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Steinberg Leaves Health Care Legacy After 14 Years in California Legislature

It only seems like Darrell Steinberg (D) has been in the California Legislature forever. Really, forever has just been 14 years.

For health care advocates, Steinberg’s presence has cast the longest shadow in the 21st century, helping advance health causes on multiple fronts — including autism care, mental health services, foster care and homeless services.

Steinberg was elected to the Assembly in 1998, the Senate in 2006 and became Senate President Pro Tempore in 2008. In that 16-year span, he took a two-year break from the Legislature, from 2004 to 2006. He built a reputation as a deal-maker, a horse trader, a broker of political compromises.

Along the way, he helped shape and muscle into existence some of the cornerstone mental health laws in the state. In 2004, Steinberg wrote and backed the voter-approved California Mental Health Services Act, passed in 2004 as Proposition 63.

That law alone has raised $13.2 billion for mental health services in the past decade, and it is due to deliver an estimated $1.58 billion in fiscal year 2014-2015. 

In 2000, he ushered in AB 2034, an expansion of an earlier pilot program he championed that integrated services to the homeless, cutting down on incarceration and hospitalization. He authored a bill in 2011 (SB 946) that required private health plans to cover autism therapy.

Steinberg has said his aggressive pursuit of mental illness issues stemmed from his time on the Sacramento City Council, just before he decided to run for Assembly. In 1997, the City Council voted 6-2 to sue Loaves and Fishes, a private charity providing food to the homeless, for becoming a nuisance to businesses around it. Steinberg was one of those “no” votes, along with then-mayor Joe Serna (D). Steve Cohn (D), a longtime City Council member now running for Assembly, was one of the people pushing the lawsuit. Steinberg said it became clear to him then that many of the homeless had mental illnesses, and that contributed to the local ruckus that prompted the lawsuit. Since then, Steinberg has made mental illness one of the legacy issues of his time in the Legislature.

Steinberg’s daughter recently revealed she has been diagnosed with bipolar disorder and said she would like to follow her father’s lead and be an advocate for mental health issues.

Steinberg has been termed out of office and has not commented on what his next career step might be. The possibilities mentioned include everything from running for mayor of Sacramento to being appointed a state Supreme Court justice, given his law background.  He also has indicated that he plans to create a foundation focused on mental health policy issues.

We sat down with Steinberg this week to review his years in office, and get his sense of the health issues on the legislative horizon, who might carry on his fights and what health care challenges he foresees in the years ahead. 

And, of course, to ask about what deals he might still make, considering he’s officially in office for another month or so.  

California Healthline: Let’s start with the issue most associated with you. Why are mental health issues so important to you? Why has that mattered so much to you?

Steinberg: It matters for many reasons. Tens of thousands of people suffer unnecessarily, because as much as we have done we still have so much more to do. It’s important because mental health and mental illness is inextricably tied to most everything else we care about and spend public money on — whether it’s criminal justice, homelessness, child welfare, kids falling behind in school, family dysfunction — and, in large part because of the continuing stigma, it’s an issue that affects every community, knows no artificial boundaries. And everybody knows somebody. It does not get the attention or resources that it deserves and needs.

I feel very strongly that the next great advance in society ought to be understanding the brain. How it functions, why people suffer from these illnesses and more importantly, what we can do to help people lead good lives.

The flip side of disability is ability. People can live good lives, even with these biochemical illnesses — if we do better.

California Healthline: When you look back over your 14 years in the Legislature at the accomplishments high on the pride list, the big one has to be the Mental Health Services Act.

Steinberg: It is, because of its magnitude. It’s projected to generate $1.7 billion a year. Even though I wished those in charge of implementing had completed a comprehensive outcome-based evaluation. But thousands of people have benefited from it.

California Healthline: So this is the biggest one…

Steinberg: But it’s not the only one. In this field, I realized what you need to do is build and layer, build and layer. It isn’t done. What we did in 2013 when the state budget finally turned around was significant — maybe not as significant in terms of magnitude as the Mental Health Services Act, but it begins to answer the question: How do you help people access these services when they have hit rock bottom?

What we did in 2013 is establish funding for 2,000 crisis beds, if you figure they turn over about three times a month, that’s 6,000 beds a month. We put together money for 600 triage workers, to help people navigate [the system] … and 25 mobile outreach teams. Really, what we really focused on there was the infrastructure. 

California Healthline: I want to get to the build-and-layer idea, but you brought up Loaves and Fishes, too. I assume you know Steve Cohn is running for Assembly.

Steinberg: Yes.

California Healthline: And you have a little history with him. Going back, you want to tell me the Loaves and Fishes story?

Steinberg: Well, sure. Steve’s my friend, we’ve traveled together, we’re members of the same synagogue, and I have respect for him, I mean real respect for him. I’m endorsing his opponent in the Assembly race, but I still have respect for Steve.

Back then we were on the other side, and I suppose that was the formative battle for me, that motivated me to take on this issue.

I’ve told the story many times. The folks in the downtown area and the businesses, it was not completely an illegitimate issue in terms of the over-concentration of people needing help in one part of town. But I disagreed with the way the city and the city council majority went about trying to address it. They sued Loaves and Fishes. It was a “Man Bites Dog” story.

The lawsuit settled relatively quickly. But for me, that was around the time I began my campaign for state Assembly, and it was very clear to me that the underlying cause of the problem was untreated mental illness.

I combined that with the advice I got from Phil Isenberg (D) (who was a former mayor of Sacramento and served in the state Assembly for 14 years before the term-limits law passed in 1990). He said to me, “If you’re going to succeed in the term-limited Legislature, you need to focus on a couple of things that really matter, that few others are really working on. Make it your passion and drive it.” So I decided I was going to make this issue a priority.

