For many Californians, the proposal of a uniform payer state health care system remains wishful thinking, and chances are it will remain so, especially if leading proponents can’t agree on how to get it there.
Democratic leaders and advocates looking to transform the current complex health care system are divided over their approach. On one side is a coalition of health, labor and civil rights advocacy groups behind Senate Bill 770, which seeks a gradual path toward “uniform funding,” in which a statewide system would fund health care for all residents. This could be a single payer model or something similar. The bill would task a working group of experts and consumers to work out the next steps to achieve that goal and submit a report to the legislature by June next year.
SB 770 also requests that the Newsom administration consult the federal government, which would need to approve such a system in California, on the matter. The bill, authored by San Francisco Sen. Scott Wiener, is currently moving through the Legislature — last week it received the green light from the Assembly’s Health Committee and it will next move to a Finance Committee.
On the other hand, the California Nurses Union, a longtime driving force behind the single payer movement, opposes Wiener’s bill, arguing it could derail his own legislation, Assembly Bill 1690. Jose Democrat would introduce a single payer system called CalCare. The bill was presented earlier this year but will not come up for hearing until the next legislative session. The CalCare bill doesn’t include specifics at this time, but union leaders said they would use their earlier attempt at a unified payer, Assembly Bill 1400, as a starting point. AB 1400 died last year after its author Kalra chose not to bring it up in plenary due to lack of voices.
Last week, Kalra joined the nurses’ union in publicly speaking out against Wiener’s bill, calling it a “disturbance” to his ongoing efforts and those of the nurses.
Even in blue California, the single-payer policy was politically tricky, with opposition from the healthcare industry, including health insurers and some medical associations, but also from powerful business interests like the Chamber of Commerce, citing the tax hikes that would be needed to fund a system. Still, the status quo costs too much and leaves too many people behind, experts and health advocates say.
Carmen Comsti, senior regulatory policy expert at the California Nurses Association, said the two bills are contradictory because lawmakers could use Wiener’s bill as an excuse to vote against the nurses’ union-backed bill next year.
“We don’t think lawmakers would adopt the single payer and pass it by if they simply authorized another working group to review the program,” Comsti told CalMatters. Instead, it opens the door for lawmakers to say, “It’s too early to talk about CalCare and the sole payer because we’re looking into it,” she said.
But Wiener and those who support his proposal see the two bills as complementary rather than contradictory. For example, to implement a payer system, California would ultimately have to obtain an exemption or permit from the federal government to circumvent current rules that dictate how the state can spend federal money on healthcare. Wiener’s bill would set those talks in motion, the author said.
“If CalCare goes through, at that time California will be approaching the federal government and making requests for exemptions. The work here and the talks with the federal government will be helpful; it fits together,” Wiener said during the hearing last week.
Some Democrats who sit on the assembly’s health committee said they view Wiener’s bill as a way to get the ball rolling while waiting for broader support from their peers.
Kevin McCarty, a Democrat from Sacramento, noted that the nurses’ unit payer bill received “significantly few votes” last year. “It’s not nearly that far,” McCarty said. “In the meantime, will we be purists or try to achieve more? I think that’s what (SB 770) is trying to do. I don’t think they’re mutually exclusive.”
Michael Lighty, president of the coalition supporting Wiener’s bill, said it was to follow up on findings from the Healthy California for All Commission, a group put together by Gov. Gavin Newsom. The group’s work culminated in a 105-page report last year, but no action.
Lighty is a veteran of the flat-rate payer movement and once worked as the public policy director for the Nurses’ Union. The California Nurses Association is actually part of the healthcare coalition he leads, but they disagree on this particular piece of legislation.
Another major concern for the nurses’ union is the language used in the Commission’s report and the Wiener bill. “Unified funding is not synonymous with a single payer,” said Comsti. She argued that when “uniform funding” includes programs that allow health insurers or intermediaries to make a profit, this essentially runs counter to the single-payer system they aspire to.
Lighty regards the language argument as a matter of nomenclature; Ultimately, both sides wanted the same result, he said. And after several failed attempts to get to the unit payer, maybe it’s time to try a new path, he said.
“It has proven politically impractical to get the legislature to pass a full-fledged depositor program in one fell swoop,” Lighty told CalMatters.
By 2031, healthcare spending in California is projected to increase by $158 billion; According to the Healthy California for All Commission report, a “single financial system” can help stunt this growth. Most importantly, extending insurance coverage to all Californians could save about 4,000 lives annually, the report said.
“People on both sides of this bill have historically worked very closely to expand access to healthcare,” Wiener said. “There is this disagreement now and I hope that the divide will heal in the future, but we all want the same outcome. We want everyone to have truly universal access to healthcare.”
Supported by the California Health Care Foundation (CHCF), which is committed to this People have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.