This week, California lawmakers will take up the latest attempt to get all state residents covered under the same health plan — an idea referred to as single payer health care — that’s been sparking debate at the Capitol for the past five years.
Under the new plan, dubbed CalCare, all Californians would be insured by the same entity and would be able to access any doctor, regardless of network. Supporters argue that this will reduce price gouging and give all residents equal access to care.
AB 1400 is sponsored by the California Nurses Association, who first introduced single payer legislation in 2017. At the time, the proposal had an estimated $400 billion price tag and no funding source.
After it failed, an Assembly committee gathered to discuss options for reforming the state’s health care delivery system. The committee put together recommendations for how to make coverage more affordable and accessible for all Californians, which informed legislation that emerged in the following years.
The new proposal would create a tax to fund the single payer option. The tax would apply to companies earning more than $2 million, businesses with 50 or more employees and individuals making more than roughly $150,000 a year.
Carmen Comsti, lead regulatory policy specialist with the nurses association, says the tax will generate somewhere between $160 and $170 billion annually.
“We are talking about ensuring that everybody gets comprehensive benefits without copays or deductibles,” Comsti said.
Opponents argue that a single payer system eliminates choices for those who might prefer to stay on a private plan, and that legislators should work instead to make sure everyone is insured and that all coverage is affordable — a model often referred to as universal health care.
A coalition that includes the California Association of Health Plans, the California Hospital Association and the California Medical Association issued a release about the new proposal.
“Californians need and deserve a stable health care system they can rely on at all times, especially now,” wrote coalition spokesperson Ned Wigglesworth. “We urge the Legislature to reject this legislation that will risk the health care of the residents of our state when they need it most.”
The coalition also voiced concern about the proposed tax structure being an economic burden to California families.
Comsti said the taxes are necessary to reform an “unsustainable system.”
“We’re already paying for all the costs of healthcare in California,” she said. “With single payer health care, we could pay less overall.”
Gov. Gavin Newsom was a supporter of single payer health care during his campaign, but more recently has been an advocate for options that build off the current system.
Assembly Health Committee Chair Jim Wood (D-Santa Rosa) announced Thursday that he will vote to move the proposal forward, citing frustration with high drug prices, insurance company profits, claim denials and other woes of the current, fragmented health care system.
“People are angry,” Wood told CapRadio. “They're frustrated, they're scared to get sick and the system is broken.”
Wood said the proposal has “a ways to go” and that he will put his concerns in writing for the bill’s author, Ash Kalra (D-San Jose). He said the primary reasons single payer has failed in the past have been cost, and opposition from health plans and other business interests.
He said it’s important to keep discussing all potential solutions, even if they don’t ultimately cross the finish line.
“For me, no is not the answer,” Wood said. “We're going to have to resolve this and we're going to have to make improvements in the system because it's not going to go away.”
Wood is also pushing his own bill, AB 1130, which would establish an Office of Health Care Affordability to analyze spending across the health care system and propose ways to cut costs related to plans, hospitals and prescription drugs.
To move forward, AB 1400 must pass the health committee by Jan. 14 and pass the Assembly by Jan. 31.
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