By Angels Hart
The Sacramento Bee, March 13, 2018
California Democratic lawmakers are quietly working on a package of up to 20 health care bills that would soften the political blow from the all-but-certain death of a single-payer universal care bill this year.
Senate Bill 562 cleared the Senate last year but stalled in the Assembly when Speaker Anthony Rendon blasted it as “woefully incomplete.” The legislation still lacks a plan to cover its $400 billion price tag, a way to control rising health care costs and a strategy to secure federal waivers needed from the Trump administration.
Rendon has not formally killed the bill, but he told The Sacramento Bee earlier this month that a fresh health care package is in the works ā the clearest sign yet that Senate Bill 562 is dead.
Democratic Assemblymen Jim Wood of Healdsburg and Joaquin Arambula of Fresno, who chair a special health committee formed by Rendon last year after the single-payer bill passed the Senate, said Tuesday they are eying legislation this year that seeks to improve quality, expand access and lower rising health care costs.
Both expressed doubt, however, that single-payer bill could move forward this year.
“I would say single-payer is not a reality this year because of the complexity of the steps that we need to go through,” Wood said.
To capture current federal health care funding and use it to fund a state-based single-payer system, California would have to secure numerous federal waivers. Voters would likely have to approve changes to the state Constitution and massive tax increases would be required.
Wood and Arambula declined to say what specific bills they’re planning to introduce, but said they’re considering legislation based on a broad set of recommendations released Tuesday by a trio of health policy experts who produced a report analyzing the committee’s work over the past four months in identifying a path forward on universal care.
Wood said he’d like to focus on a politically and financially obtainable approach to creating a universal health care system.
“I think that our report, our hearings illustrate pretty clearly that you can’t go from concept to execution of a complicated, complex, completely transformative system in a really short amount of time,” Wood said. “If you read our report…youāll understand a little better why we couldn’t just pass 562 and the next day everybody has health care. It just can’t work that way.”
Assemblywoman Laura Friedman, D-Glendale, said she’s contemplating a bill that would establish a single-payer system in future years ā once other benchmarks are met, such as achieving specific cost containment goals and obtaining needed federal waivers.
“I’m looking at legislation we could adopt that sets up a roadmap to single payer, just like we have with (Assembly Bill 32) that gives us a roadmap to reducing greenhouse gas emissions,” Friedman said. “I’m also very interested in what can give people very real relief in the short-term.”
http://www.sacbee.com…
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A Path to Universal Coverage and Unified Health Care Financing in California
By Andrew B. Bindman, MD, Marian Mulkey, M.P.P., M.P.H., and Richard Kronick, Ph.D.
University of California, San Francisco, March 12, 2018
The California State Assembly contracted with the University of California San Francisco in order for the authors of this report to (a) serve as research and subject matter experts to the co-chairs of the Select Committee on Health Care Delivery Systems and Universal Coverage (Select Committee) ; (b) assist in fact-finding for Select Committee hearing preparation; (c) attend Select Committee hearings and summarize the content of the hearings; (d) assist Select Committee in identifying and analyzing the components of a sustainable and affordable universal health care system; and (e) provide a report to Select Committee summarizing the Select Committee’s hearings, including any findings and potential options.
This report reflects the authorsā attempts to explain information that emerged from the six Select Committee hearings and yo assemble the findings from the hearing into a coherent set of possible recommendations for the California Assembly.
This report describes health coverage and care in California and identifies remaining challenges related to access, coordination, and cost. It presents a range of options to expand coverage, address issues of fragmentation and cost under our current mixed public-private financing system, followed by options and considerations should the state move toward a state-based publicly financed approach. It concludes with a discussion of potential paths forward in the near future and over the longer term.
Conclusion
California has established itself as a leader in using the opportunities created by the Affordable Care Act to increase insurance coverage. Building on that foundation, as discussed during the hearings and summarized in this report, state leaders can take steps now to make coverage more widely available, increasing coverage from its current level of 93% to very close to 100%. Further, state leaders can take steps to reduce financial barriers to care for people who are insured. Something close to universal coverage can be achieved even with continuation of the current fragmented system in which Medicare, Medi-Cal, employer-sponsored insurance and the individual market continue to be the main channels through which Californians obtain coverage.
