by Levi Sumagaysay

Spend any time thinking or talking about insurance in California these days and you’re bound to hear the word “mitigation.”

Fire officials, lawmakers, insurance agents and others are asking homeowners  to help lower the risk of devastating wildfires by making improvements to their properties — in some cases at great expense — and often in the context of trying to hang on to their insurance policies. The state has spent about $3.7 billion on forest management in the past seven years. Communities, fire districts and others are doing their part, too.

But some insurance companies citing growing risks and costs have paused or stopped writing new policies in California, causing a crisis of home-insurance affordability and availability. Some homeowners have seen their premiums spike or are being priced out, while others have been forced to turn to the ever-growing FAIR Plan, the insurer of last resort that offers less coverage but higher insurance premiums anyway.

As Insurance Commissioner Ricardo Lara rolls out his plan to try to reverse that trend, three state lawmakers are pushing for mitigation to be taken into account when insurers set premiums or when they decide whether to offer policies at all. Or they want mitigation to be more effectively tracked and strategized.

“We believe that if you do the homework, you should get the credit,” said state Sen. Josh Becker, the Democrat representing Menlo Park. “As a state, we’re doing that homework.”

Becker’s staff cites the billions of dollars the state has spent on reducing fuel and managing vegetation since 2017, when wildfires consumed many parts of California. The sum doesn’t include other spending on fire engines, air tankers and increasing staff for Cal Fire, which has added about 4,500 positions in the past decade.

A bill authored by Becker seeks to incorporate mitigation into insurance companies’ underwriting decisions — when they consider whether to write or renew policies. Senate Bill 1060 awaits a hearing in the Senate Appropriations Committee.

One of the regulations Lara has unveiled as part of his plan to try to fix the state’s insurance market involves allowing insurers to use catastrophe models in rate-making, which includes taking mitigation into account. But some say that’s not enough to address the availability of insurance.

Former state Insurance Commissioner Dave Jones recently told CalMatters that Becker’s bill is needed specifically for underwriting because the insurance commissioner’s authority is limited to rate-making.

“Local, state and federal governments are spending billions of dollars in forest treatments, so homeowners ought to see a benefit,” Jones said. “That’s not happening now, but should happen.”

Wildfire mitigation and risk

Studies show that mitigation is reducing wildfire risks. A recent study by the National Association of Insurance Commissioners found that structural modifications can reduce wildfire risk by 40%, and, when combined with vegetation modifications, can reduce risk by 75%. A subsequent Moody’s study found that utility Southern California Edison’s actions to harden its power grid reduced the risk of catastrophic wildfire losses by 75% to 80%.

But insurance-industry experts have concerns about Becker’s bill. For one thing, they say incorporating mitigation into underwriting shifts more financial risk to insurers.

In addition, they say they already use models that account for mitigation.

Sheri Lee Scott, an actuary for a Milliman Property & Casualty practice in Orange County, said the bill is yet another regulation that could “exacerbate” the insurance crisis.

“Insurance companies are trying their best to incorporate (mitigation) already,” Scott said, pointing to a recent state regulation directing insurers to incorporate mitigation into determining premiums — which Scott wrote in a report “presents tremendous challenges for insurers in terms of compliance and the potential erosion of adequate rates for wildfire risk.”

The insurance commissioner said his office started enforcing that rule on considering mitigation last year, but homeowners, insurance agents, fire chiefs and other lawmakers say the different ways everyone is trying to reduce wildfire risk isn’t making enough of a dent in the state’s insurance crisis.

Bernard Molloy, fire chief of Murrieta, said during a public workshop hosted by the Insurance Department last week that “residents don’t receive credit” for the “tremendous amount of work” they put into trying to reduce wildfire risk. Jorge Escobar, a Bay Area resident, said during the same workshop that he had just asked the Moraga fire district whether insurance companies are taking mitigation into account. “The answer was, surprisingly, no… Why isn’t this being mandated?” he asked.

Tina Purwin, an insurance agent in Northridge, told CalMatters her clients get notices that they’re not being renewed despite taking action to avoid wildfire risk.

“Carriers are being ultra picky,” Purwin said. “They’re looking for any way to not take the risks.”

At another public hearing on insurance issues last week — by the Little Hoover Commission, the independent state oversight agency — Nevada County Supervisor Heidi Hall said the Sierra Nevada-area residents she represents are spending “tens of thousands of dollars” on hardening their homes, and that the “county itself has put in millions of dollars, with the help of Cal Fire, to put in fire breaks.”

Yet, she said “we’re not seeing discounts from insurance companies. They’re still leaving.”

