Single-payer health care in California has no chance this year.
Even in this dark blue bastion, Democratic lawmakers have shied away from legislation that would put state governments in charge of health care and tax Californians heavily — a massive shift that would force them to contend with a strong health care industry.
Gov. Gavin Newsom pledged to spearhead single-payer when he ran for governor four years ago, but his refusal to publicly support it this year shatters its chances.
Instead, the first-term Democrat, who is running for re-election in November, is pushing for “Healthcare for All,” which aims to insure all Californians but, unlike single-payer, will keep private health insurance intact.
Newsom’s retreat destroyed progressive activists and the powerful California Nurses Association union that supported the cause. The death of a single-payer in the nation’s most populous state has also dealt a major blow to similar movements elsewhere in the country — which have turned to California for inspiration and leadership — casting doubt on their ability to succeed.
“We are also fighting in New York, but like in California, there is no 100 percent Democratic consensus among lawmakers,” said Ursula Rozum, co-director of the New York Movement for Health, who is working to pass single-payer legislation. Rozum) said. “It feels like a constant question, ‘Can we win?'”
Health policy experts agree that California’s failure to adopt a single payer has dented momentum across the country.
“California has been a leader in progressive policy given its size and politics, so this definitely sends a signal to other states that there are How difficult.”
But instead of giving up, Rozum and single-payer activists in Colorado, Washington and elsewhere say they have learned an important lesson from California’s failure: Winning and keeping the governor’s support is critical. Groups pushing for a single payer must unite Democrats and bring in broader support for business-friendly moderates and organized labor. They say they must learn how to counter the fierce lobbying by doctors, hospitals and health insurers to maintain the status quo.
“We’ve seen what’s going on in California, so we’re trying to get our governor on the record to support single payer so she’ll sign it when it gets to her desk,” Rozum said. “Just like there, our union movement is divisive. We know we need them to have every opportunity to advance our bill.”
So far, single-payer proponents have been unable to expand their movement beyond liberal activists or convince people they should pay higher taxes in exchange for eliminating Medicare premiums, deductibles and co-pays Forehead.
Vermont, the only state through a single payer, did not implement it.
Vermont adopted the single-payer program in 2011 with the explicit support of then-Governor Democrat Peter Shumlin. But he abandoned the effort in 2014 amid growing concerns about tax hikes and runaway health care costs.
“There is no political party in the world that raises its hands every year to raise taxes on hard-working citizens,” Shumlin told KHN. “That was my big mistake in Vermont.”
But the single-payer progressive dream didn’t go away when Vermont retreated. When Vermont Sen. Bernie Sanders saddened it during his presidential campaign, “Medicare for All” became a liberal slogan for Democrats across the country.After President Joe Biden was elected, the movement moved to the states, in part because of Biden Oppose Medicare for All.
Activists in Colorado are mobilizing another single-payer movement overwhelming failure Failed 2016 Vote Initiative Partly due to backlash from the healthcare industryOrganisers in Washington state are pushing for legislation and trying to get a single-payer initiative on the ballot next year.
Democrats must be prepared to take on deep-pocketed industry groups and rein in soaring health care spending — or they face political difficulties with ever-increasing taxes, Shumlin said.
“California is the best state to lead this trend because it has the fifth largest economy in the world. It’s all about scale,” Shumlin said. “If California does it right, other states and the federal government will follow suit. But it’s hard, so prepare to bleed.”
Some Democratic lawmakers and the California Nurses Association had hoped that California would lead the way this year, and Newsom would be their advocate.
State Assembly Member Ash Kalra (D-San Jose) Introduced legislation sponsored by unions This would create government-operated health insurance for all state residents, while substantially raising taxes for employers, employees and businesses to pay for coverage.State estimates place the cost roughly at $360 billion per yearless than half of which came from tax increases and the rest from the federal government.
On Newsom’s first day in office in 2019, he said, “I’m committed to this, and I want people to know I’m serious.” But since then, he’s distanced himself from single-payers.
Instead, he created a committee to study the concept and asked Biden administration Get permission to collect federal funds flowing to the state through the Affordable Care Act, Medicaid and Medicare that California can use to help fund the single-payer system. But Biden cannot simply grant the request — California requires complex federal waivers and congressional approval.
Newsom has turned to a “Healthcare for All” platform that includes Medicaid for all income-eligible undocumented immigrants and a state-funded subsidy for Californians who buy health insurance from Covered California, the state’s Obamacare insurance exchange.
Newsom said in January that he had always believed a single payer was “inevitable,” but suggested the federal government should take the lead.
Carla decided not to bring his bill to the state legislature for a vote, saying on Jan. 31 that he could not get enough support.
“Getting the votes you need becomes more difficult when I’m trying to convince my colleagues that there is an absolute path to success,” Kalra said. “We have a governor running for single-payer, and if we’re going to be successful in having single-payer health care in California, at some point we need his involvement, and it has to be sincere.”
Kara said he was considering another bill next year, but acknowledged he would have to change tactics to get more Democrats and unions in the race.
These are lessons other states are heeding.
“There’s no question that if California passes a single-payer health care plan, we’re going to say in Washington state, ‘Look at what California’s doing,'” campaign director Andre Stackhouse said. all of Washingtonan advocacy group trying to get a single-payer initiative on the ballot next year.
Stackhouse represented California’s single-payer campaign this year, helping with a phone-banking campaign to pressure lawmakers. He’s a member of a new national coalition called Medicare for All Everywhere, a coalition of organizers and volunteers working to find out why single-payer efforts are failing and how to overcome political and lobbying hurdles.
California is a key test, he said. “We’ve seen all the ways Democrats can kill a bill, but we can’t spend all of our time grieving this loss and huge setback,” Stackhouse said.
For example, a major goal of the movement is to persuade more unions to join the fight.although Nurses unions are leading the fight In California, other unions oppose single payer.
“As union members, we believe that everyone deserves health care, but we’re very concerned that we’re going to lose the benefits we have,” said Chris Snyder, political director of the local Union of International Operations Engineers in Northern California. “We have our own health care trust fund and we don’t want the benefits we’ve fought for decades to be stripped or watered down.”
Lack of union support is a major problem in New York, where Congressman Richard Gottfried, a Democrat, has introduced a single-payer bill in every legislative session for the past 30 years.
“What’s preventing this bill from passing through the legislature is opposition from public employee unions,” Gottfried said. “They think they’ve negotiated excellent coverage, so we need to convince them that the New York health law As good or better than what they have now.”
Gottfried said he has been negotiating legislative language with teachers, sanitation workers and other unions to provide “clearer assurances” that union members will receive better coverage without having to pay more than they already have. more out-of-pocket costs.
It is unclear whether the measure will get a vote this year.
“Whichever state goes first will help build momentum for the other states,” he said.
This story is made by KHNrelease California Healthlineeditorial independent service California Healthcare Foundation.
Photo: wenmei Zhou, Getty Images