Testimony during the hearings also suggested a number of options for mitigating the deleterious effects of fragmentation and reducing the rate of growth of health spending within the context of a fragmented financing system. This report has summarized many of those suggestions and provided an assessment of the some of their major advantages and disadvantages.
Many people who testified during the hearings also voiced the opinion that the surest way to achieve universal coverage and the most likely way to substantially improve equity, quality and efficiency would be to implement a system of unified public financing. Under such a system, all Californians would have health insurance coverage by virtue of living in the state, and the separate coverage systems of Medicare, Medi-Cal, employer sponsored insurance and the individual market would be eliminated.
However, testimony also made clear that there are substantial legal, political and technical obstacles to implementing such a system. Substantial changes in federal law and federal waivers would be required to transform Medicare, Medi-Cal and the funds used for premium tax credits for Covered California enrollees into a system of unified public financing, and to allow the federal government to transfer funds to California in lieu of continuing to pay for Medicare, the federal portion of Medi-Cal and premium tax credits. In addition, the state would need to raise new revenue to replace most of the money currently spent by employers and employees for employer-sponsored insurance.
While there are obvious shortcomings in the design and implementation of the Medicare program, the Medi-Cal program, employer-sponsored insurance, and Covered California, 93% of Californians currently have insurance through one of these channels. Transitioning the vast majority of Californians into a new system of coverage, which does not have an established track record in the state, involves uncertainty and some risk. Policymakers have a responsibility to educate the public about the benefits and risks of various options to provide health care coverage and to incorporate the publicās values and priorities into their decision-making.
Short-term changes to increase coverage and improve equity, quality, and efficiency make sense given uncertain prospects and a multi-year timeline for achieving unified public financing. This is particularly true if short term changes are pursued in ways that facilitate rather than impede a potential future transition to unified public financing. Short-term efforts to expand coverage, improve access, reduce fragmentation, and improve transparency, coupled with development of a longer-term path toward unified public financing, would help secure a future in which all Californians have access to the health care they need and deserve.
http://healthcare.assembly.ca.gov…
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Comment:
By Don McCanne, M.D.
Those following the latest single payer effort in California know that SB 562 passed the Senate but has been held back in the Assembly, substituting in its place a series of hearings by the Select Committee on Health Care Delivery Systems and Universal Coverage to be followed by a report of its findings. That report has now been released.
It was known from the beginning that this was not an effort to advance SB 562, the stalled single payer bill, but rather it was an elaborate effort to build support for incremental measures that would build on our current system. The report does make such recommendations. Statements from the legislators involved have made it clear that the process for SB 562 would be too complex to move forward with the legislation at this time. They say that they will now introduce a package of bills in support of some of the incremental steps proposed in the Select Committee report.
The report did not remain silent on “a unified, publicly financed approach that assures coverage for all state residents; pools funds for health coverage across Medicare, Medi-Cal and other major financing sources and dramatically reduces or eliminates variations in eligibility, benefits and payments” (what we would refer to as single payer). Much to its credit it did discuss some of the many considerations that would have to be addressed to achieve such a goal. They explain why the barriers are formidable as far as enacting single payer legislation in this session of the state legislature.
That said, they do discuss in general terms a roadmap to achieve unified public financing in California. They suggest establishing a planning commission tasked with resolving design features, overseeing analyses of options for financing, recommending a management plan, educating the public regarding the proposed changes, assist in the drafting of state legislation and ballot propositions necessary to implement recommendations, and then assist state policymakers in drafting needed federal statutory changes, developing federal waiver requests, and negotiating with the federal executive branch and Congress. They say that at a minimum this would require a multi-year process.
How many times do we have to start the multi-year process all over again?
It looks like California will move forward with patching ACA, even though that is the most expensive model of reform and falls far short of our goals. So the lesson is, don’t depend on California to lead the way, at least anytime soon. Medicare did not start in one state. A bona fide single payer Medicare for all will not either. California has shown us once again that we need to get on with enacting a national single payer program – an improved Medicare for all.
SB 562 may be dead this year, but the dream of single payer is alive and well.
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