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California Lawmakers Look To Other States' Single Payer Plans For Lessons

California Assembly Speaker Anthony Rendon

The California Assembly's Select Committee on Health Care Delivery Systems and Universal Coverage will meet for a second hearing Monday, this time with a panel of experts from across the country.

Assembly speaker Anthony Rendon convened the committee after shelving a Senate single payer proposal that he called “woefully incomplete.” It was expected to cost $400 billion annually in state funds.

Democratic assemblyman Jim Wood (D-Healdsburg) co-chairs the committee. He said they're looking for a solution that would cover all Californians, but not necessarily one that would eliminate all private plans, as most single payer models do. 

He said hearing from other states will be vital to moving forward.

“We hope to learn how they put their programs together and learn from their success, and then we’re going to look at the challenges around cost containment for medical care in general," Wood said. "So, we’re moving far and wide to bring as many people to give us as much information as we can.”

The panel includes former Vermont governor Peter Shumlin. Shumlin got a single-payer plan through the legislature in 2011, but ultimately determined it would betoo costly for the state.

Typically states try to pay for single payer plans by waging individual and payroll taxes for a public health pool. The idea is that people will be paying taxes for comprehensive care, but they won't be paying premiums for individual plans. 

Linda Blumberg, a senior fellow in the Health Policy Center at a D.C.-based think tank called the Urban Institute, said that proposal doesn't typically fare well in the political arena. 

“A move to a single payer in one big step is probably going to be more challenging than states in the United States can really take on politically with success at this point," she said.

"There’s potential to move more in that direction by setting up a system that’s available to everybody where the financial assistance is more generous than what the Affordable Care Act is providing, but if people want to maintain their employer-sponsored insurance, they can do that.”

Wood says he doesn’t know what California’s next proposal will look like, but he knows it will have to be realistic about cost.

"How do we get the resources from the federal government to go it alone? And if we can’t get those resources, can we go it alone? The financing part of that is a challenge, and transition is a challenge." 

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.

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