Thursday, 08 August 2019 21:05

The Role of One Payer States in the Single Payer Movement Featured

Written by One Payer States

Established in 2009, One Payer States (OPS) is dedicated to advancing America’s highest ideals in the pursuit of quality, comprehensive, and guaranteed healthcare for everyone in America. Above all, we are dedicated to the concept that universal healthcare is a human right as stated in the Universal Declaration of Human Rights (1948). The UDHR is the founding document by which all other countries, except the United States, have protected the health rights of their citizens. The United States has spectacularly failed to live up to its obligations under that, and subsequent treaties protecting healthcare rights. Through this statement of purpose, we intend to hold our government accountable and correct this historical abandonment of our nation’s duty to its citizens. We see universal healthcare not only as a human right, but as an economic imperative that will rescue Americans and our nation from both a looming financial disaster and a public health crisis. Whether or not we understand the peril of the misguided policies that got us here, we are all in a literal fight for our lives — and we regard reformed health policy as nothing less than the cornerstone of a rebuilt democracy. 


Since our formation, OPS has consistently backed Medicare-for-all campaigns at the local, state, and national levels. To further this capability, OPS’ formalization as a 501(c)3 and 501(c)4 will transition us to become a significant political force that will engage to influence the healthcare reform debate at these three levels. Once legally established, our organization will be uniquely poised to play an expanded role in educating, organizing, and mobilizing our member and partner organizations. Therefore, we have chosen to unite OPS around a three-track strategy: • state-based universal healthcare (SBUHC) legislation and citizen initiatives; • congressional enabling legislation in support of state-level campaigns; and • national Medicare-for-All legislation (HR 1384 and S.1804). 

As to what we are specifically doing today to meet these strategic goals, the nearby path to success for OPS includes the following steps:

  • firstly, we must draft organizational support for a petition calling upon citizens to lobby their Members of Congress to co-sponsor and vote for the forthcoming “State-Based Universal Health Care (SBUHC) Act of 2019”;
  • secondly, we will establish OPS as a 501(c)4 membership-based, political organization, and as a 501(c)3 non-profit;
  • thirdly, we are creating a clearly worded website to share: information, regular updates, best practices, videos, and tools among participant states and members;
  • fourthly, as we grow, we will continuously identify and recruit required professional skills (e.g., attorney/s, accountant/s), leadership volunteers for service on the (c)3 and (c)4 boards, and additional volunteer staffing (e.g., organizers, trainers, writers, speakers, social mediators, photographers, videographers, and celebrities).   

The inaugural launch of OPS occurred in West Chester, Pennsylvania, in the spring of 2009. Our leadership has attracted some of the best minds and experts in the field of US health policy. We have organized around a state-based network, which has grown and remained connected with bi-monthly and monthly phone conferences. These regular calls are focused on educating, legislating, organizing, coalition-building, lobbying, and hosting guest experts. We have held annual meetings, which have usually been integrated into the National Single Payer Strategy Convention. We have established working group-style teams focused on communications strategy, policy practices, and organization and development committees. Having experienced growth through careful planning, we believe the potential of the working group model and networking opportunities among large-scale progressive organizations is extraordinary. 

OPS has actually been building toward this breakout moment for the past decade. Going forward, we will continue to support serious healthcare reform at the local, state, and federal levels. Our study on the matter indicates the location for initial adoption of true universal healthcare is most likely to be in a key state, a few states, or a regional cluster of states. 

We have strengthened our group through our persistence and mutual support of health policy reform efforts at all levels. This is especially true during the politically arid Patient Protection and Affordable Care Act (PPACA) / ObamaCare years of 2010-2017 that precluded state innovation (see section 1332 of the PPACA) and stalled Medicare-for-All efforts. We have built trust, mutual respect, and shared experiences among fellow activists while advancing our state-level work.  OPS has grown from a handful of regular participants in 2009 to a national network of 250 engaged representatives in 2019, backed by thousands of state-level activists and mailing lists numbering in the hundreds-of-thousands.

Our current priority is to enact U.S. Representative Ro Khanna’s (CA-17) State-Based Universal Health Care Act (SBUHC) of 2019, which is the new congressional state-enabling bill in California. This bill is crucial for the seamless implementation of state and regional Medicare-for-All measures. Since Khanna took up the prime sponsorship and authorship of SBUHC, we have been working closely with his staff to develop a state-based, go-forward strategy. By item, those functions are: expand the bill’s member co-sponsorship, build coalition support, ensure media coverage, enlist business backers, and engage with the grassroots Medicare-for-All movement.  Once passed, the enabling legislation will provide critical ERISA (Employee Retirement Income Security Act of 1974) and federal funding waivers to applicant states. The importance of this initiative cannot be over-stated. For the first time, this key piece of legislation will blaze the trail forward to allow any other states to fully implement universal healthcare. But our work doesn’t end there. We are also developing plans to support governors, state legislators, and their staffs in all viable states. The Medicare-for-All / Single Payer / Universal Health Care movement is at the threshold of an important breakthrough. We are profoundly aware that not enough has been done to inform the public about where our movement stands today – very few citizen leaders, organizers, and activists outside of OPS are aware of the moment in which we find ourselves. We are literally standing at the crossroads of American history. What we do within this small organization may well determine the future of our country. 

Medicare-for-All’s congressional leaders, in the House, Pramila Jayapal (, and in the Senate, Bernie Sanders (, are both on record as saying that Medicare-for-All is more likely to come ‘bottom up’ through individual states instead of ‘top down’ from the federal government. Rep. Jayapal carried the SBUHC bill in 2018 (HR 6097) before succeeding John Conyers’ in his former role as House leader on HR 1384 (formerly HR 676).  Sen. Sanders’ first Medicare-for-All bill (S.1782 of 2013) highlighted the role of states in adopting and modeling successful new systems. 