California Healthline:  Most people get involved in a particular health issue because someone they’re close to has that health issue. It’s interesting that wasn’t the case with you.

Steinberg: Yes, my daughter’s story is something that happened recently.

California Healthline: That’s a little different. It does reinforce your point that everyone knows someone.

Steinberg: Yes, that all came out after [my work in the Legislature].

The homeless may be the most visible manifestation of untreated mental illness, but this is about every family. Every community. And people we know.

California Healthline: This idea of build and layer, build and layer. Of all the bills you’ve authored, some of them obviously are naming freeways after people, but of the health care ones, if you had to pick a top three, can you name three bills that made the biggest difference?

Steinberg: For me, it’s definitely the Mental Health Services Act, when you add the investment from 2013, you add the recidivism reduction fund … in 2013, as well, and we’re getting close to $2 billion of investment next year in the public mental health system. To me, that represents untold numbers of lives that are saved or bettered.

So that’s one. Two is autism, SB 946. That now is expanded to Medi-Cal, now thousands of kids are going to get the early help they need to have better lives. That has been transforming.

Third is restoring the Denti-Cal program for 800,000 low-income Californians. That was a horrible cut we made in 2009.

And AB 34 and AB 2034 (the homeless services bills, first as a pilot project and then expanded), those are right there at the top.

Let me just say, the 2013 package, the recidivism reduction fund, autism and ABA (applied behavior analysis) therapy for kids across the board, the restoration of Denti-Cal, and I wasn’t the only one, but I played a key role in negotiating the Affordable Care Act, making sure it was implemented in California in a way that was right and fair.

California Healthline: That’s a pretty impressive list.

Steinberg: Well, thank you.

California Healthline: So that’s 14 years of work. Now, looking ahead, at life in the Legislature without you, when you look at the governor’s veto and signing messages, there’s a theme — he says he’s weary of the cost of additional Medi-Cal benefits. What might that mean to California in the next few years?

Steinberg: California can be very proud of what it’s done with health care reform and the Affordable Care Act. I do believe there is a next evolution of change, and that is to fully integrate care — physical health care, mental health and behavioral health, substance abuse, to focus on chronic conditions, to make prevention and early intervention the priority.

So that the person being cared for is seen as a whole person and treated as a whole person, that’s the next evolution and that by definition will bring down costs.

California Healthline: But to do all of that, the cost may come down in the long run, but just to make changes in the first place — or to get more people on Medi-Cal so fewer people show up in hospital emergency departments — that takes money up front. That’s what seems to be at issue. 

Steinberg: The governor is always going to emphasize, appropriately by the way, the cost issues. But in the end, look at the result. He signed ACA implementation [and Medi-Cal expansion] in California. He most often comes down on the side that represents progress here. Yeah, it may be push and pull. But I think he’s going to be receptive to the idea of improving the effectiveness of these private and public systems that are too often balkanized and separate.

California Healthline: Getting to your replacement [as Senate pro Tem], Kevin de León (D-Los Angeles) seems to have a different agenda from yours. When he’s asked about health care issues, he’ll talk about coverage for the undocumented. He seems to shy away from provider rate increases in Medi-Cal, for instance. Where do you see him in terms of health care?

Steinberg: He’s a formidable advocate. I do believe any leader has to state their point of emphasis. If Sen. de Leon’s point of emphasis is expanding coverage to undocumented immigrants, I’m confident he will get that done and have a great legacy as a result.

The thing about this job, it’s a bit of a fire hose.

You can pick your points of emphasis. But inevitably many of the decisions will land in your office, so he’ll be dealing with every part of health care. If you don’t have a point of emphasis, or some priorities you state clearly, you’ll find yourself just trying to avoid the fire hose.

California Healthline: It was interesting to hear [Assembly Speaker] Toni Atkins (D-San Diego) and de Leon on the stage recently. They’re trying to agree on everything, but Atkins did not come down on the undocumented side, and de Leon did not come down on the provider rate increase side.

Steinberg: Maybe you see the makings of a partnership.

California Healthline: It’s the beginning of a beautiful relationship.

Steinberg: It’s often better, whether it’s intentional or not, for the two leaders in the two Houses to have different but complementary priorities.

California Healthline: You’re such a positive person.

Steinberg: Yeah, you got more to negotiate for!

California Healthline: Who is going to take up the mental health and autism issues in your absence?  How can you ensure the work you did continues?

Steinberg: I may be leaving Legislature, but I’m not leaving the community or the state or my commitment to these issues, so I’m going to stay involved myself. That’s number one.

And two, one of the things I was very excited about this year is to see someone like Jim Beall (D-San Jose) picking up the mantle. When he put together the mental health conference, it was always packed. There were always a lot of members … There’s a lot of interest out there, and it doesn’t have to be one person.

California Healthline: You say you’re staying. But no one knows what you’re going to be doing. People have said you’re going to become a Supreme Court judge.

Steinberg: No, that isn’t happening.

California Healthline: You’re going to become mayor of Sacramento.

Steinberg: Well, maybe.

California Healthline: So go ahead, what’s next?

Steinberg: I’m not ready to make any announcements yet, but I’m going to step out for a while. I’m going to affiliate with a law firm, maybe get involved with an institute around mental health advocacy, and I’m going to do a combination of things.

Will that be for a while or will that be for longer, I don’t know. I hope that I’m not done with my public service. But it would have to be the right thing.

I don’t know exactly what the future holds. I know, after 20 years, I feel good about what I’ve been able to work on, and some of the accomplishments. It’s OK to step out, and look at it all from a different vantage point for a while.

It’s not like I don’t have plans. I’m going to join a law firm and try to start my institute or foundation work, I’m not retiring I’m just changing my role. I’ve been termed out of office, it’s not as if I have a choice. I am going to miss it terribly. How could I not?

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