Still, Monday’s debate will likely be dominated by concerns about cost. The latest estimate says it would cost taxpayers at least $356.5 billion a year to pay for health care for nearly 40 million people. California’s total operating budget — which pays for public schools, courts, roads and bridges and other important services — is about $262 billion this year.
Earlier this month, Democrats filed a proposed amendment to the state Constitution that would impose steep new taxes on businesses and individuals to pay for the system. The taxes would generate about $163 billion a year, and the amendment would give lawmakers the power to raise those taxes to meet the costs.
Proponents hope the two proposals – the bill to create the system and the bill to pay for it – will move forward together this year. But Monday’s deadline is only for the bill that would create the system. Still, that hasn’t stopped naysayers from linking the two issues.
“A vote for this bill is naturally a vote for the taxes that come with it,” said Preston Young, policy advocate at the California Chamber of Commerce, who leads a coalition of 130 companies against the bill. “Health care costs continue to rise, so the related tax liabilities will also rise.”
Proponents say Californians and their employers already pay exorbitant amounts for health care through high deductibles, copayments and monthly insurance premiums. This bill, if it becomes law, would eliminate them all and replace them with taxes.
“Of course there is sticker shock. But there should be sticker shock for how much we’re paying now,” said Stephanie Roberson, director of government relations for the California Nurses Association. “What do we get? People are still uninsured. People are still underinsured. People have to reach tens of thousands of dollars in deductibles. We will eliminate that as part of this program.
Today, many people pay for the California healthcare system, including patients, insurance companies and employers. The bill before the Legislative Assembly would change that to one payer – the government. If passed, it would destroy the private health insurance market. Private health insurance would still be allowed, but only for services not covered by the government.
Progressives have long dreamed of a single-payer health care system in the United States, believing it would control costs and save lives. But that never happened. Vermont adopted the nation’s first single-payer health care system in 2011, but later abandoned it due to cost. Proposals to Congress came to nothing.
In California, voters overwhelmingly rejected a single-payer system in a 1994 ballot. State lawmakers tried again in the 2000s, twice passing single-payer legislation to make both bills of law are opposed to the veto of the government of the time. Arnold Schwarzenegger, a Republican. Another attempt in 2017 passed in the Senate but died in the Assembly.
Voting this year won’t be easy, even in famed liberal California. Although this bill has the support of some Democratic leaders and powerful unions, it is meeting intense opposition from business groups who are pressuring more moderate Democrats not to vote for it.
The bill needs 41 votes to survive Monday. Democrats hold 56 of the 80 seats in the Assembly. But they are missing three of their most liberal members who have recently quit to take other jobs, leaving little room for defections.
So far, supporters haven’t gotten a boost from someone they thought was an important ally: popular Democratic Gov. Gavin Newsom. Newsom campaigned for universal health care during his 2018 gubernatorial run. But since taking office, Newsom has focused primarily on expanding access to insurance coverage.
Newsom said he still supports a single-payer system. A commission he set up to study the idea is due to publish its report later this year. But Newsom remained silent on this latest proposal before Monday’s deadline.
“What we need right now is the governor’s support on this bill,” Roberson said. “We welcome him to deliver on his campaign promise.”