access to it, they can't afford it. And so it's not a model that a Medicare for all model would be the healthier people are contributing the same as the people who need healthcare at this moment. We're all in it together we're subsidizing each other. That doesn't work in a public option and so what will wind up happening is the very same problems that happen in a private insurance environment, where the public option managers are going to have to really think about what kind of services can they afford to provide to this population, and what will they have to deny. And they're going to be in the same boat as the private insurance companies because they're going to have a very less robust pool to with which to work to If we have a change in leadership. This November. I think the opportunity is to to take advantage of some of the provisions in the ACA, which allow initially for state implementation state examples and to fight for the right to get the waivers, so that California can bring the federal dollars it pays into into our state to create the first Medicare for all single payer. I think we need a better I mean Medicare for all is not a term that people on Medicare embrace, because Medicare has a lot of weaknesses. It doesn't cover all the things that we would want to cover so we often say improved and expanded Medicare for all because people don't necessarily know what single payer means and that's really the financing mechanism not that the, the, the care, the overall kind of caring and benefit package that we're talking about, nonetheless, I'm real kind of has a bill on that would kind of set the path for how states could apply for waivers and implement a waiver California is bigger than Canada. It's a fifth biggest economy in the world. We spend over $380 billion a year already already on public programs on medical and medical expansion on covering people who are employed by the state. We have we we the taxpayers already spend close to all the money we would need to transition and what a waiver would allow us to do is to bring the other federal dollars that we Californians pay into for Medicare while we're working. And when we're on Medicare, there's still a payment comes out of your Social Security or you pay it directly bring those dollars into California, so that we can then expand the pot and be able to provide a standard benefit package for everyone that includes the ability as Anthony said to negotiate prices both for for medicine for prescription drugs but also for procedures and to develop these global budgets for hospitals for providers so that people know what to expect as a provider of care as well as for a patient of care and to be able to move to a system that allows that is patient centered that allows the patient to work with whichever provider they choose on a plan forward for their best help. Thank you Anthony do you have a response with that. Yeah, I mean I think, I mean I would agree that there are versions of the public option that or frankly any of these reforms that can not work or or be steps backward but there are versions of it, you know that to address some of the issues that Judy raised that actually I think are in fact building the infrastructure both the policy and the political infrastructure that get us closer to the goal of a universal single payer type health care system. I think that you know the model of a public option could be very much like the model of Medicare now you have private plans and Medicare now called Medicare Advantage, and then Medicare is sort of the base public option. And then there's these other options that people have, and that they can do to supplements. I don't, you know, I don't. I would want there to be more quality between the systems I wouldn't want to replicate some of the problems of our existing Medicare system, but I'm just simply saying that, you know we do have working models about how this works. I would say, you know, in terms of, in some cases, the, the, whether it's public option or some of these other issues. It's question is, how do we sort of address the issues of how do you get to a universal single payer health care system. And, and to the extent that there are obstacles let's take them seriously if you take single payer seriously you need to take the obstacles to it seriously, and not as an excuse for inaction to be very clear, but in order, how do you take those those obstacles seriously so that we can get around them. And, you know, some of the obstacles are obvious you know the ideological opposition that you know that was that we saw against the Affordable Care Act, the, the, the industry opposition, and not just from insurers, but especially from providers who don't who frankly don't want any public system whether it's a public option or a Medicare expansion or Medicare for all, because they are concerned that that that means that they would that what Medicare for all means to them is Medicare rates for all, which they don't want. They don't want that sort of government price setting government negotiation piece of that so doctors and hospitals at least the organized lobbies for those groups are opposed and they're opposed to the public option as much as they are to you know the broader reforms, but the, but the, and then you know Jodi mentioned the issue of financing how do we, you know here in California we have a $400 billion health care system. And I absolutely agree that if we were to finance it through a tax based system, make it more efficient we could actually save the overall system money, but we still need to collect the dollars and about $250 billion comes from the federal government. And there's another $150 billion that is collected through premiums and co pays and deductibles. And so we're going to have to figure out both how do we raise the $150 billion that if we're not going to be charging private premiums and deductibles co pays, you know, so what do we do in terms of and then how do we raise the 250 how do we get the $250 billion that we get from the federal government. And again what you know waivers and congressional approvals, those administrative and the federal approvals we need to get there. I think the biggest obstacle and this is why there is a conversation about public