In a wide-ranging episode of Meidas Health, host Dr. Vin Gupta brings together two of California’s most influential health officials to make a pointed argument: when federal leadership falters, states can still defend access to care, protect scientific standards, and deliver tangible relief to families.
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Dr. Erica Pan, California’s state public health officer, and Dr. Monica Soni, the chief medical officer of Covered California, describe a state government and health ecosystem that is not merely reacting to national instability, but actively building guardrails around evidence-based medicine and public health infrastructure. The episode is framed around the simple, urgent reality that millions of Americans are bracing for higher costs and greater uncertainty as key health policies face political headwinds.
Early in the conversation, Gupta situates listeners in an environment bombarded by confusing headlines on affordability and coverage. Pan responds by highlighting a recent California law meant to protect preventive care and vaccine access from shifting federal guidance. She describes a push to “remove that reference from our laws” tied to federal vaccine recommendation structures, and to ensure that California can maintain coverage requirements if national bodies change course in ways the state views as not “credible and evidence based.” The throughline is explicit: the state is asserting its authority to keep medical recommendations aligned with scientific evidence, even if Washington’s signals become unreliable.
The episode also explores California’s efforts to confront one of the most visible pocketbook pressures in American health care: the cost of insulin. Pan notes she has not been directly involved in the initiative but says she is “super proud that California is doing this,” summarizing it plainly: “we are producing insulin at a lower rate and it’s less expensive.” Soni adds that the insulin project reflects a broader posture: “California isn’t sitting back and waiting for other folks to solve our problems.”
From there, Soni expands on the mission of Covered California, explaining it as a crucial bridge for people who do not receive employer-based insurance, earn too much for Medicaid, and are not yet eligible for Medicare. “We really fill this important gap,” she says, describing the exchange’s enrollees as “farmers,” “hairstylists,” “nail stylists,” “entrepreneurs,” and “gig workers.” The program serves nearly 2 million people, and Soni underscores the central reality of affordability: “90% of our folks… do need financial assistance to be able to purchase their premiums.”
That discussion becomes even sharper as Soni warns of looming federal policy failure: the enhanced subsidies that help lower premiums are set to expire at the end of 2025. “The… [subsidy] will expire December 31st of 2025, just a few weeks away,” she says, calling it “a really, really difficult position” for families. California, she adds, has tried to buffer the blow: “The state of California did allocate $190 million to try to support the lowest income folks.”
But the episode’s pro-democracy perspective is most pronounced in its focus on trust, fear, and whether people can safely seek care in the first place. Pan raises concerns that go beyond insurance math: people “being scared to come in,” even for essential services. She points to real-world public health risks, including H5N1 in dairy herds and the possibility that agricultural workers may avoid testing if they fear consequences. If people do not feel safe accessing care, she warns, it becomes harder to “detect novel and emerging threats.”
Soni, who still practices in Los Angeles County, speaks directly to the stakes for immigrant communities. She describes practical, immediate shifts: “the delivery system where I see patients has pivoted to be able to offer telehealth,” allowing chronic disease management “virtually by phone.” She also describes health systems preparing staff for potential immigration enforcement activity: “we as providers are getting alerts on what to do if ICE shows up,” aiming to “follow the law” while protecting “that patient and doctor relationship.” She describes “mixed families” and the ripple effects of fear: “We’re watching kids who are American citizens not go to school because of fear.”
Repeatedly, both guests return to a governing philosophy rooted in service delivery rather than rhetoric: meet people where they are. Pan connects it to public health logistics—whether to “pull people in” to mass clinics or “push things out” into communities—and argues that prevention should be designed to keep people out of hospitals rather than reward illness.
That goal, Pan says, is part of a new state initiative focused on innovation, collaboration, and communication. She describes changing media habits—“I also get a lot of my news on podcasts,” she says—while emphasizing the need for feedback loops: understanding “what are people hearing” and “what information do they need” to make healthy choices. Soni echoes the point, arguing that health leaders should be present wherever people consume information: “Wherever folks want to consume the information, I want the information to be.”
The episode closes by challenging the assumption that collaboration is impossible in a polarized era. Soni offers examples of alignment with federal priorities, including addressing food insecurity—“You cannot be well if you are hungry”—and holding insurers accountable to improve outcomes. Pan points to a state law targeting ultra-processed foods in schools and a multi-level response to a botulism outbreak, describing it as “a bright light of ongoing collaboration” across local, state, and federal agencies to “keep families healthy.”
In the episode’s final minutes, the message is unmistakable: public health is not just science. It is civic infrastructure. And when national institutions waver, California’s officials argue that democratic governance can still function—if leaders choose action, transparency, and evidence over chaos.
Check back for new episodes of Meidas Health right here on the Meidas+ Substack and on the MeidasTouch Podcast audio feed.
