A New Vision for Health Care
California’s latest health care proposal landed with a quiet thud on May 5, 2025, but its ripples could touch millions. Governor Gavin Newsom, through the Department of Managed Health Care (DMHC), applied to the federal Centers for Medicare & Medicaid Services (CMS) to update the state’s benchmark plan, which dictates required health benefits for individual and small group markets. Set to take effect in 2027, pending CMS approval, the plan mandates coverage for hearing aids, fertility treatments like in vitro fertilization, and mobility devices such as wheelchairs and scooters. For many, this promises life-changing access to care.
The move comes as health care inequities remain stark. A March 2025 study from Rutgers Health Services Research found that one in four U.S. adults has a disability, with many reporting poor provider communication and structural barriers to care. California’s plan seeks to address these issues, offering tools and treatments that have long been financially out of reach. Yet, the proposal must navigate federal scrutiny and economic concerns before it becomes reality.
Breaking Down the Benefits
The updated plan builds on the Affordable Care Act’s (ACA) essential health benefits, which require health plans to cover ten core areas, including hospital care and prescription drugs. The new additions are specific: annual hearing exams and hearing aids, fertility treatments, and durable medical equipment like walkers and power wheelchairs. These changes target barriers faced by people with hearing loss, infertility, or mobility limitations, aiming to make essential care more accessible.
State leaders have rallied behind the plan. Senator Caroline Menjivar emphasized the developmental benefits of hearing aids for children, while Assemblymember Mia Bonta highlighted the relief for couples pursuing family-building. The DMHC, under Director Mary Watanabe, spent a year engaging lawmakers, health plans, and the public, incorporating feedback from open forums and written submissions to refine the proposal.
A Broader Context
This effort reflects a decades-long push to improve health care access. Before the 1990 Americans with Disabilities Act, assistive devices and specialized treatments were rarely covered, leaving families to shoulder steep costs. The ACA’s 2010 framework established ten essential health benefits, but gaps persisted, particularly for hearing aids and fertility care. By 2025, 41 states and Washington, D.C., had expanded Medicaid, yet access to specialized services remains uneven across the U.S.
California’s proposal also navigates a complex federal-state relationship. The ACA allows states to define essential benefits through benchmark plans, subject to CMS approval. States like North Dakota and Virginia updated their plans for 2025, while California’s last revision was in 2015. The 2027 plan responds to evolving needs, but its success depends on federal alignment and state resources.
Balancing Costs and Care
The plan has sparked debate over its economic impact. Some policymakers warn that mandating new benefits could drive up premiums, burdening small businesses and individuals. They advocate for market-driven approaches, arguing that fewer federal rules could foster innovation and affordability. This view recalls 2017 ACA repeal efforts, which sought to loosen benefit mandates but faced criticism for risking coverage losses.
Conversely, supporters of expanded benefits stress the need for equitable access. They argue that covering hearing aids, fertility treatments, and mobility devices addresses critical gaps, particularly for low-income families and people with disabilities. The challenge lies in balancing these priorities, ensuring costs do not outweigh the benefits for those who need care most.
Looking Ahead
The plan’s fate rests with CMS and state lawmakers. Approval would set a new standard for California’s health coverage, potentially inspiring other states. The DMHC’s inclusive process, marked by public input, has earned praise, but the 2027 timeline means delays for residents. Economic or political shifts could further complicate the rollout.
Still, the proposal highlights real human needs: children hearing their teachers, couples starting families, individuals moving freely. Its success will depend on clearing federal and financial hurdles while maintaining focus on those it aims to serve. The bigger question lingers: can health care systems truly meet everyone’s needs?