Under pressure, California Assembly pitches alternatives to single-payer health care

California Assembly Speaker Anthony Rendon is refusing to advance this year a controversial single-payer health care bill that would dramatically reshape the state's health care financing and delivery system. Instead, he's orchestrating an alternative, narrower approach that seeks to achieve universal coverage and make Obamacare more affordable.

Rendon this year gave lawmakers in his house "autonomy to come up with a package" of health care bills, he said in a recent interview. Now, without engaging the other side in the Senate, the Assembly has unveiled a major legislative push on health care that would expand coverage and lower consumer costs while laying the groundwork for a future system financed by taxpayers.

Five Assembly lawmakers late Friday released 14 bills they're expected to promote as a package this year. Together, they would offer financial assistance to people struggling to pay for soaring insurance premiums and out-of-pocket costs, require health insurers to spend more on patient care instead of profits, create a public insurance option and offer health coverage to undocumented immigrants.

But they will likely run into similar political and financial problems faced last year by Senate Democrats, who passed the Senate Bill 562 single-payer health care bill in June without a way to pay for its $400 billion price tag. The move kept the bill alive and allowed Senate Democrats seeking election to higher office to say they voted for single-payer, an issue that has become a litmus test in the minds of progressive activists in the Democratic Party.

No detailed costs exist for the Assembly's new health care bills, but economic estimates from the state Legislative Analyst's Office indicate the measures could range from the low billions to as high as $10 billion. Gov. Jerry Brown could be a tough sell. He has voiced concerns over a major budget ask and has not made health care a core priority during his last year in office.

Brown's office declined to answer questions about what he'd be willing to do this year, instead pointing to California's past efforts to implement Obamacare. Brown said when he released his proposed budget in January that "we have to move with caution ... the path forward will not be as easy as what we've done up to date."

Even if he does engage, pushing anything costly through in an election year will be tough for Democrats, who are already facing steep criticism for raising gas taxes last year.

"As is often the case with aspirational bills like these, it's not clear yet where the money would come from to pay for them," said Larry Levitt, a health economist at the Kaiser Family Foundation. "Figuring out how to finance the increased coverage and subsidies could prove controversial."

The Assembly's actions are also drawing ire from the California Nurses Association, the lead sponsor of the single-payer bill, which has condemned anything short of single-payer as a gift to drug companies and the insurance industry.

"How many bills does it take to change a light bulb? What an insane approach ... There's only one way to have a uniform, rational, comprehensive system that protects patients and covers everyone," said Chuck Idelson, a spokesman for the nurses union. "None of these bills will do anything to stop price-gouging by the insurance industry ... This is using state money to pad insurance industry profits without doing anything to prevent them from continuing to raise (insurance) rates."

The nurses union hasn't given up this year. It is still pushing the single-payer bill and denouncing Rendon, saying he's cozy with corporate interests that oppose it. They contend the Assembly's legislative efforts on health care amount to political cover for holding up the bill.

Rendon said the nurses' desire to have single-payer is not realistic this year. In discussing that position, he has faced intense scrutiny and pressure to come up with an alternative approach. He painted the Senate's move in passing the bill last year as political theater. 

"It seemed like a stunt to me," Rendon said. "It seemed to be an entirely symbolic piece of legislation and I didn't think it had any place in a serious discussion about health care."

Sen. Ricardo Lara and Senate President Pro Tem Toni Atkins, then without the high-ranking leadership post, carried the bill and pledged to continue to figure out a way to pay for it. Then-Senate Leader Kevin de León had suggested hearings with both houses.

Lara, campaigning to be the state insurance commissioner, and de León, in an uphill battle to unseat U.S. Sen. Dianne Feinstein, both later won endorsements from the nurses union.

Rendon said he alone made the decision to deny it a committee hearing after it cleared the Senate floor.

"It seemed to have nothing to do with real people, real services, real mechanisms," he said in the interview. "It was completely lacking in substance."

Atkins didn't push against Rendon's disparaging comments about the bill.

"Well, look at what we handed him," she said. "I'm just not going to hold that against him. You know, we've all had to deal with it. He has felt the heat more than most. So, I'm going to suggest that he has a right to have his perspective because he's paid the price."

Atkins, who has publicly pledged to leave rivalries between the two houses in the past, acknowledged the leaders will eventually have to engage to convince a "frugal" Jerry Brown to provide funding on any substantial legislation.

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