California
Jan, 2025
Contributions from Lynn Huidekoper, RN, CNA; One Payer States; and PNHP CA. Reference to comprehensive history of Single Payer movement in CA from 1997 to the present by Dan Hodges < https://healthcareforall.org/wp-content/uploads/2024/09/History-of-California-Single-Payer-Legislation-and-Movement_1997_2024.pdf >
State-based Single Payer Organizations
California Nurses Association. https://www.nationalnursesunited.org/california-nurses-association. https://www.nationalnursesunited.org/about-cna
Health Care for All - California https://healthcareforall.org/
Healthy California Now (HCN) https://healthyca.org/ Broad coalition of 80 organizations (below):
Physicians for a National Health Program https://pnhp.org/chapter/california/
Organizations with strong Single Payer campaigns
Progressive Caucus of the California Democratic Party. https://www.progressivecaucuscdp.org
California Alliance for Retired Americans. https://californiaalliance.org/
(See 80 organizational Coalition Members of “Healthy California Now” list of affiliates (https://healthyca.org/about/affiliates/); Board membership https://healthyca.org/about/)
California Single Payer Medicare for All legislation
None currently, but two major initiatives are in progress.
1. Calcare: Guaranteed Health Care for All Legislation
CA has had bills almost continuously since 1994, (see Dan Hodges’s history link on OPS Google drive), but still no laws passed. In 2019, new governor Newsom advocates for Single Payer and sets up 13-member Healthy California for All Commission, as of July 1 replacing a prior Council of 5 with a similar mission. HCA Commission prioritizes “single payer” bolstered by a systematic review published in Jan 2020, in PLOS firmly establishing the feasibility and cost-savings of Single Payer.
CNA and Assemblyman Ash Kalra (and colleagues, noted below with text,) introduced comprehensive, “classic” Single Payer bills for “Calcare” the California Guaranteed Health Care for All" Act--most recently,
2021 AB1400 introduced in Jan, put on hold in April to develop financing
2022, AB1400 reintroduced in Jan, passed by Assembly Health Committee, gets media support, and other but in Jan31 is pulled by Kalra for lack of votes on the full floor.
2023, AB1690 this team continues with a similar bill which doesn't get introduced, but in
2024, AB2200, introduced Feb 7, is amended and sent to Assembly Health Committee in April, where it passes and proceeds to the Assembly Appropriations Committee. The Appropriations Committee report issued in May ignores potential savings and concludes it is too expensive. Bill dies in committee.
Text of the bill, Calcare AB 2200
https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB2200
Principal co-authors: Assembly (of 80) Bryan, Wendy Carrillo, Connolly, and Lee; Senate (of 40) Cortese, Gonzalez; other coauthors: Assembly Addis, Bonta, Friedman, Haney, Holden, Jackson, McCarty, McKinnor, Ortega, Reyes, Luz Rivas, Santiago, and Ting; Senate Becker, Laird
Summary:
Characteristics of the single payer bill
It would enact a single payer health care program (CalCare) for all residents in the state of California regardless of income level, immigration (or documented immigration) status, prior health conditions, or ability to pay. As a state-level version of Medicare for All, it would include medical, dental, hearing, vision, mental health, reproductive, and long term care.
CalCare would provide care guaranteed free at the point of service. Nearly all individuals, families, and businesses would save money with no copays, no deductibles, and no premiums. Patients could choose doctors and providers with no network restrictions.
This system would have huge cost savings through reduced bureaucracy.
Financial analyses:
From: Assembly Appropriations Committee, May 2024 https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202320240AB220
Contrast with UMass PERI analysis, link below (to doc on OPS Google Drive)
Related Information:
Press releases about AB220:
2. Law that outlines the path to Single Payer, lines up political support before drafting the bill:
Another team headed by Healthy California Now and Senators Scott Weiner and Mike McGuire and 6 co-authors (Meinivar, Smallwood-Cuevas, Min, Connolly, Schiavo, Santiago, Chavez-Zbur) outline a political strategy to overcome the power and money of the healthcare industry.
SB770 written and passed and signed by the Governor in 2023.
PowerPoint slideshow by HCN President Michael Lighty explaining the HCN strategy and how it relates to SB 770: https://drive.google.com/drive/folders/15K75glAyX05B_XbfHCQ6WLDldkmZDdmM
The (Healthy California for All) Commission, the forerunner of SB770, outlines these characteristics of the “unified financing healthcare system” (which is basically a description of a single payer system).
A single source would pay for healthcare services for California residents
Services would include physical and mental health, primary and preventive care, dental, vision, addiction and dependency treatment
All Californians will be entitled to receive a standard package of health care services
This package could include Long Term Care Support and Services, which would relieve huge and growing burdens that are falling on millions of families
Entitlement won’t vary by age, employment status, disability, income, immigration status, or other characteristics
Distinctions among Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage will be eliminated within the system of unified financing
HCN has broad support of its heavily labor coalition, but is opposed by CNA and Kalra and his team, who feel more study will delay the implementation of a Single Payer law.
Some of the opposition to the SB770 approach points to the delay caused by its timeline, but also takes issue with their use of the term “unified financing” which seems to many to pull back from the goal of a single payer system. SB770 supporters have added an amended version (April 2023) which includes a reference to Single Payer in the endorsement of the unified financing system.
Both streams are going forward. Calcare and SB770 are mutually compatible, and neither one alone will accomplish full enactment of Single Payer.
Single Payer/Medicare 4 All goals for 2025-26
Work to elect a Governor who supports Single Payer/Medicare for All and doesn’t capitulate to the business sector; follow candidates that support Single Payer, when possible.
More education to business leaders on the savings Single Payer brings and the extent to which it eliminates employers' need to negotiate with health insurance companies yearly.
More focused union outreach, especially to the central labor councils across the state.
More education inside the legislature.
More public education to address the common attacks on Single Payer, including a short video series and speakers’ training.
Work more closely with One Payer States (OPS), (onepayerstates.org) and other national organizations to help restore Medicare as a public system. CA activists recognize OPS’ special focus on state-based initiatives and interest in using the state-based efforts (like ours) as a stepping stone to national Medicare for All.
Grow the size and strength of the coalitions (contact info for CNA approach ( Calcare form ) or the Healthy California Now organizational membership packet Obstacles to Single Payer in the current context
1. Many in California do not yet understand the benefits of SP/M4A.
2. Those with vested interest in the current system, who stand to lose and are thus against SP/M4A, have tremendous resources.
3. In such a big state, the M4A community encompasses a variety of perspectives and effective communication is a challenge.
Advantages for Single Payer/M4A in the current context
1. California Congressman Ro Khanna’s bill HR 6270 State Based Universal Health Care Act of 2023 [https://www.congress.gov/bill/118th-congress/house-bill/6270/text] and Senator Ed Markey’s S4817 [https://www.congress.gov/bill/118th-congress/senate-bill/4817]. By simplifying the waiver process to allow federal funding currently flowing to CA to continue, these bills could reduce the funding burden on the state while still leaving flexibility to develop our own program (as long as the program meets clearly articulated federal standards). <link to the explanation of SBUHCA on OPS website>
2. There’s a sense of urgency from being a leading state for state-based efforts around the country.
3. There is further urgency from the continuing harms to CA residents brought by the fragmented, poorly performing healthcare system currently in place.
4. Compelling studies confirming cost containment and sustainability (as noted above in CALcare AB 2200 description and in Dan Hodges History)
Where can people find news about Single Payer in your state and/or join a group?
California Nurses Association. info@medicare4all.org
Physicians for a National Heath Program
pnhpca@pnhp.org
Heal California (Project of California One Care)