It’s not just covid: Recall candidates represent markedly different choices on health care

Gov. Gavin Newsom's covid-19 rules have been a lightning rod in California's recall election.

But there's a lot more at stake for Californians' health care than mask and vaccine mandates.

Newsom, a first-term Democrat, argues that their fundamental ability to get health insurance and medical treatments is on the line.

Republicans are seeking to "take away health care access for those who need it," according to his statement in the voter guide sent to Californians ahead of Tuesday's recall election.

Exactly where all the leading Republican recall candidates stand on health care is unclear. Other than vowing to undo state worker vaccine mandates and mask requirements in schools, none have released comprehensive health care agendas. Nor has Kevin Paffrath, the best-known Democrat in the race, who wants to keep existing vaccine and mask mandates.

Outside of his pandemic measures, Newsom has, in conjunction with the legislature, funded state subsidies to help low- and middle-income Californians buy health insurance; imposed a state tax penalty on uninsured people; and extended eligibility for Medi-Cal, the state's Medicaid program for low-income people, to undocumented immigrants ages 19 to 26. This year, he signed legislation to further expand eligibility to unauthorized immigrants ages 50 and up. Republicans opposed all those initiatives.

Voters, who have been mailed ballots, have two choices to make: First, should Newsom be removed? Second, who among the 46 replacement candidates should replace him? A Public Policy Institute of California poll released Sept. 1 showed that 58% of likely voters want to keep Newsom in office.

To see where the leading recall candidates stand on health care, KHN combed through their speeches and writings, and scoured media coverage. Republicans John Cox and Kevin Kiley and Democrat Paffrath also consented to interviews. Republicans Larry Elder and Kevin Faulconer did not respond to repeated requests for interviews.

Larry Elder

Elder, 69, a conservative talk radio host, is far ahead of other candidates in polls. Elder believes health care is a "commodity," not a right, and wants government out of health insurance.

He opposes Obamacare — even some of the most popular provisions of the 2010 law embraced by other Republicans, such as allowing children to stay on their parents' health insurance until age 26 and guaranteeing coverage for people with preexisting medical conditions.

"Forcing an insurance company to cover people with pre-existing conditions completely destroys the concept of insurance," Elder wrote in a 2017 opinion piece on his website.

In a 2010 opinion piece on creators.com, he wrote that he would end Medicaid, the state-federal health insurance program for low-income people, and phase out Medicare, the federal insurance program for older Americans and some people with disabilities. (As governor, he would not have the authority to do either.)

Instead, he wants people to rely primarily on high-deductible health plans and pay their hefty out-of-pocket costs with money they have saved in tax-free accounts.

Elder told CalMatters he doesn't think taxpayers should spend money on "health care for illegal aliens" but also recently told CNN he has no plans to limit their eligibility for Medi-Cal, saying it's "not even close to anything on my agenda."

Elder calls himself "pro-life" but has said he doesn't foresee abortion access changing in California. Still, anti-abortion activist Lila Rose tweeted that Elder had promised her he would cut abortion funding and veto legislation that made abortion more accessible.

Kevin Faulconer

In campaign stops and debates, the mayor of San Diego from 2014 to 2020 has cast himself as a moderate, experienced leader who worked with Democrats to clear the city's streets and provide shelters for homeless people.

Faulconer, 54, often refers to San Diego's success at decreasing homelessness as one of his greatest achievements in office. But that success came only after a 2017 hepatitis A outbreak killed 20 people and sickened nearly 600 others, most of whom were homeless. Faulconer and the city council were criticized for not intervening sooner to open more restrooms and hand-washing stations, despite warnings from health officials.

The city's 12% reduction in the number of people sleeping on the streets from 2019 to 2020 resulted largely from efforts to curb the spread of covid by placing people in shelters.

A fiscal conservative, Faulconer is moderate on health care. He supports abortion rights and two years ago vowed not to restrict them.

If elected governor, Faulconer said, he would push to expand California's paid parental leave program to 12 weeks at full pay. Currently, new parents get up to 70% of their income for up to eight weeks.

John Cox

Cox, 66, has centered his campaign — as he did his unsuccessful 2018 gubernatorial bid against Newsom — on his business credentials. The lawyer and accountant thinks the solution to California's health care troubles lies in the free market, for example by letting patients know the cost of care ahead of time so they can shop for a better deal.

"I understand that health care is expensive, and families can’t afford it very well," Cox said in an interview with KHN. But that’s because "there’s not enough price discrimination, not enough consumer orientation, not enough consumer choice."

Health care is expensive partly because doctors and hospitals can charge whatever they want, and patients overutilize care because they don't have to pay the full price, he said.

He favors health savings accounts with some government assistance for low-income people, which he said would make consumers more discriminating and keep health care prices in check. But he doesn't want to take profit completely out of health care.

"I certainly want companies to make money from providing health care," Cox said. "Because I think that’s what gives them an incentive to innovate."

Kevin Kiley

Kiley, 36, a state Assembly member representing a suburban Sacramento district, often speaks out against government interference in people's lives. The former teacher and attorney believes government rules about insurance coverage, doctor-patient relationships and independent contracting have contributed to higher health costs.

Like Elder and Cox, he wants more transparency and consumer choice in health care.

"I'm not sure it's necessary to be continually specifying what every single plan needs to entail," Kiley said in an interview with KHN. "I don't know that legislators are always in the best position to be weighing in."

Rather than provide health benefits to undocumented immigrants, Kiley said, lawmakers should scrutinize Medi-Cal, which covers about one-third of Californians but is failing to provide basic preventive care, including childhood vaccines, to some of its neediest patients.

Kiley downplayed the coverage gains made under Obamacare that have reduced the state's uninsured rate from about 17% in 2013 to about 7%, saying a reduction was inevitable because of state and federal requirements to get health insurance or be penalized.

He has authored legislation, which did not pass, to increase funding for K-12 student mental health, which he says has only become more urgent in the pandemic.

Kevin Paffrath

Paffrath, 29, made his fortune giving financial advice on YouTube and renovating houses in Southern California.

If elected, Paffrath said, he would create 80 emergency facilities across the state to connect homeless people with doctors and substance use and mental health treatment. And he would require schools to offer better mental health education.

He also wants to create vocational programs for interested students ages 16 and up. With better job training and higher salaries, Medi-Cal rolls would naturally shrink, he argues.

"It's not Californians' fault that one-third of Californians are on Medi-Cal," Paffrath said in an interview with KHN. "It's our schools'."

Paffrath supports the Affordable Care Act and said he is willing to consider questions such as whether California should adopt a single-payer health system or manufacture generic prescription drugs.

Paffrath said he's most interested in cutting health insurance red tape, which creates bureaucratic hurdles for patients, makes doctors spend more time on paperwork than patient care, and discourages new providers from entering the field.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.