Dr. Monica Soni on Healing Systems, Not Just Patients

When Monica Soni was preparing to start medical school, she discovered she hadn’t received her full set of childhood vaccines. Her mother, whose family was from Jamaica, believed in herbal remedies and alternative care, and had kept her children healthy without much reliance on Western medicine. So in her 20s, Soni rolled up her sleeve for a new round of polio and MMR shots. That unusual beginning says a lot about how Dr. Monica Soni, now Chief Medical Officer at Covered California, a statewide healthcare marketplace, approaches healthcare today: grounded in cultural humility, open to multiple ways of healing, and unafraid to question how the system works.

On the other side of her family tree, Soni’s father, whose family immigrated from Punjab, India, held a deep reverence for physicians, sometimes to the point of silence in the exam room. “My family has a lot of diabetes, a lot of heart disease, but at normal weights, which is very common actually in Asian communities,” Soni explained. “That was confusing to navigate — between the American vision of how health should show up, and then what some of the facts are for different communities. Trying to make sure that they were educated: Why do we have diabetes in my family? Why is there so much heart disease? A huge component of it is, frankly, just genetics and some of the dietary choices, but that’s not always how counseling is happening in the exam rooms or in primary care [spaces].”

Yet it was her father who instilled in her the spirit of advocacy: “He’d say, ‘You’re a citizen in this country. You don’t have to take it. If you want to complain about the waffles in the cafeteria, complain about the waffles.’” For Soni and her sister, that lesson wasn’t about waffles at all, it was about using their voices, however small the issue seemed.

That dual upbringing — one parent skeptical of Western medicine, the other deferential to it — shaped how Soni practices. “Because I grew up with a mother who believed in alternative care models, I found myself as a primary care practitioner trying not to [dismiss those approaches]. I might not be familiar, but I’ll ask patients to send me a picture of the ingredients, and I would spend time checking for interactions between what you are prescribed by us, or if I hear about something that sounds super healthy, I want to know more about it because I may have other patients that might benefit. It’s important to have [physicians] that are able to navigate between both traditional and more Western approaches. Because, frankly, folks are going to do what they want anyways.”

Finding Her Place in Medicine

Though there was some traditional pressure to pursue medicine, Soni gravitated to primary care because it felt most human. “It was intimate. It was personal. It was relational,” she says. “The power dynamics leveled out a little more in the clinics I shadowed. That felt like something I could spend my life doing.”

These days, her role is far more systems-focused at Covered California. She still sees patients on Fridays — a tether to what’s happening on the ground — but most of her week is spent reshaping how care is delivered statewide. This calling grew out of the realities she confronted early in her career, when the cracks in the system became impossible to ignore.

“I grew up in the Sikh tradition, and in Sikhism there are principles of equality, service, and honest living. I know I found that in primary care,” she shared. “But when I came back to LA after training, the dysfunction was everywhere. I could do great work for the person in front of me, but then I would be waiting six months for an MRI, or I’d pull up a record and see no one had followed up on results from two years ago. We didn’t even have an electronic health record. To truly serve patients, I realized I had to fix the systems around them.”

What began as curiosity soon became leadership. She reworked workflows in her own clinic, then split her time between patient care and systems redesign in urgent and specialty care. By the time the pandemic hit, she was positioned to help shape large-scale responses. The crisis, she says, briefly cracked open the possibility of transformation. 

“States of emergency were declared,” Soni recalled. “There is [a] closer connection between public health and delivery systems and policymakers than there had ever been before, and I was so optimistic. There were all these challenges that we hadn’t able to address because of these barriers that now felt like we could almost do anything on behalf of our communities, and it wasn’t clear to me that we were going to take up the mantle. And so that was very discouraging, so I didn’t burn out the way that other clinicians burned out. I burned out because I was like ‘Gosh, I’m not going to be able to make [the change] I thought I might be able to make in this particular role.’”

She stepped away for a time, working in the health plan space before returning to public service at Covered California — recommitted to pursuing the structural change she knows is possible. And still, she insists, the Friday clinic visits matter most. “I could be sitting across from a CEO, and they’re talking about something, and I can say, ‘Actually, that’s not what happened to me on Tuesday,’ and the level of credibility comes from how able you are to immediately recall your patient’s experience. I do think it makes you a better leader and decision maker, so if anything, I wish I could do a little more patient care.”

Health Equity Across Communities

One of the realities Soni has pushed Covered California to grapple with is how health outcomes diverge sharply across racial and ethnic lines, and how surface-level numbers can obscure deeper inequities.

“Folks that identify as Asian or Asian American in California have the lowest rates of pap smears, lowest rates of mammography, and colorectal cancer screening compared to every other group,” she explained. “Sometimes the narrative is, ‘Oh, Asian folks, they get their services done as compared to other groups.’ That’s not actually what the data suggests.” With the ability to stratify data more granularly, she noted, even within Asian subgroups there are striking gaps, like a 12-point difference in breast cancer screening rates between Vietnamese and other Asian populations.

Meanwhile, Black women in California have some of the highest rates of mammography use, outpacing every other group in the state, but still die from breast cancer at twice the rate of their counterparts. “Sometimes there’s something else happening that we don’t always have visibility into, or that the data isn’t as transparent about,” Soni said.

Behavioral health is another area where inequities run deep. Rates of utilization among Asian Americans are dramatically lower than every other group. That gap closes only downstream, in the most alarming way: hospitalizations and suicide, which is a leading cause of death for young Asian American teens. “We probably do have folks that are truly suffering and in need of services, that are not getting those services,” Soni said. “By the time they have uncontrolled disease and really are in need of support, then you see the disparity close.”

For Soni, the solution is not a single intervention but a commitment to transparency, collaboration, and iteration. “We’re never going to have all the answers from where we sit,” she emphasized. “One of the most important things we can do is be transparent about the data, take it back to the community, ask for help, co-create solutions, test and learn.” She points to colorectal cancer screening as an example: Pairing in-language education with follow-up phone calls, mailed stool tests, and the accompaniment of community health workers has been shown to raise screening rates when implemented together.

Designing a Healthier Future

Her perspective is grounded in optimism. California has already seen dramatic progress — reducing its uninsured rate from 17% to 6%, with an 80% drop for Black residents and a two-thirds drop for Asian residents. “Because of those improvements in coverage, we saw an increase in life expectancy, a reduction in lung cancer deaths, a reduction in infant mortality,” Soni said. “We actually have gotten healthier. Even when there are rollbacks, we know what the playbook is. We can attain it again.”

That confidence stems not just from data, but from the way Soni and her team work, pushing against silos, experimenting with solutions, and keeping community voices at the center. At Covered California, she has helped channel nearly $16 million in health plan dollars into unexpected but impactful areas: paying for food, seeding child savings accounts, and sustaining small independent primary care practices. “Sometimes you have to move resources from one part of the system to another to get the outcomes we all want,” she explained. “Being willing to try it, study it, and see what happens — that’s what will help us live longer and live better.”

For Soni, that willingness to test and learn reflects something larger: a refusal to accept the limits of the current system. “Primary care should be a common good,” she insists. “Everyone should be able to access it. The question is, are we willing to break down the barriers and design something better?”

It is the same lesson her parents taught her in different ways — to advocate, to question, to take nothing for granted. From the cafeteria waffles of her childhood to the policy tables of Sacramento, Soni has carried that charge forward. And in her vision, California’s healthcare system isn’t just about coverage — it’s about creating a society where everyone, regardless of race, income, or background, has a fair chance at health and wellness.

Images courtesy of Monica Soni. Cover image background collage created with assistance from ChatGPT-5.