The California State Assembly blocked action on a bill that would have guaranteed medical coverage to every resident of the state through a single-payer health care system days before the 31 January. In light of this, public health experts expect the national debate over health care reform could lead to the development of similar bills that would close the gap among uninsured Californians.
Assembly Bill 1400 (AB 1400), also known as the California Guaranteed Health Care for All Act, would have created a publicly funded health care system called CalCare. The system would be run by nine voting members appointed by the California Secretary of Health and Human Services who are well established in state health care and the medical field.
California State Assemblyman (D-San Jose) Ash Kalra moved to revoke the bill’s floor vote after predicting it was ‘double digits’ below the 41 threshold votes needed for it to be adopted. Kalra declined multiple requests for clarification on his decision and whether or not he would seek another path forward for his proposal.
“Despite strong opposition and substantial misinformation from those who could profit from our current healthcare system, we were able to chart a realistic and workable path to single payer and bring AB 1400 to the Assembly,” Kalra said. in a press release. by the Los Angeles Times. “However, it became clear that we did not have the necessary votes to pass and I decided the best course of action was not to put AB 1400 to a vote today.”
Passing the bill would have put California on the path to establishing the first single-payer health care system in the United States. Unlike universal health care, claims for health coverage under single-payer systems are covered by a single entity – under AB 1400 they would have been covered by the California state government.
CalCare would have provided a wide range of benefits that merge current federal and state provisions into a single program, including, but not limited to, the federal children’s health insurance program, Medi-Cal. Under current circumstances, approximately 2.5 million California residents are not covered due to high insurance costs. All California residents are eligible for CalCare benefits, regardless of any pre-existing conditions or current immigration status.
While single-payer systems are often funded by tax revenue, most countries have used a mixed model in which the government pays some of the nation’s claims. Only Canada, South Korea and Taiwan have true single-payer systems, while other countries like Germany, Spain and other European countries have a mixed system of public and private funding.
The bill was defeated in the State Assembly primarily on the basis of a tax increase. The Tax Foundation, an independent tax policy nonprofit, found that AB 1400 taxes would raise taxes by $12,250 statewide, nearly doubling California’s tax revenue. Imposed taxes would also have required voter approval.
Although there is no direct study of the tax impact of single-payer on Americans, the Fraser Institute in Canada does an annual estimate of the cost of its single-payer system. The reported cost of public funding ranges widely from $3,789 for a single person to $12,055 for a two-parent household with one dependent. A family of four pays an average of $11,735 in taxes for health care in Canada.
The bill has also become a hot topic among powerful interests and partisan circles. The California Chamber of Commerce called AB 1400 a “job killer” shortly after its introduction early last month, signaling that defeating it would be a top priority. The lobbying campaign has been led by dozens of insurers, industry groups and associations representing doctors actively speaking out against the “crippling tax increases” needed to fund the system.
Some medical groups such as the California Nurses Association supported the bill and condemned the motives of the representatives who voted against it.
“Assembly Member Ash Kalra, the lead author of the bill, chose not to vote on this bill at all, providing cover for those who would have been forced to publicly state their position,” said wrote the union in a press release. statement reported by the Sacramento Bee. “Nurses denounce this failure of elected officials to put patients before profits.”
Republicans like Republican Assembly Leader Marie Waldron of Escondido have built AB 1400 to become a major issue for this year’s midterm elections. Embodying an anti-tax hike message, House Republicans presented a 4,000-page petition signed by voters who opposed AB 1400 in the House for the House Republican leader to use as his accessory during the floor debate.
“Even though this plan is dead for now, every Democrat who backed it will have to answer for their efforts to end Medicare, kick 20 million Californians out of their existing plans, demand the biggest tax hike in America. history of the state and entrusting health to the bureaucrats. care,” Waldron said in a statement. “Thank you to the 4,900 hard-working Californians who signed our petition to stop this bill. Your voices have been heard and made a difference.
Researchers from UC San Francisco, UCLA, and UC Berkeley reviewed 22 economic analyzes from various organizations evaluating national and state single-payer plans, including proposals in California, Maryland, Vermont, in Minnesota, Pennsylvania, New York and Oregon. The researchers ultimately found that 19 of the 22 models predicted net savings after single-payer plans were introduced, averaging 3.5% of total healthcare expenditure per year.
“Even though they start with different unique designs and modeling assumptions, the vast majority of these studies all arrive at the same conclusion,” said James G. Kahn MD, MPH, professor in the Department of Epidemiology and Biostatistics at the UCSF, and Fellow of the Philip R. Lee Health Policy Institute. “This suggests that fears that a single-payer system will increase costs are probably ill-founded.”
Although Kalra is uncertain about the future of AB 1400, California Governor Gavin Newsom has pledged to implement a single-payer healthcare system and is awaiting a report from California’s Health California for All Commission detailing the different models of health care that the state could pursue in the future.
“The facts are on our side that a single-payer system will save money and lives – and the people are on our side that meaningful health care reform is urgently needed,” he said. reassured Kalra. “Especially with four vacant Democratic seats in the Assembly, the votes weren’t there today, but we won’t give up.”
Photo courtesy of Alexander Olsen for The UCSD Guardian.