Carmen Comsti, Policy Specialist, Explains CalCare and Socioeconomic Justice

(Note: Carment Comsti refers to AB 1400 which was the CalCare bill in 2021-2022. Currently the CalCare bill is now AB 2200.)


Introduces Carmen Comsti, a lead regulatory policy specialist for the California Nurses Association. It highlights her involvement in healthcare legislation and her role in addressing healthcare disparities and the need for culturally competent care. Emphasizes how AB1400 aims to eliminate financial and care barriers, address structural racism, and prioritize healthcare equity. It also discusses the importance of AB1400 for the API community, protecting frontline workers, and ensuring preparedness for pandemics. It concludes by emphasizing the need for AB1400 to achieve racial and socioeconomic justice in the healthcare system.


Um, now I’d like to introduce our final speaker. Carmen Comsti is a lead regulatory policy specialist for the California Nurses Association, which represents over 100,000 registered nurses and other healthcare workers statewide and is a sponsor of the AB1400 bill. Carmen has been a key member of the California Nurses Association and National Nurses United’s policy and legislative drafting teams for numerous state and federal bills, including AB1400in California, as well as legislation on hospital closures, medical debt relief, and occupational safety for aerosol-transmissible diseases such as COVID-19.

Carmen currently serves as a commissioner for the Healthy California for All Commission. Carmen will talk about the provisions in AB1400 that address the Asian-Pacific Islander healthcare disparities and the need for culturally competent, culturally sensitive care that the previous speakers have described. Carmen, thanks so much. Um, and you know, thanks, thanks PANA for inviting me to speak today about um AB1400. You know, there’s a lot to cover, so I’m going to jump right in.

Um, you know, the causes of health inequity for API communities and other underserved communities are structural. You know, it’s tied to the history of racism and white supremacy in the United States. What this means is that the policy solutions, in turn, must be structurally transformative. And, you know, first and foremost, AB1400 would do so by eliminating financial barriers to care and other barriers to care created by our fragmented and market-driven system of private insurance.

Single-payer begins to address the structures that drive racial income and other injustices by guaranteeing comprehensive healthcare benefits to all without regard to the ability to pay, no matter your race, ethnicity, gender identity, the language that you speak, or your immigration status. By placing everyone in one network, one plan called CalCare AB1400, it would eliminate the structures in our healthcare system that compound upon and prey on health disparities.

You know, today, competing private insurance plans cherry-pick the healthiest, and health plans avoid and limit care for low-income communities, immigrant communities, undocumented people, and communities of color because we present a financial risk to their bottom lines. But this would end with AB1400 because everyone would be in together in one single risk pool, one single network, everyone in, nobody out.

Importantly, AB1400 also addresses structural racism in healthcare and structural inequities by funding and allocating resources based on need, rather than industry profiteering. So AB1400 includes mechanisms to identify health inequities within our system, and then it includes mechanisms to direct resources to begin the long process of rebuilding our healthcare infrastructure in medically underserved communities.

With all care under the single roof of CalCare, we can better identify the gaps in the healthcare system, and with AB1400, what’s happening is that we’re using our collective power, our solidarity through a single publicly financed payer, to end our tiered system of healthcare and to explicitly target healthcare disparities and demand that resources go towards the most vulnerable communities, rather than lining the pockets of healthcare executives and administrators.

A key way that CalCare does this is by targeting racial and other health inequities through the way we fund our hospitals and other healthcare institutions. You know, what we’d be doing is we’d be eliminating many of the things that Dr. Song was just talking about, about privately driven Medicaid plans. Those would be gone, and instead, AB1400 would pay hospitals through institutional global budgets, which, simply put, means the hospitals would be getting the funding and resources required to meet all the healthcare needs of their patients and to stay open.

And through this global budgeting process and the special projects fund that is in AB1400, we’d be able to prioritize projects that target healthcare disparities in rural and medically underserved areas. So this funding could be used for things like additional staff, extended operating hours, or used for construction, renovation, or to boost nurse, doctor, and other healthcare staffing or resources in any of these rural, underserved, or medically professional shortage areas.

This means that we could finally combat the epidemic of hospital closures for communities of color enrolled in less affluent areas. And importantly, the CalCare Board is also charged with ensuring that all Californians receive culturally, linguistically, and structurally competent care. So CalCare would be responsible for ensuring that healthcare professionals receive the necessary education and training necessary to increase the delivery of culturally competent care. Importantly, funding would be directed to increase the number of nurses, doctors, and healthcare workers who are from these communities and who can provide this culturally and linguistically competent care.

And together, all these provisions of AB1400 prioritize projects on health equity to ensure that there are dedicated funding mechanisms for projects that would improve healthcare services and address inequities. And it would ensure that we are staffing and recruiting healthcare professionals from the communities that they serve and from our API communities, from immigrant communities.

Um, and we’ve structured AB1400 payment systems to ensure that healthcare workers, very importantly, as other folks have been talking about, are fairly paid, fully resourced, and have the tools that they need to provide care to their communities. But you know, really at its heart, what’s happening is that all these provisions ensure that the professional judgment and practice of your doctors, nurses, and other healthcare professionals are not compromised by bias, and they’re not compromised by business and financial interest. We can ensure that healthcare decisions under CalCare are made by you and your doctors, your nurses, your healthcare professionals, as opposed to insurance companies and corporate boardrooms so that doctors, nurses, and other healthcare workers can do what they do best, which is caring for patients.

Now, I want to quickly talk about how AB1400 is important to our API community because of its provisions to protect frontline workers. You know, at CNA, I have the honor of representing over a hundred thousand registered nurses and other healthcare workers in California, a large portion of which are Asian American and Pacific Islanders. And I’m sure many of you watching, like me, have nurses and other healthcare workers in our families. And we know healthcare workers have higher rates of exposure to infection from and death from COVID-19.

And National Nurses United, we found by combing through publicly reported data, social media obituaries that as of last month, even though in California, Filipinos make up 20% of nurses in our state, we have represented about 60% of deaths of nurses in California from COVID-19. The pandemic is a tragedy, a tale of avoidable exposures and deaths, lack of preparedness, inadequate hospital capacity, uncoordinated and uneven availability of tests, contact, and using vaccines. It’s a tale of utter indifference by our employers, the health industry employers, particularly our public health agencies, for the health and safety of nurses, doctors, and other healthcare workers, and other essential workers who have been risking their lives to keep everyone safe.

And then, if we had AB1400 during the pandemic, hospitals would have been prepared in terms of beds, equipment, staffing levels needed to respond to the pandemic. And in the bill, we’ve had provisions to ensure that hospitals had the funding required to have stockpiles of PPE and to have infectious disease response plans and preparedness to make sure that those plans are actually taken and implemented if a pandemic does happen. And we would fund to fully and adequately staff our hospitals to take care of both our healthcare workers and our patients and to protect everyone from the spread of another pandemic.

You know, I think if we had CalCare, nurses and healthcare workers would not have to needlessly die because of health industry reliance on just-in-time supply models, a profit-seeking model which failed to get healthcare workers the protections that would have kept them safe and our patients safe. And just to wrap up quickly, AB1400 is critical and a necessary step towards a concerted and measured response to achieve racial and socioeconomic justice in our healthcare system because, as you know, as I want everyone to remember, that healthcare justice is racial justice and socioeconomic justice. Thanks, thanks to all for having me today. Thank you, Carmen Comsti.