Issue:  Vol. 48 / No. 12 / 22 March 2018

Online Extra: Political Notes: Prognosis not good for CA single-payer health care, say health experts


Hoover Institution Fellow Lanhee Chen, Ph.D., spoke to attendees at a USC journalism fellowship program about health care issues. Photo: Matthew S. Bajko
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Health care experts say the prognosis is not good for California creating a single-payer health care system this year, even as fears grow over the impact of Republican federal lawmakers' plans to gut the Affordable Care Act.

Gay state Senator Ricardo Lara (D-Bell Gardens) and lesbian state Senator Toni Atkins (D-San Diego) last month introduced their Californians for a Healthy California Act (Senate Bill 562), which is backed by the California Nurses Association, to jumpstart the process of creating a universal health care system that would cover all 39 million Californians, including the estimated 3 million undocumented immigrants living in the state.

They have yet to release a more detailed plan for how the state would achieve that goal but have pledged to do so in the "weeks ahead."

"Access to affordable and quality health care is not only critical, it should be a right for everyone in California," stated Atkins. "In light of threats to the Affordable Care Act, it's important that we look at all options to maintain and expand access to health care. The Healthy California Act is an essential part of that conversation."

Added Lara, "We need to have this conversation now while hundreds of thousands of people are speaking out in support of health care. With Republicans on the brink of rolling back health care it's time for California to lead. I look forward to bringing a bill that Californians can support and the governor will sign."

Past attempts to do so have failed in California, such as when voters rejected a statewide ballot initiative in 1994. And out former lawmakers have seen opposition from insurance companies and other special interests sink their past legislation.

Former Governor Arnold Schwarzenegger twice vetoed bills carried by lesbian former state Senator Sheila Kuehl, now a Los Angeles county supervisor. And gay former state Senator Mark Leno (D-San Francisco) saw his 2012 bill to establish a single-payer health care system pass out of the Senate only to die in the Assembly.

Speaking during a multiday program held earlier this month for journalists taking part in the University of Southern California Annenberg Center for Health Journalism's 2017 California Fellowship, several health care experts from differing political backgrounds questioned if the latest proposal would garner enough political support this year.

"I still don't put good chances on it passing. There are a lot of big interests lined up against it," said Michael Lujan , who helped establish Covered California, the state's health insurance exchange begun under the ACA, as its director of sales.

Lujan is now the chief sales officer of Limelight Health, a Silicon Valley startup he co-founded. He noted other states that have tried to create single-payer systems have encountered problems in doing so.

Colorado voters in November rejected a 10 percent payroll tax that would have paid for a state-run universal health care program. Vermont ended its single-payer system in 2014 three years after its implementation due to ballooning costs for small businesses.

"People want it but don't want to pay for it," said Lujan.

Lanhee Chen, Ph.D., the David and Diane Steffy Research Fellow at the Hoover Institution at Stanford University who advises Republicans on health care issues, outright dismissed the idea of single-payer as being too costly.

"Show me a place where it has worked sustainably with the added expenses," said Chen. "Vermont had to pull back because they couldn't tax people enough to pay for it."

Should such a system be implemented in California, he suggested he would relocate elsewhere.

"I am a big believer in the fact we have a federal system of government that says states should experiment," said Chen, though he added, "If voters in California decided to go with a single-payer system, it makes it much less attractive for me to live in California."

Peter Long, the president and CEO of the Blue Shield of California Foundation, also expressed doubts about "putting faith" into a single-payer system, as he said it "doesn't solve all the underlying issues" involved in providing people health care.

Nonetheless, Lujan said the debate over creating universal health care in the Golden State should be had.

"I can't defend why we shouldn't have the discussion. We have medical bankruptcy even post the ACA. Other countries don't," he said, adding, "In the U.S. we are proud of some strange things, like a medical system that doesn't work."

Noam Levey, a reporter for the Los Angeles Times who covers health, said the state law's chances for passage are likely tied to what happens with the efforts in Washington, D.C. to replace the ACA, commonly known as Obamacare, with the House GOP's American Health Care Act.

Through Covered California, 1.2 million Californians signed up for health care on the state exchange, while an additional 3.7 million state residents gained coverage through the expansion of Medi-Cal, the state's Medicaid program. People in both groups are now at risk of losing their insurance under the AHCA.

"If the Republican bill passes, if not single-payer there will be serious discussion in California on if the state can maintain what Obamacare did," said Levey.


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Got a tip on LGBT politics? Call Matthew S. Bajko at (415) 829-8836 or e-mail


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