A bill to establish single-payer healthcare screeched to an abrupt halt earlier this summer — but that hasn't blunted its continuing influence on California politics.
Calls for a sea change in the state's healthcare system have proved remarkably durable, even after Assembly Speaker Anthony Rendon shelved a measure in June that would have made the state responsible for paying all of its residents' medical costs.
A recently filed ballot initiative, budding campaigns against sitting lawmakers — including a recall effort against Rendon — and new plans for legislators to wrestle with how to achieve universal healthcare have taken shape in recent weeks, and the conversation is poised to take on national heft as Sen. Bernie Sanders (I-Vt.) prepares to introduce a "Medicare for all" measure in the fall.
It all sets the stage for a combustible coming election year, in which questions about the viability of single payer will be posed to gubernatorial candidates, incumbent lawmakers and new entrants to politics galvanized by the healthcare debate.
"People are literally dying because of a lack of healthcare," said Don Nielsen, government relations director for the California Nurses Assn. "It's not a matter of waiting until somebody high enough in the power structure decides it's time…. The time is now."
The nurses group was the prime driver behind the legislation, SB 562, which would have established a single-payer system in California. The plan proposed to largely do away with private insurance companies and instead have the state cover the tab for residents' healthcare expenses. The proposal's total cost ranged from $330 billion to $400 billion but passed out of the state Senate without identifying a revenue source to fund it.
The effort to push through the measure came at a time of increasing awareness — and growing approval — of the single-payer concept. Pew Research Center found that nationally, 33% of respondents backed a single-payer healthcare system, a 12-percentage-point bump in approval since 2004. Statewide, the Public Policy Institute of California found in May that 65% of all adults backed the single-payer insurance system that would have been established by SB 562. But that support plunged more than 20 percentage points if the plan would require raising taxes.
Facing the prospect of saddling his caucus with an unpopular tax vote — or approval of a measure without determining how it would be paid for — Rendon opted to table the bill in June, igniting an immediate outcry from its supporters.
Two months later, that ardor has not fizzled. Last week, a new ballot measure was filed with the goal of removing "roadblocks" to establishing single payer. The initiative, filed by Dale Fountain, who leads the Facebook group Enact Universal Healthcare for California, would create a special account expressly for healthcare that would be exempt from rules that dictate how the state's general fund dollars must be spent.
The initiative also states its purpose is to spur the Legislature to act, since its passage would theoretically underscore public support for single payer.
Days after the initiative was filed, Rendon announced that informational hearings would be held during the fall legislative recess. He said lawmakers would examine a number of healthcare models, such as Medicare for all or an expansion of the Affordable Care Act, to achieve universal healthcare coverage.
SB 562 has become the most widely known single-payer proposal in the state, but it is not the only road map.
Jonathan Oberlander, professor of social medicine at the University of North Carolina-Chapel Hill, said that single-payer systems — broadly defined as those in which the government is the sole payer of healthcare costs — can vary in financing, benefits and cost-sharing. And single payer is not the only way to achieve universal coverage.
"Countries like Germany, Japan, the Netherlands, Switzerland and others have universal coverage but not through single-payer arrangements," Oberlander said. "The notion that the choice is the U.S. status quo or Canadian-style single payer is a prevalent myth."
By providing a forum to hash out the healthcare debate through the fall, the hearings almost certainly will propel the issue into 2018. But the conversation holds political risk: Will Democrats be expected to produce a bill at the hearings' close? Will their findings satisfy the most zealous advocates?
"I don't want anybody to have an impression that we'll do two or three hearings and then, boom, we'll have a magical solution," said Assemblyman Jim Wood (D-Healdsburg), one of two Democrats leading the panel.
He insisted the hearings would not be a meaningless exercise.
"This is a real effort," Wood said. "I would hope people would be patient and would learn along with us as we move forward, because there is a lot to learn."
Assemblyman Joaquin Arambula (D-Fresno), the committee's co-chairman, said he expects the conversation will spill over to the contest to succeed Gov. Jerry Brown.
"It's imperative to bring healthcare to that governor's race," Arambula said.
The top Democratic candidates have staked out varying positions on the topic: Former Los Angeles Mayor Antonio Villaraigosa has called a state-level single-payer plan "snake oil," while Lt. Gov. Gavin Newsom, who is backed by the nurses association, has called for universal healthcare but has not yet rolled out a proposal. Treasurer John Chiang has signaled support for the concept of single payer but said he has concerns over implementation.
Rendon's call for hearings was immediately greeted with suspicion from SB 562's most ardent backers, including those behind a nascent recall effort against him.
"The speaker's decision to release this misleading statement at this time demonstrates clearly that the speaker has decided not to change course, but rather that the public pressure that has been brought to bear on Speaker Rendon is succeeding," said Steve Elzie, an attorney advising the recall proponents.
Although the nurses group is not backing the recall, it is keeping the heat on other Assembly Democrats. During the summer break, the union held town halls and knocked on doors in a number of districts. It's also sent mailers to constituents asking why their representatives aren't supporting SB 562.
All signs point to the pressure continuing into 2018, and Nielsen did not rule out recruiting challengers to take on Democratic incumbents.
"All options are on the table," he said. "This is a key issue. This is an issue that really should separate the serious progressive politicians from those who are not serious about the issue."
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