health State Senator will leave office as champion of tough vaccine laws

By Angela Hart

SACRAMENTO >> A California lawmaker who rose to national prominence by muscling through some of the country’s strongest vaccination laws is leaving the state legislature later this year after a momentous tenure that made him a top target of the boisterous and burgeoning anti-vaccination movement.

State Sen. Richard Pan, a bespectacled and unassuming pediatrician who continued treating low-income children during his 12 years in the state Senate and Assembly, has been physically assaulted and verbally attacked for working to tighten childhood vaccine requirements — even as Time magazine hailed him as a “hero.” Threats against him intensified in 2019, becoming so violent that he needed a restraining order and personal security detail.

“It got really vicious, and the tenor of these protests inside the Capitol building didn’t make you feel safe, yet he stood his ground,” said Karen Smith, director of the California Department of Public Health from 2015 to 2019. “Dr. Pan is unusual because he has the knowledge and belief in science, but also the conviction to act on it.”

“That takes courage,” she added. “He’s had a tremendous impact in California, and there’s going to be a hole in the legislature when he’s gone.”

The Democrat from Sacramento is leaving the Capitol because of legislative term limits that restrict state lawmakers to 12 years of service. He has overseen state budget decisions on health care and since 2018 has chaired the Senate Health Committee, a powerful position that has allowed him to shape health care coverage for millions of Californians.

Pan, 56, helped lead the charge to restore vision, dental, and other benefits to California’s Medicaid program, called Medi-Cal, after they were slashed during the Great Recession. Since then, he has pushed to expand social services to some of the most vulnerable enrollees.

He was instrumental in implementing the Affordable Care Act in California, and when Republicans attacked the law after Donald Trump was elected president, Pan spearheaded measures to cement its provisions in state law. After the Republican-controlled Congress axed the federal coverage mandate in 2017, he led the effort to create the state penalty for not having health insurance. And he negotiated with the governor to expand health insurance subsidies for low- and middle-income Californians.

In 2020, Pan authored legislation that will put California in the generic drug-making business, starting with insulin.

“What drives me is my commitment to health and healthy communities,” Pan told KHN.

But he hasn’t always succeeded. Some of his bills — including those to expand benefits and improve the quality of care for Medi-Cal enrollees — were stalled by the influential health insurance industry or opposition from his own party. And this year, Pan retreated on his contentious proposal to require schoolchildren to get vaccinated against covid-19.

Pan has also faced criticism that he’s too closely aligned with the health care industry, including the California Medical Association, or CMA, a deep-pocketed group that lobbies in Sacramento on behalf of doctors. On contentious policy fights, such as those dealing with provider pay or physician authority, Pan has often sided with his fellow doctors.

For instance, he rallied with the doctor association against a long-sought attempt to give nurse practitioners the ability to practice without physician supervision — a bill that was one of the association’s top legislative targets but one that ultimately passed despite its vehement opposition. And two key bills that sought to rein in health care costs died in his committee after clearing the state Assembly — one in 2019 to limit surprise medical bills for emergency room visits and another this year to give the state attorney general authority over some hospital and health system mergers.

“He’s inseparable from the doctors’ lobby, and obviously he carries water for the CMA,” said Jamie Court, president of the advocacy group Consumer Watchdog, arguing that Pan has stood in the way of progressive health care bills such as a proposal to create a government-run, single-payer health care system.

Pan rejected claims that he’s too close to the industry. “I’m proud to be a member of the CMA, but I don’t just blindly follow CMA,” he said. When it came to the nurse practitioner legislation, he said, his concerns “came from my knowledge about professional medical education and how that influences patient outcomes.”

Pan isn’t running for anything this year but isn’t ruling out the possibility of doing so in the future. For now, he said, he’s focusing on his work in Sacramento until his term ends Nov. 30. After that, he plans to practice medicine full time.

Pan said the public hasn’t heard the last of him when it comes to improving Medi-Cal. The state must do more to ensure high-quality care and equitable access for the 14.5 million Californians enrolled in the low-income health program, he said.

Pan said he entered politics to improve community health. He left his job as a faculty member and head of the pediatric residency program at the University of California-Davis to run for state Assembly in 2010. He served two terms before being elected to the state Senate in 2014.

Early on, he found himself at the forefront of California’s wars over vaccination mandates.

In 2012, he authored a law making it more difficult for parents to obtain personal belief exemptions for vaccines that are required for children entering public and private schools and that prevent communicable diseases such as measles and polio. In 2015, he succeeded in banning personal belief exemptions for schoolchildren altogether.

In 2019, when lawmakers were voting on Pan’s bill that cracked down on bogus medical exemptions for required school immunizations, a protester hurled menstrual blood at them on the Senate floor. Pan also clashed with Gov. Gavin Newsom, who watered down the bill by demanding amendments that allowed doctors to retain significant authority over the exemptions. Newsom ultimately signed the measure.

“I didn’t run for the legislature because I was planning to do vaccine legislation, but I care about children and that’s what I’ve devoted my life to,” said Pan, who got his medical degree from the University of Pittsburgh and a master’s degree in public health from Harvard University. “We had a whooping cough outbreak, and 10 infants died. And I was very concerned about the fact that we could prevent these diseases, yet we were failing.”

This year, Pan introduced legislation to require covid vaccinations for school-age kids but pulled it in April, saying it would be difficult for California officials to enforce. At the time, the covid vaccination rate for schoolchildren “was too low — around 30%,” Pan said. He concluded the state should redouble its efforts to increase vaccination rates before instituting a mandate.

Pan also noted that covid-19 was mutating fast and that emerging research indicated that the vaccines weren’t very good at combating new variants. “The vaccine is very effective protecting against death, but its ability to slow down transmission seemed to decrease,” Pan said. “Unfortunately, it has also been so politicized, so we have more work to do.”

As chair of California’s Asian & Pacific Islander Legislative Caucus, Pan in 2021 helped secure a $157 million investment to combat violence and hate crimes against Asian Americans and was a powerful force advocating for more money for the state’s beleaguered public health system — a fight Democrats finally won last year when Newsom approved $300 million in ongoing funding.

State Sen. Scott Wiener (D-San Francisco) said that Pan inspired his interest in introducing tough vaccination and public health bills and that he regularly asks Pan’s advice before unveiling legislative proposals. “I’d randomly call him all the time,” Wiener said. “There’s really no one in the Senate with the experience and knowledge he has.”

Brainy and studious, Pan regularly delves deep into scientific evidence during legislative floor debates. Interviews with reporters often result in lengthy discourses about the history of the U.S. health care system — like the time a question about hospital financing led to a lesson in how hospitals are both profit-earning enterprises and institutions that provide charity care.

“How serious you are about every undertaking — it really can be a joy and an irritation,” said Senate leader Toni Atkins, who affectionately thanked Pan for his work on the floor of the Senate in mid-August. “You took a lot of flak from folks in a lot of ways, and through it all, your integrity, your sense of humor, and your very good nature has withstood it all.”