Assemblymember Freddie Rodriguez, a Democrat representing Chino, authored another bill related to mitigation. Assembly Bill 2983 calls for the Insurance Department and the California Office of Emergency Services to work together on figuring out whether investments in mitigation are helping insurance availability.

Project assessments would have to be published on state websites. And a representative of the Insurance Department would be added to the board of the California Wildfire Mitigation Program.

“Some people think (mitigation is already taken into account), some don’t,” Rodriguez said. “We need to bring everyone together. We need to talk about it.”

Rodriguez’s staff said both the Insurance Department and the mitigation program appear to be open to the board-representative idea. The Insurance Department did not answer questions and the emergency services agency did not respond to questions in time for publication.

Earlier this month, the Assembly Insurance Committee approved AB 2983 and re-referred it to the Assembly Appropriations Committee.

‘They should not be losing their insurance’

Another bill would require the Insurance Department to evaluate every three years whether to update its Safer from Wildfires regulation, which identifies steps property owners and officials can take to protect their homes and communities. The steps include installing fire-rated roofs, upgrading windows, removing combustible sheds and more. The department adopted the regulation in 2022 and says on its website that taking these measures “can help you save money on your insurance.”

Assemblymember Damon Connolly, a Democrat representing San Rafael, authored AB 2416,  which he said would “lock in periodic updates to the program so it’s most effectively serving consumers.”

Connolly said his staff is in talks with the Insurance Department, which he said is open to discussing his bill. He also said he has made amendments to address insurance-industry concerns. The Insurance Department did not answer questions about the bill.

The assemblymember also said that not only should property owners get discounts when they take the steps outlined in the regulation, “I would say if consumers are doing these steps, they should not be losing their insurance.”

The Assembly Insurance Committee has referred his bill to the Assembly Appropriations Committee.

Lawmakers representing California in Congress are trying to make mitigation measures matter, too. U.S. Rep. Mike Thompson, the Democrat who represents Napa and other counties, said during a press conference last week in Santa Rosa that his bill, HR 7849, would establish a program for individual homeowners in certain areas to receive grants of up to $10,000, as well as tax credits for homeowners and businesses, for mitigation.

The legislation, co-authored by U.S. Rep. Doug LaMalfa, the Republican who represents rural Northern California, was introduced in March and referred to the House Ways and Means Committee and the Transportation and Infrastructure Committee.

Thompson said that as he and his colleagues tried to figure out how they could help on a national level, “what we heard repeatedly from insurance companies was: Make sure there’s disaster resilience in building, that homeowners (are doing) everything necessary to protect their homes.”

Promotoras have emerged as an essential piece in California’s ambitious plan to deliver healthcare to all residents regardless of immigration status

by Peter Schurmann

Ethnic Media Services

HAMILTON CITY, Calif. – It’s late February and the road to Hamilton City, an agricultural community about 10 miles west of Chico, is lined with blooming almond trees, their pink blossoms blanketing the fields for miles around. A single clinic stands in the center of town.

Inside the clinic we meet Maria Soto, whose work as a promotora is an essential piece in California’s ambitious plan to deliver healthcare to all residents regardless of immigration status.

“I identify very much with the community,” says Soto, 57. “I worked in the fields, harvesting and sorting nuts here. So, I love it. It gives me a lot of satisfaction when someone says, ‘Thank you for helping me.’ This for me is invaluable.”

Soto is one of four promotoras (individuals who provide basic health education to the community) with the non-profit healthcare provider Ampla Health, which operates more than a dozen clinics across six counties – Glenn, Butte, Colusa, Sutter, Tehama and Yuba – in California’s rural north.  As a Federally Qualified Health Center, Ampla Health is tasked with expanding access to Medi-Cal (California’s version of Medicaid) across the entirety of its jurisdiction.

That job took on added importance as of January 1, when undocumented immigrants ages 26-49 became eligible for the program. Earlier expansions targeted both older adults and children. This latest phase makes California one of the first states in the country to offer healthcare to all eligible residents.

With nearly 16 million enrolled – or one out of every three Californians – Medi-Cal is the nation’s largest Medicaid provider. With the current expansion the state expects to add an additional 500,000 to 700,000 to its list, at a cost of some $2.6 billion per year. Medi-Cal’s total annual operating budget tops $37 billion.

Eligibility is based on income, with the upper limit for an individual set at $21,680 per year, with approximately another $7,100 for every additional member of the household. Medi-Cal covers medical, dental and vision services.

The challenge now is making sure those communities who stand to benefit are informed about the opportunities available, which in California’s far north is easier said than done.

