Dr. Richard Pan, a pediatrician and former state senator known for authoring some of California’s toughest childhood vaccination laws, is challenging Rep. Kevin Kiley, a two-term Republican-turned-independent, for the newly reconfigured 6th Congressional District, which now stretches across parts of Yolo, Sacramento and Placer counties. Their contest is emerging as one of the more closely watched matchups in the state, with control of a narrowly split House potentially hanging in the balance.

The two men could hardly be more different on healthcare policy. Pan has spent much of his career pushing for expanded vaccination requirements and broader coverage, including his vote to extend Medi-Cal to immigrants without legal status. Kiley, a Placer County native who ran unsuccessfully in the 2021 recall effort against Gov. Gavin Newsom, has built his political identity in part on opposition to pandemic-era mandates and government-run healthcare expansions.

The debate arrives as affordability concerns are surging among California voters. Health insurance premiums are set to climb more than 10% in many parts of the state next year, and the ranks of the uninsured are expected to grow as well. A recent survey from the Public Policy Institute of California found that seven in ten residents are unhappy with the cost of healthcare, while two-thirds of likely voters believe the federal government should ensure all Americans have access to care.

“We often talk about gas prices and grocery prices, but Californians right now are just as worried about the cost of healthcare,” said Mark Baldassare, the survey director at PPIC.

Much of that anxiety traces back to the sweeping federal law passed under President Donald Trump last year, which enacted the largest changes to Medicaid since the Affordable Care Act took effect. Only about a quarter of California adults approved of the measure in an earlier PPIC poll. The law is projected to cut federal Medicaid spending by nearly $1 trillion over the next decade, largely through new work requirements and shorter eligibility windows — changes expected to push millions of people off the rolls nationally and cost California billions of dollars a year.

“There’s a lot of this that ends up becoming part of the Trump agenda, and it’s hard to untangle,” said Sacramento-based Democratic strategist Andrew Acosta, noting that many House races this cycle are essentially referendums on policies enacted during the first two years of Trump’s second term.

Community health advocates say the stakes are high. Anna Marshall, deputy director of federal policy for the California Primary Care Association, said Medicaid expansion under the Affordable Care Act transformed rural and underserved communities by allowing clinics to grow and add services like behavioral health. California now has more than double the number of community clinics it had before the ACA took effect. Her organization opposed the recent federal law but has not weighed in on the Pan-Kiley race.

State officials estimate roughly 2.2 million Californians will lose health coverage in the coming years — most falling off Medi-Cal, with hundreds of thousands more priced out of the Covered California exchange as premiums rise.

Given California’s new congressional map, which gives registered Democrats a nine-point registration advantage in the district, some might assume the race is a foregone conclusion. But Acosta said he still views it as competitive, given both candidates’ long track records in public life.

“Candidates have to defend their record, and these are two candidates with a lengthy record,” he said.

Pan has become something of a lightning rod over the years for his advocacy on vaccines. He authored California’s stringent school vaccination requirements following a 2010 whooping cough outbreak that killed nine infants and a 2014 measles outbreak — traced to Disneyland — that spread across several states and into Canada and Mexico. His stance has drawn intense backlash from anti-vaccine activists, including one incident in which he was physically shoved on a downtown Sacramento street and another in which protesters threw menstrual blood onto lawmakers from the Capitol gallery.

Kiley, by contrast, has staked out a reputation as a fierce critic of pandemic-era restrictions, arguing that California’s COVID-19 vaccine mandates and prolonged school closures damaged public trust in vaccines and inadvertently drove down childhood immunization rates by keeping kids away from in-person medical visits tied to school enrollment.

Matt Fleming, a conservative columnist and district resident who once served as a legislative staffer alongside Kiley in the Assembly, said he expects a genuinely competitive race, pointing to Kiley’s strong name recognition and independent streak.

“I don’t really see Richard Pan as someone who is going to blaze a trail and be an independent voice, even as a Democrat,” Fleming said. “Kevin Kiley is not a rubber stamp for Trump or Mike Johnson.”

In fact, Kiley told the news outlet Semafor this week that he intends to stop caucusing with Republicans altogether if reelected — a move that would require House rules changes to preserve committee assignments for lawmakers who caucus with neither party.

On the substance of federal health policy, Kiley — who voted for the Trump-backed law — disputes the characterization that Medicaid was cut, arguing that overall spending continues to rise due to increasing healthcare costs even as enrollment drops. Critics, including Pan, argue that pushing people off the program functionally amounts to a cut regardless of overall spending totals.

Kiley does say Congress erred in allowing enhanced ACA subsidies to expire, which contributed to sharp premium increases this year — California’s typical Covered California plan now runs about $570 a month, with statewide rates rising another 9.9% on average in 2027. He co-authored a bipartisan bill with Democratic Rep. Sam Liccardo of San Jose seeking a two-year extension of the subsidies, though the effort stalled in Congress. He faults leadership in both parties for the impasse.

“It’s a very clear case study in how the brokenness of Congress is directly costing Americans in many ways,” Kiley said.

On that point, the two candidates find rare agreement — both support restoring the subsidies, with Pan arguing that California’s middle class is especially exposed to rising costs since many residents earn too much to qualify for assistance but still feel squeezed by higher premiums.

Where they diverge is on who bears responsibility. Pan, who serves on the state’s healthcare affordability oversight board, points to federal policy shifts under Trump as the primary driver of rising costs. Kiley instead blames state lawmakers in Sacramento, singling out a newly passed tax on health insurers — meant to help offset federal Medicaid cuts — that is projected to add roughly $100 a year to premiums per person. Kiley and fellow Republicans have asked federal regulators to block the tax from taking effect.

Pan counters that without the new revenue, “costs will start to show up in premiums anyway,” arguing that hospitals and clinics will pass along the expense of treating a growing uninsured population to commercial insurers. Economists are divided on how much of that cost actually gets shifted, though some estimates put the added burden at around $100 per person annually — with most agreeing hospitals absorb the majority of unpaid care costs.

Pan also defended his vote to extend Medi-Cal eligibility to immigrants without legal status, acknowledging the state has struggled with the program’s price tag — now exceeding $10 billion a year — but arguing government assistance shouldn’t be denied to those who qualify because of budget concerns.

“We have to ultimately recognize that we’re trying to respond to what the Trump administration, the Republican Congress, including Kevin Kiley, voted for,” Pan said.

Locally, Democrats say last year’s redistricting — which split Placer County into three Democratic-leaning districts — has energized the party in a region long dominated by Republicans.

“Now we have three winnable Democratic seats,” said Julann Brown, chair of the Placer County Democratic Party. “We’ve become relevant in a way that we didn’t expect.”

Brown said her party has endorsed Pan and is focused on defeating Kiley, whom she describes as a reliable vote for the Trump-aligned wing of the GOP despite his shift away from the Republican Party label. The Placer County Republican Party, which has endorsed Kiley, did not respond to requests for comment.

Brown said healthcare resonates strongly with rural voters in the district, many of whom already travel long distances for basic medical care and fear further service cuts if clinics and hospitals lose funding. She recalled her own family’s experience during the 2008 recession, when her husband lost his job and, with it, their health coverage — two years before the Affordable Care Act expanded options for families like hers. At the time, their children qualified for a special assistance program while she and her husband went without insurance.

“My family had a choice between making our house payment and having health coverage,” Brown said. “That’s where we’re headed again.”

Original source: CalMatters

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