Health Advice



After ambitious single-payer health care plans sputter, a new California bill tries an incremental approach

Melanie Mason, Los Angeles Times on

Published in Health & Fitness

A new bill introduced in the California state Senate aims to lay the groundwork for a state universal health care system, proposing an incremental approach that departs from recent sweeping, and unsuccessful, efforts to reshape how Californians receive care.

Under the measure by state Sen. Scott Wiener (D-San Francisco), California would begin the process of seeking a waiver from the federal government to allow Medicaid and Medicare funds to be used for a first-in-the-nation single-payer health care system.

"In the wake of COVID-19's devastation, and as costs for working people have skyrocketed, the need to provide affordable health care to all Californians has never been greater," Wiener said in a statement. He touted his measure as making "tangible steps on a concrete timeline toward achieving universal and more affordable health care in California."

The legislation would require California's health secretary to offer recommendations on crafting the federal waiver by June 1, 2024.

Proponents say single-payer health care — which would cover every California resident and be financed entirely by state funds (including repurposed federal dollars) — is more efficient than our current system, in which available care and cost is dependent on whether a person has private insurance, is enrolled in a public plan such as Medi-Cal or is uninsured.

Universal health care is a leading priority for progressives, who have rallied around the "Medicare for all" plan championed by Sen. Bernie Sanders (I-Vt.) during his two presidential runs. A 2017 California bill to establish a single-payer system cleared the state Senate, but it was shelved by Assembly Speaker Anthony Rendon (D-Lakewood).


The setback galvanized the left wing of the Democratic party, which saw single-payer as a litmus test for political candidates, and Gov. Gavin Newsom embraced the cause during his 2018 campaign.

On his first day in office in 2019, Newsom asked Congress and the White House, then occupied by President Donald Trump, to change federal laws that would enable California to pursue a single-payer system.

But Newsom has put more focus on expanding coverage in California for people living in the country illegally. Meanwhile, his 2019 budget created a commission to explore the steps to achieve a universal health care system; that panel issued its final report last year.

Newsom declined to weigh in on the last major legislative push for single-payer, a bill by Assemblyman Ash Kalra (D-San Jose). That measure was abruptly pulled by Kalra last year after fellow Democrats balked at the price tag, which ranged from an estimated $341 billion and $391 billion.


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