As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.
Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.
The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.
But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.
“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”
The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.
The bill, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.
Lara said the approach would get California closer to a system “that covers more and costs less.”
The bill’s authors haven’t announced how the program would be funded. And that’s where the biggest obstacle lies, said Oberlander: It would largely uproot California’s present system, in which roughly half of coverage is sponsored by employers.
If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” he said. “Then you have to make up all the financing that you’re going to lose.”
There’s no way to make up for those lost employer contributions other than to introduce “very visible taxes,” Oberlander said. And that’s not the only reason why a single payer plan would be controversial. “A lot of people are satisfied with what they have,” he said.