Is Single Payer Still An Option For California? Some Lawmakers Say Yes — But Not Anytime Soon
Wednesday, March 14, 2018
Photo by Susan Murphy
After months of discussions — including seven hearings — a special bipartisan Capitol committee tasked with revamping the health-care system released an update on Tuesday. The findings? Get ready to keep waiting.
The Assembly Select Committee on Health Care Delivery Systems and Universal Coverage was convened by Assembly Speaker Anthony Rendon last summer, just a few months after he turned down a single payer proposal, calling it “woefully incomplete.”
On Tuesday, a new committee report emphasized that moving to a single-payer model would take more than just a bill: It would require billions of dollars and legislative changes on the state and federal level.
The committee contracted with a trio of health-care policy experts to summarize their discussions and craft recommendations. Committee co-chairs Jim Wood and Joaquin Arambula said that single payer is still on the table — but there are a lot of moving parts.
What was this committee discussing for the last six months?
The committee’s job was to figure out how California could achieve universal coverage — which means getting health insurance to every state resident.
It was born out of interest in a single-payer system, which would involve nixing private plans and instead creating one government insurance provider for all Californians.
Throughout the fall and winter, the committee says it did a thorough survey of the current state of California’s health-care system. It also looked at how other states have approached universal coverage. Throughout the process, they heard public comment from many supporters of Senate Bill 562 — the single payer bill that stalled in the Assembly last year.
So, where does single payer stand now?
Co-chairman Wood said there needs to be further analysis, data-collection and legal strategizing before moving forward with such a complicated idea as single payer.
He said just getting the federal waivers could be a two-to-three year process, and that’s with a friendly administration.
“We can’t do it without the federal resources,” he said. “I don’t see that we could even come close to doing that in this calendar year. Can we make progress? Absolutely.”
What other models are being explored?
Committee members want to unify all the fragmented pieces of the health care system, but in the meantime hope to make short-term fixes. They’re now looking at an idea called “unified public financing,” which basically means putting the state in charge of all the health care dollars.
UC San Diego professor and report co-author Richard Kronick described it as a system “in which the government paid hospitals and physicians directly and was [their] single source of payment.” Or, he added, “it could be accomplished in a system in which the government contracted with health insurers.”
They estimate a model like this would take three to four years to establish.
What other ideas are in the report?
Its authors recommended expanding Medi-Cal eligibility to undocumented immigrants, increasing assistance for people on Covered California and imposing a state insurance mandate. They also want to raise reimbursement rates for providers that accept Medi-Cal, and set up an all-payer database for insurance claims.
But this all requires money from the state budget. The Legislative Analyst’s Office estimated these changes could cost up to $10 billion. Committee members said they’re still reviewing the report, but hinted that legislation could come up this year.
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