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California's single-payer bill dies

POLITICO logo POLITICO 2/1/2022 By Victoria Colliver
The political repercussions of upending California’s health care system were hard to overstate. © Jae C. Hong, File/AP Photo The political repercussions of upending California’s health care system were hard to overstate.

California's single-payer dreams have been dashed again.

Legislation to create what would be the nation’s first government funded state-run health care system failed to get a vote Monday on the Assembly floor, effectively ending the push for single-payer this session.

High drama surrounding CA AB1400 (21R) by Assemblymember Ash Kalra (D-San Jose) had made it the highest-profile piece of legislation remaining from last year.

Kalra said the bill did not have enough votes on Monday, its deadline to clear the Assembly.

“Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians,” Kalra said in a statement.


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The stakes: The political repercussions of upending California’s health care system were hard to overstate. The stakes were especially high given that Gov. Gavin Newsom, who campaigned for governor on the promise of single-payer, has been notably uninterested in the bill. Newsom has instead been touting his proposal to extend Medi-Cal to all income-eligible undocumented adults.

AB 1400, sponsored by the California Nurses Association, would have all but eliminated private health care and replaced it with a centralized state-run financing system known as CalCare, a plan that legislative analysts estimated could cost between $314 billion and $391 billion a year.

“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly," Kalra said. "However, it became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today."

The background: Kalra had proposed paying for the plan with a constitutional amendment, CA ACA11 (21R), which would impose tax hikes on businesses and high earners. ACA 11 faces long odds as it needs a two-thirds vote in each house as well as voter approval.

While AB 1400 had a Monday deadline to clear the Assembly, the funding legislation has a longer time frame. Amendments added by the Assembly Appropriations Committee clarified that CalCare could not be implemented without the necessary revenue mechanisms in place.

The context: Tensions over the bill have pitted not only Republicans against Democrats, but progressive Democrats against moderates with the left-wing factions promising repercussions against those who fail to support it.

The California Medical Association, the California Association of Health Plans, the California Hospital Association, the California Chamber of Commerce and numerous other business and medical forces have joined forces to lobby against the bill. Supporters included the California Labor Federation, the California Teachers Association, a number of local governments and health advocacy organizations.

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