As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.
Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.
The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.
But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.
“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”
The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.
The bill, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.
Lara said the approach would get California closer to a system “that covers more and costs less.”
The bill’s authors haven’t announced how the program would be funded. And that’s where the biggest obstacle lies, said Oberlander: It would largely uproot California’s present system, in which roughly half of coverage is sponsored by employers.
If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” he said. “Then you have to make up all the financing that you’re going to lose.”
There’s no way to make up for those lost employer contributions other than to introduce “very visible taxes,” Oberlander said. And that’s not the only reason why a single payer plan would be controversial. “A lot of people are satisfied with what they have,” he said.
The trade group for insurers in California does not support the single-payer idea.
“A single-payer system would make the quality of our health care worse, not better,” said Charles Bacchi, president and CEO of the California Association of Health Plans. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”
Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said Lanhee Chen, a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.
A single-payer system would need federal approval and likely have to overcome other bureaucratic hurdles even if approved in the state. As it stands, no state has such a system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.
Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.
One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program costing about $200 billion each year. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.
Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.
“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”
Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.
“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.
In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.
For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.
Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.
One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.
Newsom has acknowledged, however, that the San Francisco approach would not necessarily work in every county, and said he is open to other possibilities.
Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.
Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.
“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.
The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. Some Republicans favor an approach in which each state decides on its own coverage system, within certain limits.
That could mean a retraction of coverage in some states, but in California it might open the door to a new model.
“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.
–Pauline Bartolone, Kaiser Health News
And read “America’s Bitter Pill” by Steven Brill. Excellent book – had never heard of the “chargemaster” prior to reading this book.
Howard Duley says
Sounds great. Before we pat them on the back lets see who gets the benefits and
who ends up paying for those benefits. I hope you clowns realize that the illegals
won’t be paying and neither will the rich..
Who’s gonna pay for it? Last I checked CA was in debt up to it’s eyeballs and they can’t print any money.
Richard Smith says
I am open to any reasonable and affordable healthcare system as right at this moment my wife does not have health insurance. Under Obamacare her premiums would have been over $500 per month with a $9000 deductible, how affordable is that!!!
last i checked california would be the seventh largest nation if it were a country and has a higher gpd then texas and NY combined. So, this liberal paradise where everyone has healthcare and drug laws are lax is actually much much more industrially and technologically advanced then the rest of the country. its a wonder what investing in people and educations instead of corporations does FLORIDA SHOULD HEED NOTICE
The profound ignorance of the right-wing knows no bounds. California’s economic growth is higher than that of the U.S. and is projected to outpace the rest of the U.S. through 2020. The forecast is for job growth of 2.9% this year and 2.4% next year, compared with 2.1% and 1.8% for the U.S. overall.
So, righties, do your homework. California is a forward-thinking, forward-looking progressive state. It is also prospering on its own. And like New York, I expect it will soon offer universal pre-paid higher education along with universal health care for its citizens.
How many of you think Kansas or Wisconsin, or Alabama, Tennessee, Arkansas… you know, the” red” states are as advanced as liberal California or New York? Ever wonder?
Richard Smith says
I guess that’s the difference between Right -Wing Red Necks versus the Left-Wing Moonbats.
Katie Semore says
@truth @Knightwatch: I am happy to see saner minds prevail. Ignorance and bigotry seem to go hand in hand.
And that is how this Republic is meant to be. if the people of one state want something like government funded health insurance let them have it. If another State does not then they don’t have it. Let each state find what works best for them. this also lets other States and their people see how and what works best.
While I applaud California’s willingness to step up and have higher quality health care for their citizens. . . making such VITAL services controlled at the state level is completely ludicrous!
We now live in the 21st century. . . where our populace needs to be FREE to be completely mobile to move from one part of our country to another without loosing such VITAL services, rights or benefits!! The small minded, myopic notion that ALL the citizens in any one state think in lock step and completely agree on the political decisions that effect their daily lives is idiotic.
The “modern” family lives, by mind and heart, in the “entire” USA. . . their successful “job market” is not just “national”. . . it is often global. While it is logical and reasonable that finding a job in and moving to a completely “different” country would entail changes in services such as health care. . . we should all be able to easily pursue a successful life path anywhere in our entire country without worrying about major differences in rights and services from state to state. That includes not only health care, but other fundamental issues such as marriage laws, clean air and water standards, worker safety laws, the right to vote, anti-discrimination laws. . . and so forth.
We are not just a collection of territories that happen to occupy the same continent. . . we are the “UNITED States of America”! We should ALL remember that and begin to act like it!!!
Richard Smith says
Great post Sherry. I wholeheartedly agree.
Thanks so much Richard!
I don’t know about you, but when I travel for months at a time to other “first world” countries and see that their citizens pay only 10 to 20% of what we pay for the exact same pharmaceuticals. . . and medical services I feel completely ripped off by the medical and insurance industries in the USA. I personally paid only $25 to get a tooth filled in Spain last year and my husband buys his BP medication there for 10% of what it costs here. As long as we require VITAL all health care to be provided by uncontrolled “for profit” businesses, we will continue to be ripped off.
We need “Nationwide” Medicare for ALL. . . with reasonable premiums, and we need it NOW!