Advocates of moving California to a single-payer health care system renewed their push in front of a key legislative committee Wednesday.
The State Assembly's Select Committee on Health Care Delivery Systems and Universal Coverage heard testimony in favor of single payer from organizations representing health care professionals, small business and labor.
Michael Lighty, director of public policy for the California Nurses Association, called on lawmakers to support SB 562, the single-payer bill that the State Senate approved before Assembly Speaker Anthony Rendon (D-Lakewood) shelved it last summer.
In a single-payer system, the state would take over paying for all health care, cutting out insurance companies. Supporters say the cost of higher taxes would be offset by the elimination of insurance premiums, co-pays and other out-of-pocket costs.
Insurance coverage is not care, said Lighty, who expressed concern about cost, insurers' denials of coverage for certain treatments, and people who delay or skip medical care because they can't afford it.
A single-payer approach would provide comprehensive care to all, including dental, vision and long-term care, he said.
There are a number of state and federal laws that pose potential hurdles to any form of universal care in California. Acknowledging that overcoming those obstacles would be difficult, Lighty said, "We think it's worth the fight."
Rendon set SB 562 aside last June on the grounds that it lacked specific proposals laying out how to pay for or implement such a radical transformation of California's health care system. Amid a political uproar among supporters of single payer, Rendon tasked the select committee with exploring how to move the state to universal care.
Economist Robert Pollin of the University of Massachusetts Amherst, who co-wrote an analysis of SB 562 last year, also addressed the committee. The analysis found that the state would need to raise about $100 billion in additional funds each year to cover the cost of switching to single payer, but that most Californians would end up paying less for health care with the elimination of insurance-related expenses.
Some members of the committee expressed concern that the assumptions in Pollin's study might be overly optimistic about how many federal dollars will continue to flow to California, and whether the Trump administration would grant waivers to allow federal money to be used for universal care.
All of the organizations that addressed the committee supported moving towards universal health care.
Rob Lapsley, president of the California Business Roundtable, was unable to attend the hearing due to a scheduling conflict, according to a spokeswoman, who said Lapsley would have spoken against moving to a single-payer approach.
Last May, Lapsley issued a statement arguing that "[T]here is no responsible way to pay for" SB 562. He said the legislation "is part of an ongoing progressive agenda that will only result in progressively bankrupting California."
The California Chamber of Commerce, the California Medical Association and the California Association of Health Plans are among other key opponents of the bill. The Medical Association has called it "flawed legislation that would dismantle the health care marketplace and destabilize the state’s economy."
Dr. Stephen Tarzynski, president of the pro-single payer California Physicians Alliance, proposed the state move to the new system in two phases. He said his group is still working on the details of its "road map," but that the first phase would create a plan that covers the three million people in California without health insurance, many of whom are in the U.S. illegally.
In the second phase, the state would work on getting federal waivers and changing state tax law to pave the way for a single payer system, Tarzynski said. He expected it would take three years to transition from the current approach to single payer. Cost savings would come from "expanding the risk pool to the entire state," he said.
Representatives from Health Access California, the California Immigrant Policy Center, Small Business Majority and the California Labor Federation all expressed support for some form of single payer health care, although they backed shoring up the current system first.
"I don’t think that this is an either or," said Anthony Wright, executive director of Health Access California. "This is a continuum."
Wright, Small Business Majority CEO John Arensmeyer and Sara Flocks, policy coordinator of the California Labor Federation, called for extending health insurance subsidies to people at higher income levels than is currently allowed.
Arensmeyer called on lawmakers to prohibit "junk" insurance - plans that don’t provide all of the the health benefits required by the Affordable Care Act. He also encouraged the legislature "to consider proposals ... to allow pooled purchasing power for prescription drugs."
Several speakers called for expanding Medi-Cal to cover everyone in the U.S. illegally. State law currently makes the program available to those here illegally who are under the age of 19.
Wright also called on the legislature to fix to what he called the "family glitch" - it refers to situations in which people get employer-based health coverage but can’t afford to cover their dependents and they make too much to qualify for tax credits.
Wednesday's hearing was scheduled to be the last in a series that began last fall. But select committee Chairman Assemblyman Jim Wood (D-Healdsburg) said he may schedule more hearings. Wood has said he expected the committee to produce a report with recommendations for the way forward by this spring.
This story has been updated for clarity.