The Ball Is Back In Newsom’s Court On Single-Payer Health Care In California

The ball is back in Gov. Gavin Newsom’s court when it comes to creating a single-payer health care system in California. In January, when Newsom was asked if he supported a bill to create a universal, government-run health care system in California, he dodged the questions, saying he was waiting for a report from a state commission studying the issue.

On Monday, the commission finalized that report, which found that health care costs will skyrocket by 30% in nine years under the current system and advocates an overhaul that would eliminate distinctions among private and government coverage, in favor of a new system to provide health care to all Californians.

The Democratic governor has long said he supports creating such a system in California but has not endorsed specific legislation to do so. Now that the report is out, it’s not clear what steps he may take to get there.

“We have been following the progress of the commission’s work, and look forward to reviewing and discussing the final report with the Legislature and stakeholders,” Newsom spokesman Alex Stack wrote in a statement. He pointed to other ways the governor has worked to expand health care access, including by expanding eligibility for the state’s health coverage to more undocumented immigrants.

Newsom’s secretary of Health and Human Services, Dr. Mark Ghaly, chaired the commission and committed in the report to assign staff to coordinate with President Joe Biden’s administration. That’s a significant step toward overhauling California’s health care system, advocates say, because the state would need approval to repurpose the billions of federal dollars that flow into the current system.

“That’s really the key next step, and depends upon the governor’s leadership,” said Michael Lighty, a consultant working with the National Union of Healthcare Workers to advocate for a single-payer system. “This is really a new day for health care reform in California.”

The commission’s report stops short of explicitly endorsing a universal, government-run health system in California, as proponents of so-called single-payer health care had hoped, and instead leaves the door open for private health insurers to have some role in a new system. But the report does endorse a major shakeup to a “unified financing” system. The report outlines several options for how that system could look, including a “single-payer” system that would eliminate private insurance.

Carmen Comsti of the National Nurses United union, was the lone commissioner to vote against sending the report to Newsom and the Legislature on Monday, arguing it didn’t go far enough in specifically recommending to the Legislature how to implement single-payer in California.

“This report falls short of presenting clear, concrete, formal actions to get us to single-payer,” she said. “We bury the lead on single-payer and its benefits. The report scarcely uses the phrase single-payer at all.”

Newsom has long said he supports a single-payer system. Since taking office, however, he has not endorsed legislation to transition to single-payer, but has taken other steps toward expanding health care within the existing system.

He said in January that he believes it’s “inevitable” that the United States will transition to a single-payer system eventually, but stopped short of laying out a plan for how he would work toward it. He pointed to the commission’s report as a critical next step.

Any overhaul of the health care system will meet major resistance from many parts of the industry. That was illustrated earlier this year when a coalition of health care organizations and business groups, including the California trade groups representing doctors, hospitals and health insurance plans, came out in fierce opposition to a single-payer bill in the Legislature.

The bill, AB1400, was shelved by its author before coming up for a vote on the Assembly floor.

Ned Wigglesworth, a spokesman for the coalition, said the group is still reviewing the commission’s report and doesn’t want to comment yet. Previously, however, the group blasted the concept of single-payer health care. During the debate over AB1400, the coalition wrote that it would “immeasurably disrupt the health care that millions of Californians rely on every day” by forcing them all onto a government plan.

Anthony Wright, executive director of the consumer advocacy group Health Access, told The Chronicle he thinks the report could have made clearer recommendations on how to implement single-payer. Wright, who supports transitioning to single-payer and voted in favor of the report, said it’s still a significant step.

He said the discussions with the federal government that Ghaly commits to in the report are particularly consequential. In the meantime, he said there are many piecemeal steps the Legislature can take toward expanding health care access to more people and laying the groundwork for a big transition that will take many years.

“It would be a mistake to think there’s just going to be one bill. … This is too big a project,” he said. “There’s some fairly big conceptual pieces that need to pass the Legislature. It can’t all be done piecemeal, but I think it needs to be an iterative process.”



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