option and so I'm finding people, you know, don't think it's a right move and frankly I'm, you know, depending on the proposal on I can be pretty ambivalent about some of them. But I want to be clear about why it's, it's there which is that I think the biggest thing that people have acknowledged about why there is an obstacle and why when single payer has gone to a ballot. It has not fared well in Oregon, Colorado and California over the years. It's because of what people call loss aversion that we're basically telling people if you you like people really value the coverage they haven't they need to really health coverage is really important for them and their family, and to tell people okay we're going to take what you have now, we're going to replace it with something better that the government will provide trust us. That's sometimes a hard sell there's real skepticism there people value loss more than they value gain even if what they're going to get back is better. And so it's much easier. So I think the notion of the of the public option concept is is there a way that we can offer people something where that we can offer them the option and then they'll people will walk with their feet to a program that is that provides better benefits and can do a cheaper and and I think that's that's the concept. I think that there are real reasons in the implementation to make sure it's done right, but I and I think that but I do think that you know in the Sanders Biden unity proposal. I think it's an attempt to try to create something that was expansive enough that was dominant enough in the market to be able to be to not be just an add on to the market but to be a price setter in the market to get to the goal and get us that much closer to the end goal. That's the argument. Thank you. I appreciate that. In the in the interest of time here because I think you have addressed in your answers, both of you. The questions about what current federal legislative proposals are out there and what California state level leaders should be doing. I think each of you an opportunity to maybe speak to that for a minute or two about what you see as going on in the legislatures, either federally or at the state level that voters should be paying attention to that suggest ways of dealing with these challenges or propose new pathways. Actually Anthony you're the next one to start first I know you just spoke are you could you respond to that one. I actually want to, I mean if we're going to talk about the federal debate that we actually have to step take a step back that, you know, I think the friendly debate about strategy that I have with my colleague of many years Jodi Jodi here and with many some of the people in the chat who I have known over many years. I think the only debate about, can you take sequential steps to single payer does it all need to be in one leaf. I think that I'm happy to have that debate I believe that these efforts are complimentary that both the vision of getting the single payer and the steps to get this expanding Medicaid to the undocumented immigrants or whether it's, you know, creating new regular new patient protections, you know, the healthcare system, etc. I'm happy to make the case there. But if we're talking about the federal debate we have to be we have to acknowledge that these are all this that the debate we're having that we just had in the last 10 minutes is happening on one side of the spectrum. Which is about going backwards, which is about blowing up the Affordable Care Act and losing the coverage and and basically taking away coverage from over 20 million Americans, including over five four to five million here in California. And losing the Medicaid expansion which covers three to four million Californians, losing the help that people are getting to afford coverage for over a million Californians, losing the protections for people with pre existing conditions and allowing the insurers to once again deny that people are discriminated or charge them more based on their health status, losing, you know, blowing, blowing back up the donut hole in the in the Medicare benefit, and I can keep going on and on and on. And that is something that, again, the Trump administration and the state of Texas is trying to is literally arguing in front of the Supreme Court the week after the election that because it's a ridiculous legal argument, but their ultimate conclusion is that the entirety of the Affordable Care Act should be stuck down. And so, I, you know, I would be remiss in front of a of election to do that, if I think we can. We have a new, a new president and a Congress willing to work. I think they, they can sort of pass some legislative remedies to avoid that Supreme Court decision obviously there's a whole debate about the, you know, judiciary that also needs to be dealt with, and also then that takes a steps forward that that could get us both sort of short term relief like increased affordability assistance and dealing with prescription drug costs, as well as sort of the broader visions including what was in that Sanders Biden unity document. And Jody, would you like to make a comment on how you see federal legislative or state legislative opportunities to address our challenges or pathways forward. Yes. I mean, everything that Anthony said about the at the federal level and the challenges we face are real. And we have to vote. And we have to vote like our life depends upon it because literally it does, whether we're talking about COVID or access to health care or on so many levels, this is the vote of my lifetime, and I think of most of us who are on this call. And to the extent that you know California is a blue state. But you know we've got congressional races here that will make a difference. We want to hold on to the races, you know the seats that we were able to win and add to them. So we have a role to play there as well as in the presidential but we can also be helping and I know many of you are making phone calls and writing postcards etc to people in swing states that really need to hear from us because it's not just who the president is. We also need to have a Congress that is willing to take the steps necessary whether it be passing the world kind of bill