Single-Payer Healthcare Would Take Years to Develop in California, Legislative Report Says

As progressive activists clamor for California to push ahead a sweeping single-payer health plan, a legislative report released Tuesday cautioned that such an overhaul would take years.

The report, which marks the end of months of Assembly hearings on paths to achieving universal healthcare, lays out a number of options lawmakers can pursue in the near term to improve how Californians get and pay for healthcare.

The report estimated that a healthcare overhaul that would cover all Californians under one system with public financing — including those who are insured through their employer and Medi-Cal or Medicare — would probably be a multiyear process to determine what kind of benefit would be provided. It would include how the system would be paid for, how to overcome state constitutional hurdles and how to obtain necessary permission from the federal government.

“The combination of all those factors led us to think it could not happen tomorrow, even if there were complete consensus in the state” to enact such a policy, said Richard Kronick, a professor of family medicine at UC San Diego and one of three authors of the report.

The findings underscore the key tension in the debate over California’s healthcare future and, specifically, Senate Bill 562, which aims to establish a statewide single-payer program. Claiming momentum and urgent need, proponents want the bill released from legislative purgatory this year.

But Assemblyman Jim Wood (D-Healdsburg), who is co-chair of the Assembly panel on universal healthcare, said the complexity of the current system meant legislators should proceed with caution.

“You can’t just cast this all aside and start over,” Wood said. “That’s why, for me, the idea of short-term things that we could do and a long-range plan is really, really appealing. I think it’s the most realistic way to get us to where we want to be.”

Bonnie Castillo, executive director of the California Nurses Assn., which sponsored SB 562, said the report was a “public disservice” by being dismissive of their proposal.

“The report inflates the obstacles to single payer, all of which are a reflection of lack of political will, the kind of political will California has demonstrated when it wants to in pushing for environmental protections, a gas tax, a carbon tax, a highway system, a world-renown public university system, and other examples,” Castillo said. “Why is the health of Californians such an irrelevant priority to California policymakers?”

The more immediate policy options include expanding Medi-Cal to cover people without legal immigration status, using state money to increase subsidies for those buying insurance on the Covered California exchange and increasing Medi-Cal payments to doctors as a way to increase access to care.

Castillo derided those recommendations as “a deceptive façade, pretending to address the problem, but not solving it.”

The co-chairs did not commit to specific legislation based on the report’s findings but noted they had introduced “spot bills” that could eventually serve as vehicles to enact some of the policy suggestions.

“I would expect multiple proposals that are referenced [as short-term options] will find a place within legislation this year,” said Assemblyman Joaquin Arambula (D-Fresno), also a co-chair of the committee.

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