By Tom Elias
Single-payer health insurance that would cover every Californian has stalled, at least for now. Because Democratic Speaker Anthony Rendon shelved state Assembly consideration of the Senate-passed insurance outline at least until next year, a popular vote on the well-publicized, often criticized single-payer health insurance plan is probably at least three years away, and probably more.
Chances are the idea won’t reach voters before June 2020, if then.
The many Californians who wanted this quickly as a potential defense against whatever changes President Trump and the Republican-dominated Congress might bring to ex-President Barack Obama’s Affordable Care Act will just have to wait. It’s the third time in the last 12 years this idea has been stymied in California despite getting considerable legislative support.
Twice former Democratic state Sen. Sheila Kuehl, now a Los Angeles county supervisor, got a single-payer plan through the Legislature in this century’s first decade, only to see it vetoed by then-Gov. Arnold Schwarzenegger. Her idea – like this year’s plan – was to use existing health insurance premiums as the main funding source. Coverage of the previously uninsured would be paid with the approximately 15 percent of premiums now going to insurance executives and corporate profits.
As before, this year saw a lot of lip service to single payer, sponsored now by Democratic state Sen. Ricardo Lara of Bell Gardens, also a candidate for state insurance commissioner.
Single payer is sometimes called “Medicare for all” because, like federal Medicare insurance covering all those over 65 who want it, the latest plan would have a central clearing house for claims. Payroll taxes would help fund it, also like Medicare.
As was Schwarzenegger, current Gov. Jerry Brown has been skeptical, mostly because of costs. But if this proposal gets no action until after next year’s election, now very likely, Brown’s views will no longer matter much. Current gubernatorial possibilities like Lt. Gov. Gavin Newsom, former Los Angeles Mayor Antonio Villaraigosa or state Treasurer John Chiang might be more favorable, if elected.
Meanwhile, cost estimates vary from about $340 billion to $400 billion yearly, while California and its citizens now spend about $395 billion on medical care. Lara insists his plan could cut many billions from that figure, even though individuals would see a new payroll tax and businesses would pay a new levy. Taxpayers, he said, would save money via a halt to all premiums, deductibles, co-pays, doctor and hospital bills to the uninsured – including undocumented immigrants – and an end to employer payments for health plans.
In the end, had the Assembly and then Brown approved the Senate-passed outline this year, voters would likely have decided the issue as early next June. This won’t happen now, in large part because all details of what Lara wanted were never certain, giving Rendon and others cold feet. But single-payer has the possibility of ending up a lot like the system Canada now has, one that some Canadians swear by and others swear at. That country experiences vast differences by location in the speed and competence of medical care.
Californians have previously voted just once on single payer, defeating the idea in 1994. But times are different now. Millions here gained insurance under Obamacare. Who knows how they might vote if Congress and Trump take away much of their coverage?
As with the 1994 California ballot proposal, Lara’s measure could have eliminated companies like Blue Cross, Blue Shield and HealthNet.
So far, surveys say the vast majority in this state wants health care for all. But a similar majority also wants no new taxes. The problem is that the twain probably cannot meet.
What’s more, opponents already argue the quality of health care would decline under single payer, even though it has not under Medicare. Reality, though, might not matter if enough advertising money were spent to push the idea of lower medical quality.
If it ever reaches them, this just might be the most idealistic plan ever put before California voters. It would also be one of the easiest for opponents to attack. And there would be plenty of well-funded opponents, starting with insurance companies desperate to preserve one of their largest markets.
The bottom line: If you lose all or part of your health coverage because of Republican-led changes, California won’t soon bail you out.