California’s single-payer health care proposal faces crucial vote

The asterisk: A.B. 1400 doesn’t include how the state’s new health care system would be financed

By Soumya Karlamangla

The New York Times

Editor’s note: Assembly Bill 1400 was pulled from Monday’s agenda and not voted on by members of the assembly. According to the bill’s author, Ash Kalra (D- San Jose), the legislation was pulled because “we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today.”

For years, the single-payer health care movement has found traction in California.

In 1994, a proposal that would have replaced private health insurance with a government-run system made the ballot, although it failed to garner enough votes. In 2017, a similar overhaul passed in the state Senate. The following year, Gov. Gavin Newsom made a campaign pledge to create the nation’s first single-payer system at the state level.

Now, yet another such proposal is being put to the test in the Golden State.

Assembly Bill 1400 would create CalCare, a publicly financed health care system that would provide coverage to all Californians, similar to the way that medical treatments are delivered in Britain or Canada. The bill must garner a majority in a state Assembly vote Monday to have a chance of survival.

The proposal from Assemblyman Ash Kalra, a Democrat, would create a nine-person board to govern CalCare and would eliminate the fragmented ways in which California residents currently receive health care — and the co-pays and deductibles that often go along with them.

If enacted, the changes would make California the only U.S. state with a single-payer health care system. Vermont approved one in 2011, but the plan fell apart before it was implemented.

There’s an asterisk next to California’s big plans, though. A.B. 1400 doesn’t include any information about how the state’s new health care system would be financed.

A recent legislative analysis estimated it could cost between $314 billion and $391 billion annually. Supporters say that price tag, while high, would still be lower than what employers and Californians currently pay for private insurance.

Still, the state would need funding to get the system up and running. And the details for how California will come up with that money aren’t included in A.B. 1400 — they’re in a separate, accompanying bill that has yet to come up for a vote.

That bill, Assembly Constitutional Amendment 11, proposes a tax hike on businesses, large companies and the wealthiest Californians to fund the single-payer system.

It faces many obstacles to approval. It would need to pass the Senate and Assembly and then go before voters, something that Kalra said was not likely to happen before 2024, The Los Angeles Times reported.

In other words, no matter what happens Monday, supporters of single-payer health care in California still have a long road ahead of them.

This article originally appeared in The New York Times.

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