This approach also matches the way our federalist neighbor to the north, Canada, achieved universal healthcare. The province of Saskatchewan first demonstrated overwhelming popularity of their single payer provincial system. ‘Medicare’ became so popular in Saskatchewan that no other federal or provincial government dared to oppose it at any provincial or national level from that day forward. After 1962, all Canadians were clamouring for what the people in Saskatchewan had. To oppose such popular legislation that created a successful working system literally overnight would have been political suicide for any Canadian politician. Even politicians with diametrically opposed political views got behind it to make it work. With the help of the federal government in Canada, Medicare became a reality in every province in less than a decade. That’s the point we believe we can get to in our country, given a fighting chance to successfully convert a single state.   

We are under no illusions that this will be anything but difficult. American history, the U.S. Constitution, and corporate dominance of both major political parties are against our success. The fact that all of these forces line up against us at this time underscores the difficulty of adopting sweeping national solutions in the face of a dysfunctional, apartheid-like healthcare system. That is why we believe that we’ll be better able to achieve success by fostering opportunities to pass universal healthcare legislation in various single states. In this quest, we do have one powerful constitutional tool on our side. The shared powers of a federalist constitution defer considerable control to the states to implement and fund according to local culture and politics (the First and Second Industrial Revolutions, the Progressive Era, the New Deal, and the Great Society are examples that inform us now). 

Action Step One: Draft a bold national petition in support of Rep. Ro Khanna’s soon-to-be-introduced State-Based Universal Health Care (SBUHC). Present the petition language to progressive leaders who support national Medicare-for-All as the first step in a process of educating would-be partners on the critical importance of SBUHC. OPS seeks to forge a broad-based citizen coalition around SBUHC. In support, OPS will contribute to the larger objectives of other like-minded progressive organizations by way of connecting-the-dots across all healthcare-related issues. 

Petitions are a starting point, not an end point. They are one of an array of many tools in our political toolbox. The way in which grassroots progressive politics now operates in Washington DC, petitions serve to advance organizational relevance, educate on the issues, grow databases, develop coalition partnerships, raise resources, and build mass-level activism. Petitions put nascent organizations in the orbit of organizations such as Credo, MoveOn, and Social Security Works. This is the way we’ll build a collective community of membership organizations with support in the many millions. With that level of achievement, doors will automatically open for us. Even smaller affiliated organizations can punch above their weight and dramatically increase the likelihood of legislative success. 

Action Step Two: OPS will pursue a 501(c)3 non-profit status after gaining a 501(c)4 membership-based, political organization stature.  Once obtained, the 501(c)3 will enhance OPS’s capacity to apply for grants and to receive donations for tax-deductible advantages to the donor. While the (c)3 mission will be 75% education, the other 25% can be spent on lobbying for specific legislation, such as SBUHC legislation. The (c)4 mission is far more political, including lobbying and candidate endorsements, though in all cases OPS must remain strictly non-partisan. In the case of the (c)3 and (c)4, we will be requesting volunteer board and officer service. The search for accountants and attorneys will begin immediately. General membership will follow the model of suggested monthly contributions of from $1 to $25, determined by the giver.  No one will be denied membership if they lack the ability to give (or get) financially. Fundraising beyond membership dues will determine OPS’s ability to hire full-time or part-time staff, starting with an executive director (ED). 

Action Step Three: OPS will establish a robust and dynamic internet presence. The ‘’ domain has already been purchased. Again, our goal here is to create an interactive website to share information, update members, determine best ‘system change’ practices, host video testimonials, and provide learning and teaching tools to our state communities and supporters. Using the website as a model, the OPS Organization and Development Working Group will provide and maintain timely and relevant web content. And of course, we will continue to highlight activities occurring state-by-state and on activities in WDC relevant to OPS’s work. 

Action Step Four: OPS will develop and recruit an asset pool of strategic talent from among our members and associate organizations in support all of our objectives and day-to-day needs. We will establish officers (president, vice president, secretary, treasurer), and twenty or so (c)3 and (c)4 board members (with a few members serving on both entities), and top staff (e.g., organizers, trainers, writers, speakers, social mediators, photographers, and videographers). Imagine the power of being able to dial up our own experts to appear on local and national news media. Or drop an expert witness into a hearing in any state that needs help. The repetition by experts of our best arguments and key phrases is how we beat/neutralize the corporations that have been seeding phrases like “socialized medicine” and “government-run healthcare” into the American psyche for decades. This talent pool will give us the tools to play our winning hand in that game too.    

Action Step Five: OPS will create a strong social media presence, using select existing platforms, following the social footprint of a member-volunteer with at least 1000 followers.  

Action Step Six: OPS members will record and post video stories on the website of 30-60-90 seconds, and 3- and 5-minutes in length – testimonials and education shorts intended to advance the goals of the One Payer States community. 

Summary and Prospects
Beginning as a unique association of several state-based single-payer leaders and organizers in 2009, One Payer States has evolved over the last decade into a unique national network with unlimited political potential to lead and shape the debate on state-based universal healthcare systems. OPS is singularly positioned to direct large-scale citizen activism (outside power) in coordination with members of congress, state legislators, and state executives (inside power).  We seek the urgent passage and seamless implementation of state-level ‘Medicare-for-All’ – rights-based, universal, guaranteed healthcare systems – in enlightened states from coast to coast.  With history as our guide, we are confident that the successful modeling of universal healthcare in one or more states will trigger the embrace of Medicare-for-All across our nation.  With an understanding of our reformist history, federalist constitution, and corporatized political system, we see the adoption of state-based universal healthcare as the clearest path forward to improved and expanded national Medicare-for-All. 

Read 755 times Last modified on Tuesday, 13 August 2019 18:29

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