Over 500 physicians, medical students and stakeholders gathered in Sacramento on April 18 to bring the voice of medicine to legislators for the 43rd annual California Medical Association (CMA) Legislative Advocacy Day.

Wearing white coats, physicians converged on the Capitol to educate legislators about critical health care issues, including the negative impact Governor Brown's proposed budget would have on health care in our state.

“It’s a day-in and day-out grind to make sure that health care rises to the top in the Capitol,” CMA CEO Dustin Corcoran told attendees before they headed out to meet with their legislators. “But when the legislators see you in your white coat [they] will remember your face and remember the stories you tell about how bills will impact you and your patients.”

And the physicians and medical students who took time out of their busy schedules to be there indeed felt that they made a difference.

"I was really impressed by how interested the legislators are in listening to what we have to say, and how much they respect our opinion as practicing physicians," said Jessica Deas, M.D., a pediatric resident at UC San Francisco's Children’s Hospital. "They’re interested in hearing our stories, and I really felt like in a single day, we had some impact, which is very cool."

California Attorney General Xavier Becerra spoke to attendees and reinforced how much weight the physician voice carries with lawmakers.

“You were a force in D.C. and you have always been a force in Sacramento,” said Becerra, encouraging California physicians to remain engaged as the health reform debate continues.

“We’ll move forward with health reform; it’s a work in progress,” he said, pointing out that California has served like a lab for the rest of the country, testing and improving the process of providing care to large numbers of people. “We’ll figure out how to make this better,” he said, calling the current proposals on health reform in the nation’s capital “frightening.”

Becerra, whose wife is an OB/GYN, said he sees firsthand the challenges faced by physicians.

“I know you work hard and spend plenty of time in the evening checking boxes," he said. “I understand what you do, and the closer we get to universal health care for all, the easier it will be for you to practice. I’ve got your back on this."

Attendees also heard from California Health and Human Services Secretary Diana Dooley, who got right to the point.

“I know we don’t pay enough," said Dooley. "I know what it means to be a Medicaid provider. There aren't enough resources. So we work together to stretch what we have as far as it will go. And in California, we’ve stretched it much further than anywhere in the country."

Dooley noted that the quest for universal coverage in California has been going on for close to 40 years.

"We’ve been searching for a way to find a level of cost that is manageable," she said. "We do have very good quality health care in this country. We provide care to a lot of people, but we provide it at a very high cost. We have to be looking at ways we can reduce that cost, or at least mitigate its growth."

The reason California has been as successful as it has in the implementation of the Affordable Care Act (ACA), according to Dooley, is because we haven't had the partisan rancor.

"I’m very proud of the work that we’ve done to make it work as well as it has," she said. "It’s a work in progress and there’s more we need to do but at the moment, I’m deeply committed to preserving the gains that we’ve made and doing everything we can to assure that we can move forward in California."

"What we’ve heard over the past six or seven years as we’ve worked to implement the law is what’s wrong with it," said Dooley.

One of the side effects of the challenge to the ACA has been the recognition of what we actually have done right, she said.

"What we’ve done in the past three or four months is coalesce around the actual language of the law and what it has done. And I think the political system has actually worked very well."

"There have been a lot of voices about what’s wrong with it, and those voices have been across the spectrum. From consumers who want more. From plans who want more flexibility. From physicians who want higher pay," said Dooley. "All of the challenges in the health care system have now been given a name: Obamacare. But many of those challenges existed precedent to the law. And, in fact, the law was trying to address some of them."

Dooley believes that California can lead the way as we continue to work to address the challenges of our market-driven health care system.

"It's a patchwork of add-ons that has very much encumbered our ability to function in an efficient way," she said. "The first order of business for me is to illustrate in every way that I know the gains that we’ve made, the success that we’ve had and the willingness to reach across lines—whether they're partisan or professional—and find solutions to the real problems that get beyond the rhetoric of the left and the right."