From racial justice to dirty air, California’s new AG plots a progressive health care agenda

California Attorney General Rob Bonta, a longtime Democratic state lawmaker, comes to his new role well known for pursuing an unabashedly progressive agenda on criminal justice issues. He has pushed for legislation to eliminate cash bail and to ban for-profit prisons and detention centers. But Bonta also has a distinctive record on health care, successfully advancing legislation to protect consumers from so-called surprise medical bills when they inadvertently get treatment from out-of-network providers and framing environmental hazards like pollution as issues of social justice.

He was among the Democratic lawmakers leading the charge at the California Capitol to take on Big Soda, pushing to cut consumption of sugary drinks through taxes and warning labels. Such proposals so far have faltered under the influence of the soda industry.

Bonta, 49, was an infant when his family, in 1971, moved to California from the Philippines, where his parents worked as missionaries. His father, Warren Bonta, a native Californian, worked for the state for decades as a health care official, setting up clinics to expand access to medical care in rural and refugee communities. Rob Bonta's first elected position was to the Alameda Health Care District, overseeing local medical services.

Appointed by Gov. Gavin Newsom this year, Bonta in April succeeded former state Attorney General Xavier Becerra, who was tapped by President Joe Biden to serve as secretary of the U.S. Department of Health and Human Services. In the weeks since, Bonta has beefed up the number of lawyers working in the Department of Justice's Bureau of Environmental Justice and has created a Racial Justice Bureau that he said will play a pivotal role in ensuring equal access to health care for Black and Latino residents.

A graduate of Yale Law School, Bonta spent nine years as a deputy city attorney in San Francisco before his election to the state Assembly in 2012, representing Oakland and the East Bay. He was the first Filipino American elected to the California legislature, and is now the first Filipino American to serve as the state's chief law enforcement officer.

As attorney general, Bonta said he envisions a far different relationship with the Biden administration than his predecessor had with the Trump administration. Becerra emerged as one of former President Donald Trump's fiercest critics during his tenure as the state's top cop, filing more than 120 lawsuits to oppose Trump administration policies on the environment and health care, including leading the ongoing fight to preserve the Affordable Care Act in its case before the U.S. Supreme Court. Vice President Kamala Harris also once served as California's attorney general, and Bonta said he sees tremendous opportunity to shape a more progressive agenda on issues such as reproductive health and universal, single-payer health care working in concert with the new administration.

Bonta spoke with KHN about how health care would shape his agenda as attorney general. The interview has been edited for length and clarity.

Q: Your predecessor made health care a priority. Will it be one of yours?

It's going to be a top priority for me, and it was a top priority for me as a legislator. I was chair of the Assembly Health Committee or a health committee member the entire time I was there, almost nine years. Before that, I was on a health care district board. My very first elected office I ever had was making sure we provided true access to high-quality, affordable health care to the community that I served.

This is a really foundational part of who I am, and who my family is — our legacy and our values and what we stood for. I think health care is a right, not a privilege. It’s for all, not the few.

Q: You've said you would make racial justice a priority. Do you believe racism is a public health crisis?

Yes, I do. Covid-19 revealed a lot of what was inequitable and racist about our systems — the disparate impacts that we saw, the inequity that we saw. And I think racism is not just a public health crisis — it is a public health crisis — but it also infects our economic system, it infects our criminal justice system, it infects all of our systems. And it has led to a public health crisis.

Q: What does that look like in health care? How does inequity show up?

It looks like making sure that in health care there aren't disparate impacts on communities of color. That race is not correlated to less access or less quality, and making sure that no one is left out. That can look like access to reproductive health care; that can look like access to real health insurance as opposed to sham health insurance plans. It can look like a charge that is inappropriately placed on a vaccine — vaccines are supposed to be free. That's something else we worked on recently.

Q: Can you elaborate?

Through a joint investigation with U.S. Health and Human Services, as well as the U.S. attorney's office, we identified that vaccines — which should be provided to individuals for free under the law — that a charge was being placed on the vaccine.

The vaccine should be universally accessible. And when that isn't being done, barriers are being put up in vulnerable communities, keeping people from their vaccine that we all need right now. That is a problem. We put out an alert and reminded people of the laws that provide free vaccines to all individuals under the Centers for Disease Control and Prevention program.

Q: What areas of environmental health might you look into?

The building of huge warehouses. In the Inland Empire, there are quite a few being built. They’re being built adjacent to or in disadvantaged communities. And all the goods movement activity — and all of the emissions that are created from the goods movement — create a threat, and a risk to those communities.

Q: Like Amazon, for instance? The corporation has come under scrutiny for environmental harms associated with its sprawling warehouses.

Yeah. These warehouses have really created problems for disadvantaged communities in California. We expanded the Bureau of Environmental Justice to provide more resources and more ability to go after big polluters, and to protect communities that live at the intersection of poverty and pollution who are being forced to drink dirty water and breathe unhealthy air.

I see the role of the attorney general as standing up for everyday people who are abused or hurt and neglected or mistreated, and generally protecting the little guy from the overreach and abuse of power of the big guy.

We have more authority in the environmental realm than in many other areas. And we want to use those tools — that authority, that influence, that power — to protect communities, often low-income communities, often communities of color, who are being hurt by polluters.

Q: Becerra filed a lawsuit and sponsored legislation going after health industry mergers alleged to be anti-competitive, a practice he argues drives up health care prices. Will you continue to go after anti-competitive practices in health care?

That's definitely a priority. That’s a critical tool in the toolbox that the California attorney general uniquely has to approve — or put conditions on, or not approve — proposed mergers involving a nonprofit hospital.

The lens to see that through is: How does it impact patients? How does it impact access to quality care, and cost of care? And so that is exactly why the attorney general has that role, to review these proposed mergers with an eye towards patients and communities that don’t necessarily have a voice in the merger.

Q: As attorney general, do you support single-payer health care?

My involvement will be different. Having said that, I co-authored the single-payer bill from a few years back. And I was a co-author of this year's single-payer bill that Assemblyman Ash Kalra was leading that I think is no longer moving. [Kalra has withdrawn the bill from consideration for this year.]

I support single-payer health care. I support universal health care. I think single-payer health care is a way to get to that aspiration.

As the attorney general, I enforce the law. We don’t have a single-payer law in California. So, I’ll enforce the existing laws, which are very strong, to help make sure Californians have the most accessible, affordable, highest-quality health care.

Q: The U.S. Supreme Court has agreed to hear a Mississippi abortion case that some say could threaten abortion rights at the state level. If upheld, how could that affect the abortion protections in California?

That’s going to be a really important case for reproductive freedom, and important, in my view, for California to be involved in given our leadership in this space. As the case gets briefed and prepped for consideration and argument before the U.S. Supreme Court, I expect we will be very active in making arguments to the court to help guide [the justices'] thinking and their decisions.

Q: What will California's relationship with the federal government be like?

I think the posture and the relationship between the federal administration and California over the last four years are very different than what they will be for the next four.

Attorney General Becerra was the warrior and the champion that we needed, and that was necessary as we faced a full-frontal assault on California, our people, our values and our resources, and he fought back and protected us and defended us and stood up for our values time and time again.

Now, I think we have a Biden-Harris administration that largely does agree that we should have, certainly, the Affordable Care Act, that we should have reproductive freedom, that we should address the inequities in our health care system, that we should have affordable, accessible, high-quality health care for all — and will help us get there.

So, with the new administration, I look to collaboration. California can and should continue to be who we are. We lead. We go first. We pioneer. We’re bold and we’re big in how we think. That's who we are, so that leading role is our natural place to be, including in health care.

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

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.