Earlier this month, the California State Legislature Commission reviewed the state’s health system and approved two steps to provide free insurance to all residents.
Parliamentary Bill 1400 sets up “CalCare,” a state-operated, state-wide system, and Parliamentary Constitutional Amendment 11 changes state tax law to pay through voter voting.
The fate of the bill to establish a taxpayer-paying system similar to that of the UK, Canada and Japan could be carefully watched by policy makers in other states and federal governments to deal with the rising costs of national consumers. There are millions of uninsured people.
The national single payer system has been controversial among Democratic presidential candidates for 2020, and support for this idea has increased in recent years.
“California is a big and diverse place. If you can make it work here, you can make it work anywhere,” Jack Needleman, chairman of Health Policy Management at the Fielding School of Public Health at UCLA, told ABC News. rice field.
State leaders on both sides of the aisle, including Democratic Governor Gavin Newsom, theoretically endorse a single payer and do not promise full support for these new bills.
And if the plan passes, it requires a significant tax change that can only be approved by a voter referendum and will appear in the vote at the earliest in 2024.
Public health experts said the debate could lead to a similar bill that would fill the gap between uninsured Californians, even if it doesn’t pay off in the near future.
High interest despite previous failures
This is not the first time the state has tried a single payer plan. Under this plan, all health insurance provisions will be controlled by the government and made available to everyone.
Vermont enacted a single payer system in 2011, but it broke up three years later due to rising costs and delayed tax revenues. Colorado and Massachusetts also attempted to create a single payer system through voter voting and state bills, respectively, but neither was passed.
Like other states, California is trying to solve the costly problem of uninsured residents, according to public health experts. According to a study released last year by the University of California, Berkeley Labor Center and the UCLA Health Policy Research Center, 3.2 million Californians, 9.5% of the state’s population, could remain uninsured in 2022. Is high.
John McDonough, a professor of health policy at Harvard TH Chan School of Public Health, told ABC News that the failure of Vermont has slowed the promotion of the state’s single-payer program, but a member of the California State Legislature. Interest from is still strong after many attempts.
In 1994, California voters rejected a voting proposal that would create a single payer system for the state. In 2017, a bill to establish a single payer system was passed by the California Senate, but concerns over the $ 400 billion price tag prevented Congress from voting.
Former Massachusetts MP McDonough, who also advised the U.S. Senate when the Affordable Healthcare Act was drafted, has a reputation for California being the first step in healthcare reform, including the Open. The exchange market, which mentioned it, and some of its progressive leaders, are determined to break the code when it comes to effective single payer programs.
“California has long been a hit for single payers,” McDonough told ABC News. “This bill is its latest statement.”
State legislator Ash Kalra, the main sponsor of both bills, claims that millions of Californians suffer from high costs and deductions and have few coverage options, making a single payment. I have repeatedly asked for a person’s plan.
“In reality, in our state and in our country, there is a medical system in which so much suffering is embedded,” he said in a recent hearing at the California State Capitol.
California’s latest attempt
Kalra argued that this latest single payer proposal solved the problems that plagued past attempts.
Under the AB1400 introduced last year, the new system will provide care to all residents, regardless of immigrant status.
Nine boards oversee the program and “seek the exemptions, approvals, and agreements needed to allow CalCare to pay various existing federal health care costs. CalCare previously with these funds. Responsible for all benefits and services paid. “The word of the bill said.
Kalra also introduced the companion bill ACA 11. If this is passed, the approval of a majority voter will be required.
This amendment will impose a new excise tax on businesses. That’s 2.3% of total income over $ 2 million. Payroll tax is levied on companies and organizations with more than 50 employees at 1.25% of total wages, and organizations in this category have an additional 1% if their annual income exceeds $ 49,000. You have to pay payroll tax. Invoice.
The amendment also aims to raise personal income tax. Residents who earn $ 149,509 a year will pay an additional 0.5%, and those who earn $ 2.5 million will increase to 2.5%.
Kalra admitted in a recent hearing at the Parliamentary Health Committee that voters would not be able to vote for ACA 11 until 2024, but emphasized that it was not too early to create a blueprint.
