Friday, June 2, 2017

The Golden (State) Road To Single-Payer

California's state Senate has moved forward with a single-payer health care framework plan, the first step in what would be the largest change to the American health care market since Obamacare was signed in 2010...but there are still a lot of potholes on this road and the biggest roadblock may be Trump.

As a legislative deadline loomed, California senators Thursday — in some cases, reluctantly — voted to pass a $400 billion plan to create a government-run health care system without a way to pay for it. 
Senate Bill 562, by Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego, passed 23-14 and will now advance to the Assembly, where it will likely be amended to include taxes. And that would mean the measure would require two-thirds votes in both chambers. 
“What we did today was really approve the concept of a single-payer system in California,” Lara said in an interview after the vote.

The California Nurses Association, the bill’s lead sponsor, has pushed the proposal hard, organizing demonstrations at the California Democratic Convention last month and promising to “primary” incumbent Democrats who don’t jump on board. On Wednesday, a study commissioned by the nurses concluded that Californians could save tens of billions of dollars annually under such a system through lowering of drug prices and elimination of administrative overhead. 
Most California families and businesses, the University of Massachusetts study said, would pay less for health care than they do now, even with the new taxes, because they would no longer pay premiums, deductibles or co-pays.

That's the good news.  The bad news...

A Senate committee analysis released last week, however, estimated that the state would have to raise $200 billion in revenue each year, which it said could be done through a 15 percent payroll tax. 
Republicans argued forcefully against the bill, questioning its cost and the very idea of a government-run program. 
“How do we possibly pay for this thing?” asked Sen. Tom Berryhill, R-Oakdale.
Sen. John Moorlach, R-Costa Mesa, said he felt like he was in the car with “Thelma and Louise.” 
“Colleagues, cliff dead ahead,” he said.
Lara acknowledged the bill was “a work in progress.” One of the many big questions left unanswered in the thin, 38-page proposal is whether the federal government would permit California to use existing Medicare funding for such a plan. The state also doesn’t know whether Congress will slash health care funding by repealing the Affordable Care Act.

It’s also possible that voters might need to approve such a change because of a rule called the “Gann Limit,” a 1979 statewide measure approved by voters that limits the growth in spending of the state and local governments. 
The vote put Democrats in an awkward position, and a number of lawmakers made that clear on the floor. 
Sen. Ben Hueso, D-Chula Vista, said he could not support the proposal because it lacked so much detail that if it passed, the Senate would be “kicking the can down the road” to the Assembly, where, he predicted, it would die. 
“The people of our state deserve a more substantive discussion,” he said. “I don’t know what I’m voting on.”

I'm glad California is starting on making the process of single-payer work for 40 million Americans, but the reality is California Republicans most likely have the votes to kill this right now.  That may not be the case in 2018, but that brings us to whatever Trump and the GOP does with healthcare, almost assuredly massive cuts to California's federal Medicaid allotment or even legislation or an executive order that outright prevents Medicaid money from being used for California's program at all. And then there's the real issue of having to hold a referendum for this, something that I think that Republicans can terrify voters, especially older ones, into killing for them.

There are still a lot of massive obstacles to get California to single-payer, but if any state can do it, it's this one.

I'll keep an eye on this for sure.

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