Wesley G. Bradford, MD, MPH
This year has been busy, especially since the federal government shut-down October 1 by the Congressional standoff on dropping tax credits for marketplace health plans (created by the ACA in 2021). Covered California’s Open Enrollment is scheduled to begin on November 1st, with enrollees expected to see an average 97% premiums increase. Many will likely become uninsured, passing their healthcare costs onto everyone else. (“There is no free lunch.”) (AAFP information on the shutdown is available at: https://www.aafp.org/news/government-medicine/health-extenders-shutdown.html.
AAFP has up-to-date details at https://www.aafp.org/advocacy.html on changing Federal policies and funding.
CalRx is a California program created in 2019 to produce and distribute generic drugs at a low cost directly to consumers. Beginning January 1, 2026, biosimilar insulin glargine pens will be made available for about $55 per five pack. SB 40 (Wiener) caps insulin costs at $35 per month and ends step therapy requirements for insulin coverage.
Cigna released a new policy to automatically downcode higher-level E/M codes based on its criteria. CAFP & CMA oppose this unlawful downcoding policy, and Cigna has agreed to pause implementation pending review by the California Department of Managed Health Care.
AB 489 (Bonta) Ensures that patients know when they’re communicating with AI in a health care setting (“Brave New World!”).
Since HHS Secretary Robert F. Kennedy Jr dismissed the CDC’s 17-member vaccine advisory panel, AAFP and other physician organizations have produced their own recommended vaccines schedule for adults, adolescents & children. AAFP distributed copies of AAFP 2025 vaccine recommendations at the recent FMX meeting in Anaheim. CAFP played an important role to ensure family physicians were included in vaccine coverage determinations after federal changes threatened access by incorporating AAFP immunization guidelines (AB 144, Committee on Budget).
On September 21, 2025, President Trump issued a Proclamation imposing a new $100,000 fee on employers that seek to hire new employees using the H-1B visa program. The H-1B visa program allows employers to hire foreign workers in specialty occupations, including medicine. These visas are available to graduates of foreign medical schools who meet certain requirements. H-1B Visas are important for health care access because 23% of licensed physicians in the U.S. are foreign trained and many practice in rural and underserved communities.
