Dr. Monica Soni Leads Covered California’s Push for Health Care Quality Amid Federal Funding Cut Concerns

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Covered California Pushes for Better Health Care as Federal Spending Cuts Loom

As the nation braces for potential federal budget reductions, Covered California, the state’s Affordable Care Act (ACA) health insurance marketplace, is intensifying efforts to enhance the quality of care for its nearly 2 million enrollees. At the forefront of this mission is Dr. Monica Soni, Covered California’s chief medical officer, who is spearheading an innovative program to hold health plans financially accountable for delivering high-quality care. However, Soni and other health officials are increasingly concerned that looming federal spending cuts could destabilize the marketplace, threatening access to affordable coverage and exacerbating existing challenges, such as declining childhood vaccination rates.

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A Commitment to Quality and Equity

Since joining Covered California in May 2023, Dr. Soni, a Harvard-trained primary care physician, has led the Quality Transformation Initiative (QTI), a first-in-the-nation program designed to ensure health plans meet rigorous performance standards. The QTI holds insurers accountable for key health metrics, including blood pressure control, diabetes management, colorectal cancer screenings, and childhood vaccinations. Plans that fail to meet these benchmarks face financial penalties, with the funds redirected to support enrollees and improve care.

In its inaugural year, the QTI yielded mixed results. Covered California reported improvements in three of the four targeted measures—blood pressure control, diabetes management, and colorectal cancer screenings—demonstrating progress in managing chronic conditions and preventive care. However, childhood vaccination rates for children under 2 declined by 4% across seven of the ten participating health plans, mirroring a troubling national trend. Soni attributes this drop to post-pandemic vaccine hesitancy and growing skepticism toward the medical industry, noting that misinformation about vaccines, such as false claims about measles, has contributed to parental uncertainty.

“Lack of access to critical care, like childhood immunizations, disproportionately impacts underserved communities,” Soni said. “Our efforts are not just about improving health outcomes but also advancing health equity.” As a physician who continues to see patients one day a week at an urgent care clinic in Los Angeles County’s public safety net system, Soni is acutely aware of the barriers faced by low-income and minority populations.

The $15 million collected from health plan penalties in 2024 is being reinvested into Covered California’s Population Health Initiative (PopHI), which Soni also oversees. This program, set to launch in early 2025, includes grocery support for 6,900 households, contributions to over 250 college savings accounts for children who complete routine checkups and vaccines, and funding for small primary care practices to improve care quality. The savings accounts, which offer up to $1,000 per child, are designed to incentivize preventive care while fostering long-term financial stability. Research shows that even modest savings accounts increase the likelihood of college attendance, which can improve health outcomes and economic mobility.

The Threat of Federal Spending Cuts

While Covered California’s initiatives aim to strengthen the state’s health care system, the prospect of federal spending cuts casts a shadow over these efforts. The ACA marketplace in California covers nearly 2 million residents, 89% of whom rely on federal subsidies to afford their premiums. These subsidies, expanded in 2021 under the American Rescue Plan Act and extended through the Inflation Reduction Act, reduce the average monthly premium from $698 to $135 for enrollees. However, the enhanced subsidies are set to expire at the end of 2025 unless Congress acts to renew them.

Soni warns that the loss of these subsidies could lead to significant disenrollment. “Our estimates suggest that nearly 400,000 Californians would drop coverage immediately if the subsidies end,” she said. “As a primary care doctor, I’ve seen patients delay care for preventable conditions due to cost. We can’t afford to go back to those days.” The potential cuts come at a time when many enrollees are already living on tight budgets, forced to make difficult trade-offs between health care, food, and other essentials.

Beyond the ACA subsidies, broader federal health care funding reductions, including proposed cuts to Medicaid, could further strain California’s health system. Medicaid, known as Medi-Cal in California, covers one in three residents, and any reduction in federal support could limit access to care for low-income families, particularly in rural and underserved areas. The Center on Budget and Policy Priorities estimates that Republican proposals under consideration could result in millions losing coverage or facing higher costs nationwide.

Navigating Declining Vaccination Rates

The decline in childhood vaccination rates adds another layer of complexity to Covered California’s mission. Immunizations prevent up to 10.5 million diseases annually and save significant health care costs—up to $29 for every dollar spent. Yet, national and state-level data show a 4% drop in vaccination rates for children under 2, driven by misinformation and distrust. An April KFF poll found that many parents have encountered false information about vaccines, leaving them unsure what to believe.

Covered California’s response includes financial incentives through the PopHI program, such as the college savings accounts tied to well-child visits and vaccinations. “We’re trying to make it easier for families to prioritize preventive care,” Soni explained. “By addressing barriers like cost and mistrust, we hope to reverse this trend.” The initiative also supports primary care practices, which play a critical role in educating parents and administering vaccines.

A Call for Resilience and Reform

As federal budget negotiations loom, Covered California remains committed to building on the ACA’s foundation. The state has a history of proactive health reforms, including expanding Medi-Cal to undocumented children and young adults and implementing state-level subsidies to complement federal support. In 2020, California introduced a state individual mandate to maintain coverage levels after the federal mandate penalty was eliminated.

Soni and her team are optimistic that the QTI and PopHI programs will continue to drive improvements in care quality and equity, but they stress the need for sustained federal investment. “The ACA has transformed access to care in California, reducing the uninsured rate from 17% to about 7%,” said Jessica Altman, Covered California’s executive director. “Protecting these gains requires collaboration between state and federal leaders to ensure affordable, equitable health care for all.”

For Soni, a mother of two young children and a physician dedicated to underserved communities, the stakes are personal as well as professional. “We’re not just fighting for better health care—we’re fighting for a system that gives every Californian a chance to thrive,” she said. As Covered California navigates the challenges ahead, its focus on accountability, innovation, and equity offers a model for how states can strengthen health care in an era of uncertainty.