Single-payer health care is a giant leap. Here are 14 steps California might take to get there

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Key state lawmakers are set to introduce a series of bills designed to lower costs and expand access to health insurance on California's individual market, following through on a strategy they embraced earlier this month that calls for an incremental approach to reform rather than an immediate push for government-backed universal health coverage.

Much of the legislation is based on recommendations in a report by three independent consultants to the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage. The consultants based their analysis on 30 hours of testimony given to the committee between October and February.

Short-term reforms

Arguing that it would take several years and a lot of heavy political lifting at the state and federal levels to move to a so-called single-payer health care system, the report recommends taking a series of short-term steps to improve coverage, affordability and access while simultaneously studying how to get to universal coverage.

That will lead to at least 14 bills from select committee members, said Cathy Mudge, spokeswoman for committee co-chair Assemblyman Jim Wood (D-Healdsburg). She said that other legislators may introduce their own reform bills.

Lawmakers are still working on the language of most of the bills, said Mudge, but she provided a list that states "the intent and goal" of each one, along with its sponsor:

Bill Sponsor Description
AB 2965 Select Committee co-chair Assemblyman Joaquin Arambula, D-Delano Expand Medi-Cal coverage to all income-eligible adults regardless of immigration status.
AB 2472 Wood Establish a public option.
AB 2416 Wood Increase health plan competition by requiring plans with Medi-Cal contracts to participate in Covered California.
AB 2459 Assemblywoman Laura Friedman, D-Glendale Provide for state subsidies and/or tax credits for those people in the individual market with incomes more than 400 percent of FPL and/or place a cap on the cost of premiums at a percentage of income.
AB 2565 Assemblyman David Chiu, D-San Francisco Provide increased state subsidies for individual market policies for people with incomes between 138 percent and 400 percent of FPL.
AB 3148 Arambula Limit amount of cost sharing for people in individual market plans with incomes between 138 percent and 400 percent of FPL.
AB 2430 Arambula Increase Medi-Cal eligibility for seniors/disabled individuals whose income is between 123 percent of the federal poverty level (FPL) and 138 percent of FPL to create consistency in eligibility and expand coverage to 60,000 seniors/disabled.
AB 2499 Arambula Limit health plan administrative costs by establishing a medical loss ratio (MLR) in statute that assures 85 percent of premium goes to care.
AB 2502 Wood Establish an all-payer claims data base to gather information on the actual cost of services.
AB 2579 Assemblywoman Autumn Burke, D-Inglewood Streamline eligibility to enroll uninsured individuals who are eligible for Medi-Cal, creating an
AB 2597 Arambula Increase availability of primary care physicians by fully funding and expanding the Public Hospital Redesign and Incentives Program in Medi-Cal (known as PRIME)
AB 2275 Arambula Increase accountability for health care quality standards and reducing disparities in Medi-Cal managed care plans.
AB 2427 Wood Addressing profits in Medi-Cal managed care plans.

One of the reports' recommendations was missing from the list of legislation: the creation of a state health insurance mandate. Wood and Arambula said earlier this month they weren't ready to back a state mandate, which has the support of Covered California and the California Association of Health Plans.

"Subsidies are more of an incentive than mandates are," said Arambula. 

While acknowledging their strategy is more "methodical" than many activists want, Wood was not apologetic about backing a step-by-step approach.

"Even one small tweak to the system could have huge ramifications to another part of the system," he said.

The long-term plan

Following the consultants' recommendation, Wood and Arambula did endorse the consultants' recommendation to start the hard work of laying the political, legal and financial groundwork for a government-run single-payer system. They're sponsoring AB 2517, which Mudge said would "provide a road map, with benchmarks, to move California toward a uniform publicly funded health care system."

The consultants pointed to a number of state and federal legal hurdles to single payer in the short-term. Both Arambula and Wood expressed doubt that the Trump administration would support changing federal rules and laws to allow California to use Medicaid and Medicare dollars to pay for a state-run health care system.

"We can’t do it without the federal resources," said Wood.

The experts suggested creating a "planning commission" that would work on designing a single-payer system and figuring out how to pay for it.

The select committee was created to look at the issues raised by SB 562, which proposed a Canadian-style single-payer health system for California. It passed the state Senate last spring but never reached the Assembly. Speaker Anthony Rendon shelved it, calling the measure "woefully incomplete" because it lacked details on how to implement or pay for single payer.

SB 562's main backer, the California Nurses Association, slammed the report's call for an incremental strategy.

"The report inflates the obstacles to single payer, all of which are a reflection of lack of political will," Association Executive Director Bonnie Castillo said earlier this month.

Many of the short-term proposals are "a deceptive facade," she said, "pretending to address the problem." 

They will "do little to address the biggest hole in our health care system, the failure to guarantee actual health care, not 'insurance' for all Californians, said Castillo.

The Association said it will continue to press the legislature to consider SB 562.