that I mentioned, or a bill to negotiate for drug prices or whatever we need the Senate and the house to support that effort, and And so the election is pivotal. But because I don't want to sound sometimes hopeless about this, I also think that we're at a different, another pivotal moment in our country's history, not just with COVID, but with all of the organizing and leadership that's coming up through the Black Lives Movement and through, you know, efforts for social and racial justice. And if you look at who's been impacted the most by COVID, who's impacted the most by health disparities and lack of access to health care. The growing majority of our country, which right now are those populations and communities of color, and they are rising up and need to take the lead on demanding economic justice, health care justice, housing justice, racial justice, and that I think is a movement that isn't going to be And even if the worst happens in Washington, that movement is going to continue and I think we need to do everything we can to support that effort and to make sure that health care justice is a part of that conversation. And there's no place more important for that to happen in California our demographics are completely being flipped on their heads, and the majority population in our state, our communities of color, right now, and who have suffered because of our broken systems and our economic inequality. And so we need to join forces with that movement. And the only way we're going to get our elected officials to implement a single payer Medicare for all system in California or nationally is if we make them do it, we have to make them do it We have to show them that their political livelihood is dependent on moving this forward because that's what their constituents are demanding. So we have an opportunity with this increasing organizing and And sort of movement building that's happening right around us right now we need to be part of that we need to support that we need to make sure these issues are at the front and center of that. And we need to push our elected officials in California, and ultimately nationally to respond to the reality of our Society right now and I think there's I have a lot of hope in that. You know came out of some really horrendous terrifying hideous incidents, but the movement is strong and I think it gives me a lot of hope. Thank you. I think you've both given us and our audience a lot to think about this evening and I really thank you for your comprehensive answers to these, these questions and a lot of them are very clarifying and actually Covered many of what the audience had submitted as questions as well. So I'm going to select a couple of the audience questions and ask if you can give a one or two minute response to those some of which are a little different than What we have talked about right now that the first question is with the ever increasing numbers of Californians losing not only their jobs but also their health insurance as you pointed out earlier, Jody. What do you recommend the governor and legislators legislators do that is economically feasible and equitable and I'll answer I'll ask either of you to answer this first and then and then one of you to answer it second. You want to start with that Anthony. I mean, you know, I think this is the first stress test of the Affordable Care Act as a safety net in an economic downturn we know that since unlike as opposed to the opponent to the ACA who thought it would bring economic room we had actually 10 years of economic growth since its passage and so this is the first time that it is serving as a safety net. You know, Medicaid, Medicaid, which is now much more broadly expanded is now a safety net for the rest of us from California as well. But there's a need there needs to be more help. So, I'm very proud that, you know, health access co chairs, the health for all campaign, alive with the California immigrant policy center and many in the immigrant rights movement to try to expand Medicaid to to be inclusive of all regardless of immigration status and we were able to move to California to win coverage expansions for all income eligible children and then young adults, regardless of immigration status. We were this close to winning for seniors, but unfortunately the budget deficit that came along with the forstalled that and we're going to but we're going to continue to fight for that. I think we're going to continue to fight for additional affordability systems so that people have lost their, their, their employer based coverage that they do have an ability to not have sticker shock when they are trying to buy coverage by themselves. I do think that that's work that we need to do that's the most that's immediate stuff that that needs to be done yesterday. But I also think that I also just want to be responsive to some of the questions I see in the chat of just, I do think that we also need to move forward on the planning of, especially of what kind of waivers and approvals we may be at the federal government. I was disappointed when the commission that I'm on was suspended. They say that they're going to re re am a re engage us as no later than February. And I think a part of that is because some of the key principles in the Newsom administration are just so taken up by the emergencies of COVID-19 and, and, you know, I understand the, you know, their argument is that they have to put, you know, they're literally not just figuratively but literally putting out fires. And so planning for the next house is a little bit hard when you're still putting out just fires, but I would, but I also think that we do have this huge opportunity with a new administration, and we want to get in as quickly as possible to sort of put in those requests, because some of the stuff that we want to do at the federal, at the state level, really does require at least an engagement with the federal government, if not waivers or legislation or some or act of Congress, and, you know, and some of that work takes some time. So we want to get with it. So, Jodi, same question. What would you see as a first line response from the governor and the legislators to deal with the number of Californians that have now lost their