December 10, 2023

Health Insurance

Follow Your Health Insurance

Why CA wants opioid overdose spray covered by health insurance

In summary

To reduce the death toll of the opioid epidemic, California Assemblymember Liz Ortega wants health insurers to cover the costs of Narcan, a nasal spray that can reverse an overdose. Of course, increasing access comes with a price tag.

The ubiquity of the synthetic painkiller fentanyl has supercharged the opioid crisis to the point that California schools are now making overdose treatments readily available, turning teachers and even children into emergency responders. 

More than 11,000 Californians reportedly died from a drug overdose over a one-year span ending in February, according to the Centers for Disease Control and Prevention. The overwhelming majority were caused by opioids.

The nasal spray Narcan, which the Food and Drug administration in March approved for over-the-counter purchases, has been one solution to at least reduce the amount of fatal overdoses. For freshman Assemblymember Liz Ortega, a Hayward Democrat and labor executive whose nickname is “The Peoples’ Lobbyist,” the FDA’s extraordinary move still made it inaccessible to those who might need it. 

Her idea: Assembly Bill 1060, which would require health insurance providers – public and private – to cover the cost. The proposal advanced out of the Assembly with bipartisan support but now faces industry opposition and comes with an estimated $9.2 million annual price tag, an increase that would likely trickle down to consumers. 

Ortega and I recently talked about the merits of the bill and the pushback she’s received. The bill needs to clear the Senate Appropriations Committee before senators can vote to put it on the governor’s desk this fall.

This interview has been condensed for clarity and length.

Q: Tell me about your background on this issue and whether this is something that you have personal experience in or has touched your life in some way.

A: This came to me when I got to the legislature. When I got here, I started to hear more stories from families and in the news about the opioid crisis – particularly fentanyl – and the number of people that were dying. One of the stories that stood out to me when I was learning about it was the number of kids that were dying from fentanyl overdoses. As a mother, all I kept thinking about were my kids and how I would feel if my baby was playing in the park and accidentally overdosed, like we saw in San Francisco, or if my daughter – she’s 16 years old – what if she goes to a party and someone gives her a pill, god forbid, she takes it and dies? These are the stories that I started to hear over and over again that got me into the space where I started to ask more questions and do a little bit more research on it. 

Learn more about legislators mentioned in this story

Liz Ortega

State Assembly, District 20 (Hayward)

Liz Ortega

State Assembly, District 20 (Hayward)

District 20 Demographics

Voter Registration

Dem 57%

GOP 13%

No party 25%

Campaign Contributions

Asm. Liz Ortega has taken at least $596,000 from the Labor sector since she was elected to the legislature. That represents 55% of her total campaign contributions.

Then one weekend, there was an article that came out that talked about the (U.S. Food and Drug Administration) addressing this fentanyl crisis by making Narcan available over-the-counter. I was excited now more people will have access to this life-saving drug, but the counter to that was that it’s not affordable. So the people that would need it the most would not be able to access it because it would still cost anywhere between $50-100. 

If I’m a struggling mother barely making ends meet … how am I gonna afford buying a life-saving medication that I might or might not use? That’s where I came up with AB 1060. What am I gonna do to address this crisis in a way that deals with the accessibility, deals with affordability and saves lives?

Can you explain what the bill would do? 

What my bill does is make Narcan and other other medications like Narcan that reverse opioid overdoses – now that it’s going to be available over-the-counter, it’s added to the list of covered medications, by Medi-Cal and private insurance. So if I go into a Walgreens or Rite Aid, I can go and pick up a spray of Narcan and it’s free. I don’t have to worry about paying $50-100 to be able to buy this life-saving medication.

I’ve seen some of the comments and some of the committee analyses – the health insurance lobby, private insurers are not going to accept something like this without a fight. What have you been hearing from opponents, and how are you working to address their critiques?

Interestingly enough, the hospital insurance industry reached out to me very early on when I first introduced (the bill) and said “We might have some concerns. We will get back to you if we do.” They never showed up to any of the hearings (before it passed out of the Assembly). They never sent me any letters – not until (June 28). Three hours before I walked into the Senate (Health Committee) hearing, I received an email from (the California Association of Health Plans) … basically it said they were going to show up in committee and oppose my bill unless I took their amendments. They gave me a list of amendments – three hours! 

So I walked into the hearing and my opening statement was this email, addressing the fact that they were trying to bully me to accept the amendment three hours before a hearing. We have rules in the legislature that say we have to have things in print for up to 72 hours before we can vote on them. How was I supposed to walk into a hearing room, accepting amendments that I hadn’t even had an opportunity to look at? 

Assemblymember Liz Ortega, a San Leandro Democrat, addresses reporters on newly unveiled legislation on taxing the rich, during a press conference at the state Capitol in Sacramento on Jan. 23, 2023. Photo by Rahul Lal, CalMatters
Assemblymember Liz Ortega, a San Leandro Democrat, addresses reporters on newly unveiled legislation on taxing the rich, during a press conference at the state Capitol in Sacramento on Jan. 23, 2023. Photo by Rahul Lal, CalMatters

I made it very clear to the health care insurance industry that I would not be bullied or cornered into accepting any amendments because I understand that they’re in the business of making profits – I’m in the business of saving lives. That’s what my bill does.

What was the result of the committee hearing?

It passed unanimously. It was bipartisan.

Republicans are always skeptical of cost increases, especially when it comes from the government. I think it was the Assembly floor analysis that laid out that there’d be about ($9.2 million) in extra annual costs for the state and private insurance to cover Narcan if this bill was to pass. What is your response to fiscal conservatives who are concerned about how to address cost increases, especially in a time when we’re dealing with budget deficits that may be here to stay in the years to come?

I did the math*, and ($9.2 million) – that’s about $17.4 million less than the $26 million that we’re spending on our health care system right now for all these overdoses and people going into the emergency room. So thinking about the deficit, as legislators … we have to make a choice: Do we cut costs or do we improve quality of life and save lives? My bill does both. We save resources and we save lives.

*(Using a 2017 CDC report on the economic impact of opioid overdoses and data from a state naloxone distribution program to determine the number of preventable deaths, Ortega’s office said fatal overdoses cost the California health care system $26.7 million annually.) 

Obviously fentanyl is an issue that both parties have tried to take on. Have you been surprised at all – from the responses you’ve gotten from colleagues across the aisle that they’re willing to do this?

I’ve been surprised at the amount of support that we’ve received and the amount of stories and people that would be impacted by this. Those who already have lost (loved ones) and it’s too late for them have come to me and been so appreciative about what I’m doing. It’s not too late for others, and that’s why I’m doing it. My husband had a coworker – he had no idea – she asked to speak to him real quick privately. She said, “Please tell your wife ‘thank you.’” Her son was on his way to college, was a good kid, thought he was smoking marijuana … she found him dead in the morning. 

Oh, wow.

She said he had enough fentanyl (in his system) to kill 10 people. She was extremely grateful for AB 1060 and what I’m doing to bring light to this. She said it might be too late for her but it’s not too late for other mothers.

For those who might be skeptical of your legislation – what would you say to them?

The opioid epidemic is a complex issue that will require confronting the root causes of addiction and equipping law enforcement agencies to take down some high-level drug dealers. I sit on (the Assembly) public safety (committee), so I also (encounter) war-on-drug (rhetoric) and (proposals) trying to increase sentencing. I’m focused on high-level dealers and holding them accountable. 

But I also want to make sure that we’re evidence-based, and we’re providing treatment and support services. And in the meantime, getting this life-saving medication to as many hands as possible, while saving money for our health care system.