Despite essential health care reforms brought about by the Affordable Care Act (ACA), issues still remain, including falling short of universal coverage, instability in the individual marketplace and rising health care costs - which grew another 4.3 percent in 2016. U.S. health spending reached $4.3. trillion in 2016, or $10,348 per capita, and accounted for 17.9 percent of gross domestic product (GDP).

The magnitude of the problem and consideration of the many downstream impacts and trade-offs have made clear that a comprehensive solution must address the many cost drivers that create incentives for higher spending. 

The California Medical Association (CMA) has adopted policy positions in support of containing costs, and we have advocated against incomplete and ill-conceived proposals that would have simply shifted costs from one stakeholder to another without lowering overall costs:

• In 2017, CMA's House of Delegates (HOD) adopted policies that were used to guide advocacy in 2018 towards achieving universal access and improving health care affordability.
• In 2018, CMA defeated Assembly Bill 3087 (Kalra), which would have established an untested and incomplete health care rate-setting system in California. Poorly drafted, this irresponsible legislation only addressed the commercial market and would have based providers' pricing off Medicare reimbursement rates.

As California prepares for a new gubernatorial administration, developing a comprehensive plan is critical to ensuring sound and achievable policy. To that end, CMA will invest a majority of time at HOD (in October 2018) to the discussion of health care cost containment strategies that focus on:

• Addressing utilization through improved care delivery
• Addressing increasing pharmaceutical costs
• Reducing administrative burdens on physician practices
• Enhancing competitiveness of the health care market

In the coming months, CMA will continue to lead the charge for more affordable health care and ensure that California's physicians have a seat at the policy-making table. Members with ideas or who want to get more involved should contact CMA Communications.