Many conservatives oppose the single-payer approach. "We have come to value and expect a health care system that has private-sector market elements,” said Lanhee Chen, a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.
A single-payer system would need federal approval and likely have to overcome other bureaucratic hurdles even if approved in the state. As it stands, no state has such a system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn't figure out how to finance it.
Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks. One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program costing about $200 billion each year. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.
Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C. "The ACA created more familiarity with being insured," said Kuehl. "They’ve recognized the value."
Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say. "California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA," said Jerry Kominski, director of the UCLA Center for Health Policy Research."It would take decades to get back to where we are now," he said.
In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one. For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few "outliers" who wouldn’t support raising new revenues.
Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.
One option, according to Newsom's office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.
Newsom has acknowledged, however, that the San Francisco approach would not necessarily work in every county, and said he is open to other possibilities.
Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.
Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.
"We have to be able to move on multiple tracks at once," said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.
The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. Some Republicans favor an approach in which each state decides on its own coverage system, within certain limits.
That could mean a retraction of coverage in some states, but in California it might open the door to a new model.
"It is possible that some liberal-leaning states are going to do things that we didn't think possible before," Oberlander said.
Grasping For The Middle Ground On Obamacare: A University of Southern California professor says conservatives and liberals should split the difference: Scrap the exchanges and expand Medicaid. (Emily Bazar, 4/14)
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- A Conundrum: Preserving Fertility When It Is Threatened By Life-Saving Medicine
- Executive Order - - - Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal
- Eliminating the Statute of Limitations for Rape and Related Crimes in California
- On The Trail: Bernie Calls for Free Tuition Despite Opposition
- Few Uninsured Know Date of Pending Deadline for Obtaining Marketplace Coverage; Many Say They Will Get Coverage Soon, Though Cost is a Concern
- Bills Passed, Introduced: Reporting & Treatment of Opioid Abuse Among Pregnant Women, Repeal of the Prevention and Public Health Fund (part of ACA)
- Defund Planned Parenthood Act - Who Voted For and Against; Pope Has Addressed Congressional Joint Meeting
- HHS Pushes States To Negotiate Lower Obamacare Rates
- High Court Upholds Health Law Subsidies