health insurance due to COVID? Well, obviously, I agree that we need to be focused on maintaining coverage for everybody who has it and expanding access to those who don't or who have lost it, but everything with the goal in mind of moving towards what I see as a Medicare for all system. And so the first step is the budget. We're going to start our next legislative session with a proposed budget by the governor that's going to be probably fairly just more given the recession. And so, you know, fighting to make sure that the programs that exist remain. And that we look for new options to cover those who have lost coverage and that can build into a single payer system. So there were some really progressive proposals that came up at the end of the year. They didn't make make it through the legislature and health access and car and many other organizations were part of a coalition called commit to equity that had a couple of different proposals. One was a millionaire's tax that pay a higher income tax when you're a one millionaire, two millionaire, three millionaire. And another which I think is a really brilliant idea is a wealth tax that actually taxes on your total wealth, not just on your income. So your yachts and your property and your investments and not just on how much you make that could get both of these could generate billions of dollars and those dollars should be spent to make sure people who don't have access to coverage get it. And so those are proposals that I feel like need to be part of the conversation in California as we move towards getting this commission reinstated getting potentially legislation, getting the governor if we have a new president and a new administration the very first thing we should do on November 4 is get the governor to write a letter to the president requesting a waiver to bring California, the dollars and the federal dollars that could help us build the system that we need to cover everybody. So, you know, I feel like you know what we do in Washington will be dependent on the election. But what we do in California some of it isn't dependent on the election. We have the power to do some of this in California with our governor and our state leadership without any regardless of what happens with Washington it will be more limited, depending on who wins, but there are some things we need to do we have to fight to keep some basic programs in our budget during this budget session that were programs that are out of nursing homes out of hospitals with access to health care because the governor originally proposed cuts there were hideous. And together we fought to do our best to maintain those and we're going to have to fight again come January when the new budget is presented, and we need to offer revenue options that are fair and progressive, like a wealth tax, and so I think we need to be united around doing that with all of the other organizations that are working for economic and social justice. Thank you. I think we are getting close to the end of our hour. I know many people submitted questions, I hope that they feel that in the course of these times and so much information was exchanged that the main thrust of their questions were responded to I've, I've been over the questions over and over again to see if there was something in there that maybe you hadn't addressed maybe it won't be as completely as those folks had hoped for we will be having more forums, and we welcome the opportunity for more questions. But I want to thank you both because I think that your answers have been very comprehensive you've really devoted yourselves to informing the audience and expanding upon the topics that have been raised. I would ask now at at the end here that each of you, if you could provide a closing statement. We've sort of been asked to ask you this in your in your closing statement. Can you tell us what you would counsel voters to listen for or to pay the most attention to as they're weighing the healthcare positions of our candidates in November. And are there any actions our voters can be taking to now address their health care policy concerns and we'll begin with Jodi. Oh boy well certainly I would be asking candidates at every level local state and federal. How they, you know how they see addressing the health care disparities that are facing our communities and our state in our country, and what proposals they would be supporting at the national level. There's also about measure right now profit team that I want to plug I know the league supports this but at at this time when we are struggling with revenue at every level because of coven and the recession that it's brought. We have an opportunity for the first time in 41 years to pass proposition that would require corporate big commercial properties and industrial properties to pay their fair share and property taxes that would bring $12 billion into our state. That goes directly to schools and to local community services and this is an opportunity at the local level it's not state money. It's local money but it gives us an opportunity at and Davis and in every community to really work with our local officials to talk about how are we going to provide access to care during this very difficult and challenging budgetary time it's in front of us you're going to get your ballots next week. Vote yes on prop 15. It's a lot of money to every community and it's been wrong that we haven't regularly reassessed these properties every other state in the country does accept us, and it's time we rectify that. Finally, I would say that we need you know we need to there are lots there are a lot of organizations that are focused on different aspects of dealing with our health care crisis. From Black Lives Matter, and some of the organizations that are working for racial and economic justice to Kara that kind of works on this issue through the lens of people who are older and have disabilities to help access that brings coalitions that are working with our health care together. Healthy California now is a statewide organization that is primarily focused on single payer in California. Find a way to connect in healthcare for all. You know there is so much work to be done so much education still to be done so much