California lawmakers look to other states for single-payer model

Dec 11, 2017

A committee of California lawmakers is working toward a universal health care plan that would cover all state residents. This week they’ll hear from policymakers in other states who’ve attempted to launch similar models. 

When former Vermont governor Peter Shumlin abandoned his proposed single-payer health care plan in 2014, he said the costs were just too high. “

The lesson is, I was wrong. I don’t think small states can go it alone - at least little states like Vermont, with an unstable federal partnership,” Shumlin told a panel at Harvard in September.

So the question is, can California do what Vermont couldn’t? Jim Wood is the Democratic assemblyman who co-chairs the new committee

“Vermont went further than anyone, San Francisco created a very different model. And so this is all a big learning experience. We need to learn this, this is critical information for us, so we can craft what is the best way forward for California,” Wood said.

Assembly speaker Anthony Rendon convened the committee after blocking a Senate single payer proposal that was expected to cost the state $400 billion annually.

Linda Blumberg is a senior health policy fellow at a D.C.-based think tank called The Urban Institute. She says Vermont’s mistake was trying to move too quickly from a system where people pay premiums for their own plans to one where they pay high taxes to a public insurance pool. She recommends California tackle it in pieces.

“So that we’re moving in a direction of more uniformity, we’re moving in a direction of greater access and affordability, but we’re doing it in steps instead of something that would be a huge change and disruptive and very expensive on the public ledger side, all in one big move,” Blumberg said.

The universal coverage committee will hold a third hearing in early 2018.

How Other Single-Payer Plans Have Fared

In the last few years, single-payer models have popped up all over the country. Some plans have died at the governors’ desk, others on the Senate or Assembly floor. Many are still in progress, and some have just begun. Here’s a look at what a few other states have tried:

Vermont- Vermont’s Green Mountain Health Care system would have provided publicly financed coverage for all Vermont residents. A bill establishing the system was signed into law in 2011, bringing Vermont closer to a single-payer system than any other state. But former Vermont Governor Peter Shumlin shelved the plan in 2014, after financial analysis showed that paying for it would have required a payroll tax of 11.5 percent and an income tax as high as 9.5 percent.

California- The single-payer plan proposed in SB562 this year would have cost roughly $400 billion dollars per year. Assembly Speaker Anthony Rendon shelved the bill, calling it “woefully incomplete,” but said he would continue to fight for health care for all Californians. In August, Rendon called for the launch of the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage. The committee will hold its second hearing on Monday.

New York- The proposed New York Health Act - a law to establish a single payer system - passed in the assembly for the third time this May, but was later vetoed in the Senate. The plan would have been funded by a payroll assessment, similar to a Medicare tax.

Massachusetts- The Massachusetts Senate passed a health care reform bill last month calling for further study of the cost of a single payer system. The bill includes a special amendment - if the annual cost-estimate turns out to be lower than the overall cost of the current market-based system, the state will then be directed to begin laying groundwork for a single-payer plan. The bill now moves to the House.

Colorado- ColoradoCare was defeated on a public referendum in November 2016. It would have eliminated most private health insurance and created a taxpayer-funded cooperative to provide healthcare for all residents.

Maryland- A Maryland gubernatorial candidate called for a single-payer plan this week that would eliminate all premiums and out-of-pocket costs for state residents. He did not specify how the state would cover the cost of the plan.