Accessing healthcare ‘without fear’ 

We’re standing in an open field of almond trees, on a farm about 30 minutes outside Hamilton City. Around us a group of about a dozen farmworkers is gathered, all originally from the same community in the state of Puebla, Mexico.

“She came and interrupted our work once,” jokes Elfego Palestino Vidal gesturing towards Soto. “I never enrolled before,” he says, adding that in recent years he’s seen more of his coworkers fall ill because of the increasingly extreme weather. “Sometimes it gets very cold, it rains a lot, then it gets very hot.” Having access to Medi-Cal will “help a lot,” he says.

Famed for its sprawling forests, towering peaks and rugged coastline, the North State, as it’s known – stretching from the Oregon border in the north to just above Sacramento farther south – is beset by some of the state’s most glaring health disparities, from higher rates of poverty and premature death to substance abuse, and behavioral and mental health challenges.

Much of the region is also designated as a Health Provider Shortage Area (HPSA), meaning fewer healthcare resources per capita. For marginalized communities, including many of the farmworkers interviewed for this story, that creates additional barriers to accessing care.

Another farmworker, Leonardo Hernandez Mesa, a husband and father of two, describes how he put off visiting the doctor in the past when he fell ill. He points to his throat and ear as he recalls a recent bout of infections. “Emergency visits are too expensive,” he says, noting that his brother – also a farmworker – has Type 1 Diabetes.

“This is a great opportunity to get health insurance without fear,” says Hernandez, adding that it will allow people to detect health issues earlier rather than later. He says he’s often heard others talk about putting off hospital visits.

A study from UC Merced last year found that nearly half of all farmworkers in California lacked health insurance at some point over the previous 12 months. The study also found that just 43% of farmworkers had visited a doctor’s office while only 35 percent had been to a dentist. Other studies have found a stark disparity in access to mental health and other behavioral services for farmworkers in particular.

Simon Vazquez, who has worked at the same farm in Hamilton City for over two decades and is the foreman here, hasn’t seen a doctor since 2018. He peppers Soto with questions about where and how to contact her, whether he needs to renew every year (you do), and what he needs to bring for a medical or dental visit (a photo ID and Medi-Cal card).

“We’re here to help you with whatever questions you have. You have my information, you have my phone number,” she says patiently.

Reaching the ‘hardly reached’

“A big part of my day is driving around looking for farmworkers,” explains Soto, who came to the US as an undocumented immigrant herself in 1991 and spent time working in the almond fields surrounding Hamilton City. In 2007, she began working with Ampla Health, then known as Del Norte Clinics, after a chance meeting with the organization’s promotora coordinator at a local Mexican eatery.

“She asked me what I knew about being a promotora. I told her I didn’t know anything.” Soto eventually applied, was given training, and has been committed to promotora work ever since. “I’ve fallen more in love with the work as the years have passed,” she says.

The promotora model was first developed in the northern Mexican city of Ciudad Juarez in the early 1970s as a way for the city government to deliver healthcare and related information to marginalized communities. The model soon spread across Latin America, later making its way into the US.

It’s unclear how many promotoras are currently working across California. Some, like Soto, are employed directly by healthcare providers or community organizations. Others work in more informal capacities. The advocacy group Visión y Compromiso, which launched the state’s first network of promotoras in 2001, claims some 4,000 members across 13 regions of California, almost all of them in the southern and central parts of the state where population numbers are larger and overall demand for services greater.

According to data from UC Davis’s Center for Reducing Health Disparities, there are an estimated 10,000 farmworkers across the six counties served by Ampla Health. If their family members are included, that number jumps to nearly 30,000 individuals. While it’s unclear how many are undocumented, data shows that nearly three quarters of the more than half a million farmworkers in California lack documentation.

Dr. Sergio Aguilar-Gaxiola, who heads the Center for Reducing Health Disparities, calls these communities “hardly reached,” and says local and state agencies have to be proactive in terms of getting the word out. “I’m not sure if they will take advantage of this,” he said during a recent Ethnic Media Services briefing. “It depends on how you communicate.”

A ‘tremendous need’

Aguilar-Gaxiola, who has spent decades researching health inequities impacting California’s farmworker population, points to a range of barriers – from language and culture to fear of deportation – that prevent many from coming forward to access available resources.

“This is a tremendous need,” says Aguilar-Gaxiola. “Meeting it requires more than goodwill and wanting to do the right thing. In order to reach these populations, building trust is front and center.”

During the Trump administration a law known as the Public Charge Rule, which threatened deportation for migrants accessing public benefits, cast a shadow of fear over the community. While essentials like healthcare and food are not considered part of a public charge determination, many immigrants continue to be fearful of enrolling in public programs like Medi-Cal.