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Single-payer bill all but dead this year as California lawmakers craft new health package

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Single-payer bill all but dead this year as California lawmakers craft new health package

Picture of Angela Hart

Angela Hart's reporting on single-payer health care was undertaken as a 2017 California Data Fellow at the USC Annenberg Center for Health Journalism.


The Sacramento Bee
Tuesday, March 13, 2018

California Democratic lawmakers are quietly working on a package of up to 20 health care bills that would soften the political blow from the all-but-certain death of a single-payer universal care bill this year.

Senate Bill 562 cleared the Senate last year but stalled in the Assembly when Speaker Anthony Rendon blasted it as "woefully incomplete." The legislation still lacks a plan to cover its $400 billion price tag, a way to control rising health care costs and a strategy to secure federal waivers needed from the Trump administration.

Rendon has not formally killed the bill, but he told The Sacramento Bee earlier this month that a fresh health care package is in the works – the clearest sign yet that Senate Bill 562 is dead.

Democratic Assemblymen Jim Wood of Healdsburg and Joaquin Arambula of Fresno, who chair a special health committee formed by Rendon last year after the single-payer bill passed the Senate, said Tuesday they are eying legislation this year that seeks to improve quality, expand access and lower rising health care costs.

Both expressed doubt, however, that single-payer bill could move forward this year.

"I would say single-payer is not a reality this year because of the complexity of the steps that we need to go through," Wood said.

To capture current federal health care funding and use it to fund a state-based single-payer system, California would have to secure numerous federal waivers. Voters would likely have to approve changes to the state Constitution and massive tax increases would be required.

Wood and Arambula declined to say what specific bills they're planning to introduce, but said they're considering legislation based on a broad set of recommendations released Tuesday by a trio of health policy experts who produced a report analyzing the committee's work over the past four months in identifying a path forward on universal care.

The report outlines short- and long-term ways the Legislature can improve health care in California. Some ideas include creating a state-based public insurance option to compete with private insurers, allowing undocumented immigrants to enroll in Medi-Cal or sign up for insurance through Covered California depending on income, imposing a state individual mandate and issuing penalties for Californians who don't have coverage, boosting federal subsidies for individuals to purchase insurance with state assistance and capping payments to medical providers to help control rising costs.

Bonnie Castillo, the incoming executive director for the California Nurses Association, the bill's chief sponsor, said the Assembly's discussions are nothing more than political cover for Rendon. "It's clearly an attempt to redirect and distract," she said. "We know there are amendments that need to be made. He really should release the bill... The legislative process belongs to the people and not just the legislators."

Wood said he'd like to focus on a politically and financially obtainable approach to creating a universal health care system.

"I think that our report, our hearings illustrate pretty clearly that you can't go from concept to execution of a complicated, complex, completely transformative system in a really short amount of time," Wood said. "If you read our’ll understand a little better why we couldn't just pass 562 and the next day everybody has health care. It just can't work that way."

Rendon declined interview requests to discuss a possible package and the single-payer bill, but spokesman Kevin Liao said in an email Tuesday morning that it will remain parked "until further notice" unless its authors amend it.

The authors, Sens. Toni Atkins, D-San Diego, and Ricardo Lara, D-Bell Gardens, did not agree to be interviewed. In an emailed statement, Atkins hinted at the bleak chances of single-payer going anywhere this year.

"I remain a supporter of single-payer, but to get it done we must rebuild bridges among the parties that are crucial for success," Atkins said. "That will take time.”

Lara, in an emailed statement, said he was working with the nurses union to "to ensure the long-term financial sustainability" of the proposal.

Rendon and other Assembly Democrats, under political pressure from nurses and other single-payer proponents, have felt an urgent need to come up with legislative fixes to the state's health care system since the single-payer bill stalled in their chamber.

"With millions of Californians who remain uninsured and under-insured, we need to act immediately and boldly in addressing the challenges facing our health care system, including Trump's efforts to dismantle it," said Assemblyman David Chiu, D-San Francisco. "We should lead by establishing truly universal health care in California, but we should also consider what a roadmap to a single-payer system would entail."

Assemblywoman Laura Friedman, D-Glendale, said she's contemplating a bill that would establish a single-payer system in future years — once other benchmarks are met, such as achieving specific cost containment goals and obtaining needed federal waivers.

"I'm looking at legislation we could adopt that sets up a roadmap to single payer, just like we have with (Assembly Bill 32) that gives us a roadmap to reducing greenhouse gas emissions," Friedman said. "I'm also very interested in what can give people very real relief in the short-term."

Chiu and Friedman are also members of the special health committee, though the discussion over a health care package is taking place both in the Assembly and Senate.


[This story was originally published by The Sacramento Bee.]