Newsom Aims to Remake Health Council Into Single-Payer Commission

Gov. Gavin Newsom is proposing to gut California’s new Council on Health Care Delivery Systems and remake it into his own single-payer commission, according to a summary of the plan obtained by POLITICO, as health care advocates jostle for position in California’s single-payer debate.

The Newsom administration will propose changing the scope, mission and timing of the existing council, which was spearheaded by Assembly leaders and signed into law last year by former Gov. Jerry Brown. The administration will re-name the panel the “Healthy California for All” commission and focus it solely on how California could begin the transition toward single-payer under a future Democratic president, according to the summary, which was provided to POLITICO by Newsom’s office.

The move is likely to win backing from advocates who feel the current council is moving too slowly on single-payer, including the California Nurses Association. The nurses have ceded primary leadership of the coalition that drove the failed 2017 single-payer effort in Sacramento — Healthy California — amid disputes over political tactics and 2019 legislative strategy.

Newsom campaigned in favor of a single-payer plan, but has sought to tamp down expectations since taking office. The summary document outlines his latest strategy.

Newsom will still work to build a single-payer plan in California, according to his administration, and intends to do so from the governor’s office. In the late days of his 2018 gubernatorial campaign, he voiced concern about separate pushes bubbling up on single-payer, in the Legislature and among advocacy groups, and said any major proposal would be led from “the horseshoe,” referring to the executive branch.

The new commission would lay the groundwork for a single-payer plan and would work on a shorter timeline than the council created under Brown, according to the document. The panel would:

—Analyze California’s existing health care delivery system, including issues surrounding cost, quality, workforce and provider consolidation trends — and how they impact access.

—Develop recommendations on steps California can take to prepare for the transition to a single-payer financing system.

—Develop recommendations for key design options under a single-payer system.

Newsom in January submitted a federal request for an innovation waiver that would allow California to retain federal health care dollars needed to finance a single-payer system. As part of his new plan, he also has directed his administration to further analyze what changes would be required under federal or state law to preserve and capture federal funding, according to the document.

The plan does not discuss how new membership would be organized, when members would be assigned or a specific timeline for reporting.

Newsom will pursue the commission overhaul “legislatively,” said Newsom spokesperson Nathan Click. He will propose changing the current statute approved last year under CA AB1810 (17R), which created the Council on Health Care Delivery Systems with a $5 million budget and a mission to “develop a plan that includes options for advancing progress toward achieving a health care delivery system in California that provides coverage and access through a unified financing system for all Californians.”

Newsom is expected to take concrete action before July 1, the date by which the current council is required to meet.

The current council is charged with submitting a report to the governor and Legislature on or before Oct. 1, 2021 that outlines a “timeline of benchmarks and steps necessary to implement health care delivery system changes.” It was spearheaded by Assembly leaders last year, including Speaker Anthony Rendon, Assemblyman Jim Wood, (D-Santa Rosa) and Assemblyman Joaquin Arambula, (D-Kingsburg). It followed a series of lengthy health care hearings between October 2017 and February 2018 that sought to identify challenges in the current delivery and financing system, and with establishing a future single-payer system. Its final report, published last March, came nine months after Rendon shelved CA SB562 (17R) because it lacked a financing plan.

Rendon made his appointment to the council last week. Lizelda Lopez, spokesperson for Senate President Pro Tempore Toni Atkins, said last week that Atkins hasn’t yet decided when she’ll make her appointment, and Newsom administration officials didn’t respond to requests on timing for his three appointments. The new strategy raises questions about whether Atkins will make her appointment.

Since taking office, Newsom has said that California can’t achieve such a plan under President Donald Trump. Newsom has pushed a health care agenda that seeks to transform drug pricing schemes, expand Obamacare subsidies for low- and middle-income people, extend Medi-Cal to undocumented young adults and restore a state-based individual mandate requiring everyone to have coverage or pay a tax penalty.

The Council on Health Care Delivery Systems is seen by some advocates as the key mechanism for moving in the direction of single-payer. But the California Nurses Association has blasted the current council, saying it doesn’t have a specific single-payer focus, and has pushed behind the scenes for an alternative single-payer commission.

“We will be taking the temperature of the Legislature in the coming weeks to see what proposals arise, and we hope we can be in conversations about a true single-payer commission that builds the necessary building blocks toward getting to that system,” Stephanie Roberson, chief lobbyist for the CNA, told POLITICO Sunday following a joint board meeting in Alabama of the state nurses union and its national organization, the National Nurses United.

The nurses recently splintered from the Healthy California coalition, the driving force behind the 2017 single-payer bill. The nurses wanted to see a new bill this year, while the coalition has pushed for the existing council to tackle a more piecemeal, pragmatic approach.

Though the Nurses Association is still involved at the board level, it is no longer steering the organization.

Sal Rosselli, president of the National Union of Healthcare Workers, said the union is now taking charge of the coalition’s single-payer advocacy effort, and will reorganize it with a new political strategy. Its major focus, he said, is to steer their advocacy for single-payer through the health care council created under Brown.

Its goal is to “liberate California from the stranglehold of the health insurance companies and the pharmaceutical industry, to end the opaque and exorbitant pricing practices of California’s giant hospital chains and to delivery guaranteed health care to all of our state’s residents,” according to its new mission statement.

“We want to work more constructively to accomplish our goals,” Rosselli said in an interview. “The nurses have a different focus. … I absolutely disagreed with their tactics with the speaker. At times, we weren’t on the same page.”

The Healthy California coalition is looking to expand its reach and power, enlisting more unions and other groups and charging $25,000 per year to join.

“It’s an ask we’re making of organizations that have the resources,” Rosselli said. “We’ll be bigger, represent more people and have more resources to do the actions needed down the road.”


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