ATTENTION: This is a beta website, the final version will look significantly different. Thanks for bearing with us while HJM is under construction! Posts can now be found here.

California’s new single payer bill

February 22, 2021

Topics: Quote of the Day

By California Nurses Association
National Nurses United, February 19, 2021

Renewing its commitment to the larger fight for health care justice, the California Nurses Association (CNA) is pleased to sponsor Assembly Bill 1400 (Kalra), the California Guaranteed Health Care for All Act (CalCare), which would guarantee comprehensive, high-quality health care to all California residents as a human right. The establishment of the CalCare program is an improved Medicare for All-type health care system.

Despite the gains made under the Affordable Care Act, nearly 3 million Californians have no health insurance, while millions more have insurance that they can’t afford to use because their copays and deductibles are too high. Meanwhile, for-profit insurance companies are reporting record-breaking profits, even while the Covid-19 pandemic continues to ravage California and medical bankruptcies are at an all time high.

Sponsored by CNA and authored by Assemblymember Ash Kalra, AB 1400 will ensure that all Californians, regardless of employment, income, immigration status, race, gender, or any other considerations, can get the health care they need, free at the point of service.

“A single-payer health system represents the belief that health care is truly a human right. Our current system results in unjust outcomes and these inequities are underscored especially now, exacerbating economic downturns for working families who have lost their income and meaningful access to health care,” said Assemblymember Ash Kalra. “We will have a long fight ahead in fixing our broken system, but this bill will set us on a real path towards a single-payer system and affirms the policy that would save lives, decrease suffering, and improve public health in California.”


Assembly Bill No. 1400: AB-1400 Guaranteed Health Care for All. (2021-2022)

California Legislative Information, February 19, 2021

From the Legislative Counsel’s Digest

This bill, the California Guaranteed Health Care for All Act, would create the California Guaranteed Health Care for All program, or CalCare, to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that CalCare cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children’s Health Insurance Program, Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program. The bill would require the board to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to CalCare, which would then assume responsibility for all benefits and services previously paid for with those funds.

This bill would prohibit a participating provider from billing or entering into a private contract with an individual eligible for CalCare benefits regarding a covered benefit, but would authorize contracting for a health care item or service that is not a covered benefit if specified criteria are met. The bill would authorize health care providers to collectively negotiate fee-for-service rates of payment for health care items and services using a 3rd-party representative, as provided. The bill would require the board to annually determine an institutional provider’s global budget, to be used to cover operating expenses related to covered health care items and services for that fiscal year, and would authorize payments under the global budget.

This bill would state the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. The bill would create the CalCare Trust Fund in the State Treasury, as a continuously appropriated fund, consisting of any federal and state moneys received for the purposes of the act.

This bill would prohibit specified provisions of this act from becoming operative until the Secretary of California Health and Human Services gives written notice to the Secretary of the Senate and the Chief Clerk of the Assembly that the CalCare Trust Fund has the revenues to fund the costs of implementing the act.

Section 1.

(b) (2) It is the intent of the Legislature to work to obtain waivers and other approvals relating to Medi-Cal, the federal Children’s Health Insurance Program, Medicare, PPACA, and any other federal programs pertaining to the provision of health care so that any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the CalCare Trust Fund.

(3) Under those waivers and approvals, those funds would be used for health care coverage that provides health care benefits equal to or exceeded by those programs as well as other program modifications, including elimination of cost sharing and insurance premiums.

(4) Those programs would be replaced and merged into CalCare, which will operate as a true single-payer program.

Section 2. TITLE 23. The California Guaranteed Health Care for All Act

Chapter 7. Funding

Article 1. Federal Health Programs and Funding

100660. (b) (1) The board shall apply to the United States Secretary of Health and Human Services or other appropriate federal official for all waivers of requirements, and make other arrangements, under Medicare, any federally matched public health program, the Affordable Care Act, and any other federal programs or laws, as appropriate, that are necessary to enable all CalCare members to receive all benefits under CalCare through CalCare, to enable the state to implement this title, and to allow the state to receive and deposit all federal payments under those programs, including funds that may be provided in lieu of premium tax credits, cost-sharing subsidies, and small business tax credits, in the State Treasury to the credit of the CalCare Trust Fund, created pursuant to Section 100665, and to use those funds for CalCare and other provisions under this title.

Article 3. CalCare Financing

100670. (a) It is the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. In developing the revenue plan, it is the intent of the Legislature to consult with appropriate officials and stakeholders.

(b) It is the intent of the Legislature to enact legislation that would require all state revenues from CalCare to be deposited in an account within the CalCare Trust Fund to be established and known as the CalCare Trust Fund Account.



By Don McCanne, M.D.

So California is once again attempting to enact and implement a state-level single payer system. As before, they run into the glitch as to how they are going to pay for it.

They are intensifying their efforts to obtain “waivers” for all federal sources of health care funds so that they can be deposited into California’s single payer CalCare fund. One barrier is that California cannot dictate to the federal government – Congress and the administration – the use of those funds, rather the federal government has to set up avenues through which those funds can be transferred. Some mechanisms already exist but there is considerable more work to be done to accomplish this task.

The CalCare program will also need the health care funds that are generated within the state, whether by individuals, businesses, or local governmental agencies. They will also need to generate any funds that might be required to provide additional care for those currently uninsured or underinsured. The amount is unknown especially since it is hoped that there will be considerable savings through elimination of administrative excesses and more efficient purchasing of health care products and services. As in previous California legislative attempts, this effort is addressed by stating in the legislation that it is the “intent” of the Legislature to enact legislation that would develop a revenue plan. In the last attempt, this caused a rather dramatic pulling of the bill with the claim that it was incomplete legislation.

Although a national single payer Medicare for All would be greatly preferred, we have a president that has threatened to veto any such legislation. We can be thankful for California and a few other states that are keeping the concept alive through their state efforts.

But we can no longer hide the issue of how we are going to pay for the program. Besides obtaining what federal funds are available, we are going to have to establish equitable, progressive taxes within the state, and we are going to have to let the people know just what that means. This situation requires transparency. We can no longer hide behind a vague “legislative intent” statement. We can develop a system that works well for all of the people, as long as the super wealthy recognize their obligation to return a modest portion of their rewards to society. But we are simply going to have to let the people know what that system is. Taxes are good when they enable beneficial, equitable societal goals.

In the meantime, let’s celebrate the fact that California has not given up.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

See All Posts

You might also be interested in...

© Health Justice Monitor
Facebook Twitter