California Is Paving the Path Toward Statewide Universal Healthcare

It’s another major election year in the United States and seats in Congress and governor’s mansions are up for grabs. That means there’s a lot of fine-tuning and triangulating going on right now in terms of policy platforms.

In the state of California, the process of hammering out a Democratic Party platform has been a long and contentious one. But now, with clear primary winners heading to the general elections in the fall, Democrats in the Golden State have come to a consensus on what has become a major flashpoint of public interest: universal health care.

With the primaries and budget negotiations over, leftist and progressive voices in California have created a legal mandate for themselves to build a universal healthcare system. The road ahead is going to be a long one and, more than likely, quite a lot of private money will change hands in attempts to alter the conversation. But it’s a bold start, even if the details are hazy at best right now.

Why California’s Government Now Has a Universal Healthcare Mandate

California’s new universal healthcare system, right now, only exists on paper. It’s more than most states in the Union can boast, and that makes it somewhat unique.

The Democratic Party in California rallied recently around campaign pledges to provide healthcare for all 40 million Californians. In 2015, even after the passage of the Affordable Care Act, 2.8 million California residents still did not have health insurance.

Progressive voices within the Democratic Party secured enough support during recent budget negotiations to add a number of “trailer bills” to the state’s budget for the fiscal year of 2018-2019. Enact Universal Healthcare for California was a co-sponsor of AB-2517, the Single Payer Planning Commission, which passed the Assembly, and then was more or less copied into the state budget. Any state budget is a lengthy and oftentimes deceptively written document, but the most important passage in these trailer bills concerning healthcare is fairly unambiguous:

“…establishes the intent of the Legislature to provide coverage and access through a unified financing system for all Californians, to control health care and administrative costs, to ensure high-quality health care, to limit out-of-pocket costs, to train and employ an adequate health care workforce, and to ensure all Californians have timely access to necessary health care.”

Gavin Newsom has been one of the strongest voices for transitioning the state of California to a single-payer healthcare system — and now he’s the Democratic candidate for governor. But even Newsom is realistic about the timeline ahead. “Years,” he said in an interview. “First of all, you will deal with litigation. You’ll deal with setbacks. You’ll have constitutional questions that have to be addressed by the voters. You’ll have propositions on the ballot … “It is not an act that would occur by the signature of the next governor.”

There are, nevertheless, significant steps already being taken to bring this about.

What Comes Next for Single-Payer Healthcare in California?

It was Assembly Bill 1810 which gave California’s government a mandate to build a healthcare platform with a “unified financing system.” That same bill provided the next steps, and a deadline, on the way toward turning this idea into a practical reality.

Working toward an October 2021 deadline, the “Council on Health Care Delivery Systems” will draw up a plan for a single-payer healthcare system. Such a system would, in simplest terms, leave hospitals and doctors as autonomous healthcare providers and practitioners, but which would replace the private insurance apparatus with a more streamlined government-run bureaucracy to manage the distribution of funds. Such a system would, according to researchers, single-payer proponents, nurses and doctors’ advocacy groups, bring into being a stable, cost-efficient, accessible and universal healthcare system.

In simpler terms still, it would create a nationwide Medicare-for-All system.

The five-member Council in California is made up of three governor-appointed members and two legislature-appointed ones. Three years from now, they should have a workable plan to present to the rest of the state government — and the country.

The Current and Future Outlook on Healthcare in CA

The Affordable Care Act facilitated the creation of state-run healthcare exchanges where residents could shop for health insurance plans. Under this system, one of the best metrics for the “strength” of a state’s healthcare exchange was the number of insurers (the availability of “market choices”) and the stability of the pricing of the plans offered.

According to these criteria, California has enjoyed one of the most successful and stable of all state exchanges that came about thanks to the ACA. As of 2017, every region in the state had at least three insurance carriers available. It might seem an unideal time — especially politically — to shake things up again. The ACA provided subsidies for insurers along with stricter rules about who they can and cannot exclude from buying coverage, which has broadened the pool of insured persons and helped to bring prices lower and make them more stable. The diversity, size and relative wealth of California’s population also contributed to the success of the state’s exchange.

But the Democratic Party there has charted a new course — and step one is for their newly formed Council to research practical ways for paying for a new system. Required new revenue is expected to be on the order of $100 billion per year.

There’s an image coming together about what the future of American healthcare will look like — and Democrats and further-left liberals are staking their hopes for real change on the outcome of some quickly approaching and surprisingly competitive elections. That makes the 2018 campaign season a referendum, in all but name, on universal healthcare and a host of other issues that require incisive leadership.