California Assembly Speaker Robert Rivas cast doubt on the latest proposal to create a state-run single-payer healthcare system, saying he likes the idea but isn't convinced the state can afford it in the face of a deficit. budget of at least $38 billion. .
“The concept of single payer and expanding access and affordability are good ideas,” Rivas, a Democrat from Hollister, told reporters at the state Capitol on Tuesday. “I say this with great respect to stakeholders and their advocates: we need to see how this is funded. “It’s a good idea, but it’s a tough sell, especially in the budget climate we’re experiencing right now.”
Assembly Bill 2200, called Guaranteed Health Care for All, or CalCare, would establish a single-payer universal health care system for all California residents. Assemblyman Ash Kalra's (D-San Jose) bill builds on his previous single-payer legislation, which failed to get enough votes to advance in January 2022.
A legislative analysis of that bill put the cost at between $314 billion and $391 billion in state and federal funds, a sum larger than the entire state budget Newsom proposed for fiscal year 2024-25: $291.5 billion.
Analysts in the Legislature have not yet determined the price tag for Kalra's new bill. It says it differs from its previous attempt because it establishes an advisory committee, explicitly lists gender-affirming care and expanded reproductive care as benefits, requires an investment in recruiting and retaining health workers to meet demand for services, and ensures that doctors are represented on the CalCare board.
Under pressure from progressive activists and a politically engaged nurses union that has been pushing for single-payer health care, California lawmakers have tried about 10 times over the years to reform the state's health care system.
The proposals typically end up dividing Democrats and weakening them over concerns about costs, opposition from private insurers and the complex bureaucracy that underpins the delivery of health care in the country.
Last year, Gov. Gavin Newsom signed a bill that would lay the groundwork for universal health care by helping California obtain a waiver from the federal government to use Medicaid and Medicare funds for a potential single-payer system. The bill by Sen. Scott Wiener (D-San Francisco) was intended to be a gradual step toward addressing some of the logistical hurdles that had stymied previous proposals for sweeping reform.
The California Nurses Association, a strong supporter of single-payer health care, opposed Wiener's bill, expressing skepticism about whether it would help create a single-payer system or simply facilitate an iteration of universal health care, which According to them they are different systems. A single-payer system means that the public receives health insurance through a centralized payer, usually through a government. Universal coverage generally refers to ensuring that all residents have coverage through public and private systems.
During his conversation with journalists, Rivas reiterated his concern about the budget deficit.
Rivas called Newsom's deficit projection of $38 billion “more optimistic” than that provided by the Legislative Analyst's Office, the state's nonpartisan agency that advises the Legislature, which projected a deficit of nearly $68 billion in December. . On Tuesday he updated his estimate to put the deficit at around $73 billion. The figures are estimates based, in part, on future revenue projections.