conversation to be had and we. There are lots of opportunities to do that and find your way into one of those that makes sense for you and start raising these issues and we need to start finding our strategy forward and to unite wherever we can because together we are much more powerful than if we're all fighting separately on different issues so looking for ways that we can come together on those things that we agree upon and then do it. You know the election is just one day and it's the beginning but the work is really about the organizing that we all do together and I hope you'll join us as we continue to fight for healthcare for all. Thank you and Anthony your your advice to voters as to what to listen for and to pay attention to and what they can do now to address their health care policy concerns. You know he had an excellent and and summary son I took many points so I'll just maybe say them a couple ways I mean one is obviously voting, you know vote up and down the ballot every thing everything matters. I do think that when you're talking about healthcare you're talking about money. And so, you know to the extent that, and, you know, especially in a moment of COVID especially in a moment of economic distress. One of the problems with healthcare is that it's counter cyclical. The demand is greatest at the time when we have the least of it. And so we, you know we are facing, as Jody said some significant things we were proud to work with. Kara and many other groups to to try to fight some of the horrific proposed cuts to especially to senior healthcare. And so we need to work on revenues both, you know, and raising taxes, including, you know, that means raising taxes where the money is and that, you know, means some of the wealthier an upper income that also means on the ballot on corporations that have gotten sort of unfair over over the years, and that's what prop 15 does and that would provide a of a in flu infusion of dollars to count. So, you know I just want to underline that support for that. I do also think that as you know moving forward into the new world, the federal stuff will always matter. It will raise a lot of money in California, but the scale of what we get from the federal government is just mind about, you know, whether in the context of like financing a whole universal system. I mentioned 250 billion, but even, you know the striking down to the Affordable Care Act. I mean, if they strike down the Affordable Care Act just from a dollars point of view, not in terms of the millions of people would lose coverage, but just from a dollars point of view that's $20 billion lost and from the Medicaid expansion and $7 billion lost from the subsidies $27 billion is the equivalent to what California spends on all of higher education, UC, CSUs, including UC Davis and all of prisons combined. It's not the kind of money that we can make up easily. And so that's why we need to fight at the federal level. And then we also need to keep and then the last thing I'll say is that we need to keep our local elected officials about holding the health industry accountable, because they're also with some of the people who take some of the money from our health care system and we need to hold them in check. And we have two members here in Davis, you know, and Aguilar Curry and in Assemblywoman Aguilar Curry and in Senator Bill Dodd, who sometimes are the swing votes on some of these key issues, you know, like bills in just in the last year on having the Attorney General have greater oversight over hospital consolidation or whether, you know, there should be greater oversight over surprise medical billing or things like that. So, you know, we, you know, so, so even folks in a blue state like Davis in a blue city like Davis in a county like yellow have a real role to play at the federal level, but also at the state level. And so please be engaged and I think Jodi listed. And I think that there's a role for everybody if you want to be focused on single payer that's great that helps to debate. If you want to be focused on a variety of on the issue of health equity or the issue of coverage expansion or the question of covering the undocumented. There is a place for you to be in this movement. Thank you. I think it's a resource I didn't put it in the chat but I wanted people to be able to see it because I don't know how many people got a chance to but there was an incredible program put on by public citizen, which is a national organization on single payer. That was a group of panels one led by Bernie Sanders one led by Congresswoman, Jaya Paul, and one led by Congresswoman Perry from Massachusetts, all who are single payer supporters and part of the public citizen are on the Sanders and Jaya Paul bills. But what was really amazing about it is the people who they brought together to talk about different aspects of the fight it's recorded. And if you go to public citizen and look for healthcare town hall you can watch it. And a lot of things we didn't get to today about financing and about equity and about coverage were talked about there and really powerful ways. I wish people to take a look at that because it was it fills in some of the blanks that we didn't get to today. And we'll be happy to to put that link on the follow up information from this forum this evening thank you so much for mentioning that. So it's this evening's health care forum. This forum has been recorded and so it can be viewed at our League of Women Voters Davis area website, which is LWVDAVISAREA.org. We'd like to thank once again our speakers Anthony Wright and Jody Reed for guiding us to better understanding this evening. Thank you so much for this rich discussion. Thank you so much for your earnest invitation for voter engagement right along with the League of Women Voters. This is exactly what we want to hear. Inspire engagement, inspire voting. We thank our audience for your interest and participation. We greatly appreciate the opportunity the League has provided to our committee to present these forums. And we're actively working now to provide a third forum focused on California health reform in November. Again, thank you to our audience stay safe and have a good evening. This concludes our forum. Thank you. Thank you.