On the same weekend that California took its first steps toward securing universal health coverage, the top three Democratic candidates for the state Senate emphasized that the issue remains part of the debate. in health care.
While the issue has stalled at the federal level, the push toward single-payer health care continues to resonate as a campaign issue for Democrats. Advocates of an integrated health system have largely rallied behind “Medicare for All,” a federal effort to fund medically necessary care for US residents through taxes.
Sen. Bernie Sanders, I-Vt., the chamber’s biggest proponent of Medicare for All, held the last congressional hearing on the policy in May 2022 while serving as Senate Budget chairman. But the hearing did not spark any new momentum for the bill and mostly served as a forum for partisan debate. And while President Joe Biden campaigned for a public-choice health system, he opposed supporting Medicare for All.
Action at the state level, however, continues.
On Saturday, California Governor Gavin Newsom, a Democrat, signed SB 770, a law that begins the process to secure a single-payer health system in the state. This is the first such step by a state.
Universal health care coverage, ensuring that no one is uninsured, can take many forms. Under a single-payer system, one entity is responsible for all costs. Medicare for All refers to a specific federal single-payer plan sought by some Democrats.
The law directs the secretary of the California Health and Human Services Agency to work with federal partners on a path forward in a unified health financing system. The agency must submit an interim report in January 2025, a federal waiver framework in June 2025 and a final framework for state leaders in November 2025.
The timeline will pave the way for the final waiver to be submitted for federal approval in 2026. Health and Human Services Secretary Xavier Becerra, a former California representative and state attorney general, has long advocated a single-payer health care system. .
On Sunday, the front-runners in next year’s California US Senate race – Democratic Reps. Barbara Lee, Katie Porter and Adam B. Schiff – reiterated their support for Medicare for All as their chosen path to federal universal health care during a National. Conference of the Union of Healthcare Workers.
But they stopped short of criticizing California’s separate efforts.
Medicare for All “is not going to replace California’s efforts because, frankly, it’s probably going to take longer for the federal government than the states,” Schiff said.
“I think it’s important that the states become the frontline laboratories with someone paying, which I support,” he added.
Conference attendees applauded California’s new law during Sunday’s forum. The union will officially endorse one of the three candidates on Wednesday.
However, the approach led by the state of California has faced some pushback, including from the largest nurses union, which wants a more comprehensive approach and health payer groups that oppose it. in efforts to eliminate private insurance options.
Sandy Reding, president of the California Nurses Association, called the law a “complete betrayal of nurses’ fight for a single-payer health care policy” and criticized Newsom’s decision to sign the bill. which is “a complete lack of political courage.” The California Nurses Association, a division of National Nurses United, represents 100,000 members in California.
Some advocates are divided on whether they will seek state-based solutions to universal coverage or whether federal action later could disrupt state-led systems that operate at a faster pace.
At least four states have already implemented a public option, which is a more incremental approach to government-run health care than single-payer health that allows residents to choose one government-funded health programs or continue their private coverage.
The states of Washington, Colorado, Minnesota and Nevada have all enacted laws creating modified public options. Unlike the traditional concept of a government-run public option, these three states partner with private carriers to offer public option-style plans.
Several other states, including New Mexico and Connecticut, have considered but not passed legislation to implement public options.
“I don’t support a public option or an incremental approach. I support Medicare for All, period, and I’m disappointed that when I came to Congress and we had grass as Democrats and we had the ability to pass Medicare for All and put it on the floor for a vote, we didn’t do it,” Porter said Sunday.
Lee said he introduced one of the first single-payer bills in the 1990s while serving in the California Legislature.
“I am very happy that the governor signed it into law. California is once again leading the way,” said Lee, who said that as a member of the House’s Medicare for All Caucus he hopes to establish a sister caucus in the Senate to continue discussions.
Lee and Schiff said they advocated for a public option during negotiations before the passage of the 2010 health care law. While the law does not include a public option, it gives states the ability to seek federal approval through a so-called 1332 waiver to pivot to a single-payer system.
“Right now we don’t have that,” Schiff said, referring to a federal public option, “but if we did we would have a federal model that pays year in and year out.
“But we need to pass Medicare for All, and as we fight to do that, we need to support efforts like California’s to promote single-payer.”