Parliamentarians said his goal was to give California residents, businesses, and other stakeholders time to prepare for the launch of CalCare if both bills were passed and a potential referendum was passed. Said there is.
Battle line
Opponents of the bill were involved in a heated debate at a hearing of the Health Committee on January 11.
Proponents said the tax increase would generate more than $ 160 billion annually in payments for single payer plans, supplemented by federal funding.
Kalra claimed that private companies and employees have already paid billions of dollars through premiums, deductions and out-of-pocket payments. He argued that a single payer would eliminate these costs without affecting the patient’s coverage.
“It’s a clear day when they’re freaking out, and it’s not surprising that too many people feel helpless about it,” he said of California residents.
Kara was backed by Republicans, who said the single-payer system was too costly, too different, and difficult to implement.
Republican Rep. Heath Flora condemned the proposal, arguing that it would be a major mess for patients, businesses and medical facilities that have been operating in the open market for decades.
“People spend their entire lives paying for the system, and are they going to strip the carpet from under them for a program that isn’t even funded?” He said in a hearing.
“This bill will change things now, and it’s been sold to my community because it’s free, and neither of them is true,” she mentions ACA11 and the voter referendum. And said.
Proponents of single payers categorically argue that the discussion needs to start early rather than later.
Carmen Comsty, chief policy specialist at the California Nurses Association, testified that under the single payer system, patients would be less likely to be denied compensation.
“Profit motivations and financial incentives will no longer determine care,” she added. “Rather, decisions about patient care under CalCare will be based on the needs of the patient.”
Protect California Health Care, a coalition that includes the California Medical Association and the California Hospital Association, opposed the bill, saying consumers would have less choice.
The Health Commission must pass the bill in line with party policy, vote 11 to 3, and the entire parliament must pass the proposal by the end of the month.
Country is watching
Stephen Shortell, a professor of health policy and management at the UC Berkeley School of Public Health, told ABC News that recent attempts at single payers in California have generated national debate and are noteworthy.
Shortel said Kara’s bill, especially the constitutional amendment, is a good attempt to solve the cost problem destined for other single payers’ proposals.
“This particular approach will work for a single payer. This time they’re going to be paid in taxes. That’s a good starting point,” Shotel said.
Needleman said no other legislature has submitted a single payer bill for this year’s work, so a “waiting” approach to potential changes in California is likely. rice field.
Unlike Vermont, California has a more diverse population and a mix of rural and urban environments, which could be a perfect test for the system to work, he said.
“If California can adopt and make it work, it gives confidence to other states and gives confidence to the national level,” Needleman said.
Spillover, pass or fail
Many health policy experts said California was not optimistic about switching to a single payer system.
Shotel and other experts say that waiting for a referendum on tax law for two years will be a difficult sale for state leaders, as the state is at stake until voters approve the tax change. I said I would.
“There is already a lot of backlash when it comes to taxation from both sides,” Shortell said.
However, both California and national legislators may look at the cost analysis of California’s single payer proposal and compare it to existing public health programs like Medicaid, Shortel said. And perhaps some of those policy makers will find California’s plans more cost-effective.
“It’s driving an increase in universal access,” says Shortell. “Even if the plan is not a single payer, it still increases coverage.”
Governor Gavin Newsom has already proposed alternatives to two new bills.
As part of his current budget, he seeks to extend coverage from the state medical program Medi-Cal among low-income earners.
Under that proposal, families of four who earn less than $ 36,156 a year are eligible for stronger state compensation, regardless of immigration status. Current Medi-Cal regulations only allow emergency room and pregnancy-related medical visits for these residents.
According to Newsom’s office, the expansion will cover 700,000 residents next year and cost $ 613.5 million. This is about the same as in 2023, which, when fully implemented, will be $ 2.2 billion annually.
Proponents of the single payer bill are still awaiting approval from Newsom. The Governor’s Office told ABC News that it is waiting for a report from the state’s Healthy California for All Commission. The committee is analyzing ways to expand the reach of healthcare.
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