Single-payer health care didn’t stand a chance in California this year.

Even in this deep-blue bastion, Democratic lawmakers shied away from legislation that would have put state government in charge of healthcare and taxed Californians heavily to do so — a massive transformation that would have forced them to take on the powerful healthcare industry.

Gov. Gavin Newsom, who had promised to spearhead single-payer care when he ran for governor four years ago, dashed its chances this year when he declined to publicly support it.

Newsom is now pushing for “universal health care,” which aims to provide all Californians with coverage but, unlike single-payer, would keep private health insurance intact.

Newsom’s retreat devastated progressive activists and the powerful California Nurses Association union, which championed the cause. The death of single-payer in the nation’s most populous state also dealt a major blow to similar campaigns elsewhere in the nation.

“We’re also fighting in New York, but just like in California, there’s not 100-percent Democratic consensus among legislators,” said Ursula Rozum, co-director of the Campaign for New York Health, which is working to pass single-payer legislation. “It feels like a constant question of ‘Can we win this?’”

Health policy experts agree that California’s failure to adopt single-payer dampens momentum across the country.

“California, given its size and politics, has always been a bellwether for progressive policy, so this certainly sends a signal to other states about how hard this is,” said Larry Levitt, executive vice president for health policy at Kaiser Family Foundation.

But Rozum and single-payer activists in Colorado, Washington state and elsewhere say that rather than giving up, they are taking key lessons from California’s failure: It is essential to win — and keep — support from the governor.

“We’ve seen what happened in California, so we are working hard to get our governor on the record in support of single-payer so she will sign it when it gets to her desk,” Rozum said. “And just like there, our union movement is divided. We know we need them to have any chance of moving forward with our bill.”

The only state that has passed single-payer, Vermont, didn’t implement it.

Vermont adopted a single-payer plan in 2011 with unequivocal support from its then-governor, Democrat Peter Shumlin. But he abandoned the effort in 2014 amid growing concerns about tax increases and runaway health care costs.

“There isn’t a political party in the world that’s going to raise their hands every year to increase taxes on hard-working citizens,” Shumlin told Kaiser Health News. “That’s the big mistake I made in Vermont.”

Activists in Colorado are mobilizing for another single-payer campaign after the overwhelming defeat of a 2016 ballot initiative that failed partly because of intense health care industry opposition. Organizers in Washington state are pushing legislation and trying to get a single-payer initiative on the ballot next year.

Shumlin said Democrats must be prepared to take on deep-pocketed industry groups and rein in soaring health care spending — or they’ll be confronted with the political difficulty of constantly raising taxes.

“California is the best state to lead this because it has the fifth-biggest economy in the world. It’s all about scale,” Shumlin said. “And if California gets it right, other states and the federal government will follow. But this is hard stuff, so get ready to get bloodied.”

Some Democratic lawmakers and the California Nurses Association had hoped California would lead the way this year and that Newsom would be their champion.

State Assembly member Ash Kalra (D-San Jose) introduced legislation sponsored by the union that would have created government-run health insurance for all state residents while significantly raising taxes on employers, employees, and businesses to pay for it. State estimates pegged the cost at roughly $360 billion a year, with a little less than half coming from tax increases and the rest from the federal government.

Newsom created a commission to study the concept and asked the Biden administration for permission to collect federal money that flows to the state via the Affordable Care Act, Medicaid, and Medicare, which California could use to help finance a single-payer system. To accomplish this, California would need approval from Congress.

Newsom has shifted to a platform of “universal health care,” which includes Medicaid coverage for all income-eligible unauthorized immigrants and state-funded subsidies for Californians who buy health insurance from Covered California, the state’s Obamacare insurance exchange.

Newsom said in January that he has long believed single-payer is “inevitable” but signaled that the federal government should take the lead.

Kalra said he’s considering introducing another bill next year but conceded that he must shift his strategy to bring more Democrats and unions into the campaign.

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