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SACRAMENTO, Calif. — When his 20-month-old daughter developed a rash earlier this month, Anthony Rendon did what many other parents do when their child is sick: The speaker of the California Assembly took Vienna to her pediatrician — but he did so via video from the comfort and safety of his home.

Many Californians have relied on telehealth to connect with their health care providers during the covid-19 pandemic, but the option isn’t available to everyone. That imbalance is just one of the “frailties” in America’s health system that Rendon says lawmakers must address.

“So many folks, when they lose their job, they're in trouble,” he said.

A Democrat from Los Angeles County and grandson of Mexican immigrants, Rendon led a nonprofit organization dedicated to early childhood education before his election to the Assembly in 2012. Although he hasn’t authored any sweeping bills on health care, as leader of the Assembly since 2016 he has influenced which measures get a vote — and which don’t.

For instance, though he says he’s a , he angered many progressives four years ago when he blocked a bill that would have provided government-funded health care to all Californians. Rendon described the measure, approved by the state Senate, as “woefully incomplete.” While that decision drew the ire of the powerful California Nurses Association union — its leader an illustration of California’s iconic grizzly bear logo with — some Capitol insiders say Rendon made the strategic decision to take the hit for his members on a politically charged issue that didn’t have the votes to pass.

“It’s never leadership acting alone,” said David Panush, a health care policy consultant who worked in state government for 35 years. “They do it on behalf of their caucuses.”

Rendon won his post as California’s 70th Assembly speaker in part by pledging to allow his colleagues to set their own agendas in their policy committees. Under his leadership, the legislature has approved measures to expand Medicaid coverage to undocumented immigrants ages 19 to 26, protect patients from some surprise medical bills, ban the sale of flavored tobacco products, and require drug companies to report and explain drug price increases. But lawmakers rejected bills that would have taxed sugary drinks and given the state attorney general more authority over hospital consolidations.

After missing nine weeks of work last year when covid shuttered the Capitol, lawmakers returned to plastic barriers on their desks, mask requirements and other safety measures.

In December, Rendon’s colleagues elected him to a third term as speaker. He talked with KHN’s Samantha Young about his leadership role during the pandemic and his legislative priorities for the rest of this year.

Q: What did you learn leading this legislative body through a pandemic as a lawmaker, a husband and a dad?

First of all, we're all very fragile and we're all very resilient. It doesn’t take much for our various systems to be upset and to change course. At the same time, we adjust, whether it's as a society, as a state, as an institution. In the Assembly, for example, we’ve almost learned how to do our business in a completely different manner, in the same way that Californians up and down the state have learned to navigate their lives in a different way.

Q: How have you juggled home and work life?

On the one hand, weekends are great. A lot of district events don’t happen, my wife can work on her dissertation full time, and I get to take care of the baby from sunup until around dinnertime. Having worked in early childhood education for 20 years, I realize how important the first couple years are. I’ve spent way more time with her than I thought I would. At the same time, there’s been challenges finding safe child care.

Q: What weaknesses did the pandemic expose in the health care system, and what can the legislature do about it?

Telehealth is great and can be very helpful but has its limitations. The pandemic really exposed the need for effective broadband throughout the state and broadband equity as well. We used to regard lack of broadband access as a rural issue.

Once we sent schoolkids home, we realized there were more pervasive broadband problems. So, there’s absolutely a need to do something big around broadband this year, and that’s because of education and also because of health care.

Q: You say you’re a single-payer advocate, but under your leadership, California’s coverage gains have been piecemeal. Why not just go for it and pass single-payer for everyone?

Mostly because of the challenges. First of all, we would need a federal waiver. The Biden administration has already hinted that they won't do so. The president has said time and time again that he wants Obamacare to be expanded.

And there's the huge price tag. There are very, very serious constitutional problems relating to the development and implementation of single-payer.

Q: So, who should get coverage next?

Senior undocumented immigrants are the next big group left. It's a population that obviously has tremendous challenges with respect to access and language. They tend to have a lot of preexisting conditions, a lot of other health challenges as well. So, it's important that we make sure that we cover those folks.

Q: Is there anything you would have done differently, looking back on the past year?

I wish we could have come up with some of the ideas for social distancing and bringing the legislature back more quickly. I think there was a sense early on in March and April [of last year] that the pandemic would run its course more quickly than it did. I remember people saying, “We'll be back in two weeks, we'll be back by midsummer, the pandemic will be gone.” So, in terms of developing a lot of those plans, they came to us a little later than I wish they had.

Q: How do you think vaccine distribution is going now that supply is exceeding demand?

I received a phone call from a neighboring district, the president of a community college, who called me up saying, “We have all these vaccines and people have stopped showing up.”

We've reached this sort of plateau that's disappointing. We haven't reached this plateau because 90% of people have been vaccinated. It links directly to public health, education and information campaigns. We have to talk about the safety of the vaccine and have validators also talk about the need to get to herd immunity.

Q: Along those lines, local public health departments feel that they have been underfunded for years and that they haven't had the money to do the job in this pandemic. Do you support for additional state funding?

We need to make sure that they're adequately funded. There was a problem with respect to the pandemic. We honestly weren't ready for it. As far as these health efforts are concerned, they have to happen at the local level.

The conversation has to go hand in hand with accountability measures and accountability metrics. We're not going to give folks a blank check. We know that there are vast differences in practices that a lot of the public health agencies throughout the state want to pursue, and we want to make sure that best practices are really implemented.

Q: How do you negotiate with influential industries, such as hospitals, pharmaceutical companies and big labor, to get meaningful legislation passed that goes against their interests?

When people boil it down to a simple question of who gives the most money, that's overly simplistic. Look at the incredible amount of work we've done here in California with respect to oil. The enviros do not give as much money to politicians as the oil companies do.

But with respect to having these conversations, we take all of their input, and then the decisions, for me, are informed by what's best for the state.

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