Single-payer and the long game

(Editor’s Note: AB 1690 (Kalra) was introduced on 2/17 as an intent bill)

 It looks like California’s single-payer dreams will be delayed at least another year.

After suffering a devastating blow in the Capitol last winter, advocates had been eager to reintroduce legislation that would create a first-in-the nation, state-run health care system. Speaking to members and supporters Wednesday night, the California Nurses Association said it’s “in talks” with Assemblymember Ash Kalra (D-San José) to introduce a spot bill by Friday’s deadline. That bill, however, would only state the intent of the Legislature to act on the health care proposal. CNA said it will wait to introduce a full bill in 2024.

“The other option was to have no single-payer bill this legislative session at all,” said CNA Government Relations Director Puneet Maharaj.

A quick recap of the last effort— Kalra in 2021 introduced Assembly Bill 1400, which was temporarily tabled over funding questions until the following January. The subsequent down-to-the-wire negotiations brought high drama to the Assembly, ending in Kalra pulling the bill just before a floor vote. At the time, he said he wasn’t confident it had the votes — even with Speaker Anthony Rendon backing it — and didn’t want to alienate fellow Democrats. That move elicited outrage from supporters, including the Nurses Association, which, at the time, accused him of “giving up on patients across the state.”

Wednesday night, Maharaj acknowledged some proponents might be wary of Kalra after last session’s dramatic end, but after conversations with members, there is “broad consensus” that his heart is fully committed to CalCare, Maharaj said. Additionally, he’s also the “only legislator to date who was willing to lead the fight for single-payer in the state Legislature.”

Single payer health-care in California historically has been a hard sell. In the past, lawmakers have balked at the price tag and raised concerns about funding mechanisms. A report from the Legislative Analyst’s Office last year estimated the cost of such a system would be somewhere between $494 billion and $552 billion, and now California is facing the possibility of several years of dour revenue projections.

Organizers say by spreading the efforts over two years, it’ll give supporters more time to talk with lawmakers and assuage concerns, but the opposition is likely to be fierce.

California’s past single-payer health care efforts have faced heavy-hitting opponents, including the California Medical Association and California Chamber of Commerce, but they also have a tendency to pit moderate and progressive Democrats against one another. Left-wing members of the state party last year threatened to pull endorsements for lawmakers who voted against AB 1400.

We can expect those same kinds of factions to emerge as pressure builds ahead of 2024.

“That may seem far away,” Maharaj said. “But that’s going to go by faster than we think.“


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