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Legislation to Advance California Single Payer Process

A proposed law in the California Senate would instruct state officials to engage with the federal government on approvals and coordination for a state single payer bill. This is an important complement to a single payer bill in the Assembly.

March 27, 2023

New bill would pressure Newsom to speed up work on single-payer health care
San Francisco Chronicle
March 21, 2023
By Sophia Bollag

Gov. Gavin Newsom would face new deadlines on his administration’s work to revamp the state’s health care system under a bill unveiled Tuesday in the state Legislature.

Newsom, a Democrat, has said for years that he supports creating a government-run health system in California, including while campaigning for governor, but since taking office has not endorsed specific legislation to do so.

Early last year, when Newsom was asked if he supported a bill to create a universal, government-run health care system in California, he dodged the question, saying he was waiting for a report from a state commission studying the issue. That report came out last April, and endorsed a vast overhaul of California’s health system.

Transitioning the state from a system where private health insurance companies control much of the market to one run by the state would be a huge undertaking, one that would require permission from the federal government in the form of a waiver. On his first day in office, Newsom announced that he was pursuing such a waiver. More than four years later, California still does not have one.

A bill Sen. Scott Wiener, D-San Francisco, announced Tuesday would impose deadlines on the administration and give the Legislature a role in the process of securing a waiver. It doesn’t explicitly call for a single-payer health care system, and instead uses the term “unified financing,” which is the language endorsed by the report from the state commission.

Advocates of “single payer” generally endorse a system that is government-run, and where the state is the sole entity paying for health care. A “unified financing” system could take that form, according to the report, but could also include a role for private insurance companies that fiercely oppose a single-payer system that would put them out of business. The report does, however, call for distinctions between private insurance and government plans to be dissolved.

Wiener’s bill, SB770, would require Newsom’s health secretary to brief the Legislature on the status of its work to secure a federal waiver every few months, and to produce a formal report on the administration’s progress and plans by June 2024. It would also give legislative leaders power to appoint people to a group advising the administration’s work.

Comment by: Michael Lighty

With the introduction last week of California Senate Bill 770, advocates for health justice opened a new path to achieve guaranteed healthcare for all based on single payer financing.

Rather than propose a comprehensive policy bill developed by a few single payer experts (an essential component of our work but an approach that has not succeeded politically after numerous attempts), SB 770 seeks to engage health justice supporters of all stripes to collaborate on a proposal to be presented to the California Legislature under a definite timeline.

SB 770 is part of the newly launched Healthy California for All Now campaign. Our goal is to guarantee equitable healthcare to all California residents that provides better care at less cost for families, through public financing.

The campaign builds on the positive momentum created by the Healthy California for All Commission, which concluded that single payer (what they call “unified financing”) could save at least 4,000 lives annually and $158 billion in 2031. The Commission gave official approval for a program which it summarized as:

  • All Californians will be entitled to receive a standard package of health care services;
  • This package could include Long Term Care Support and Services, which would relieve huge and growing burdens that are falling on millions of families; 
  • Entitlement will not vary by age, employment status, disability status, income, immigration status, or other characteristics; and
  • Distinctions among Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage will be eliminated within the system of unified financing.

Those findings are incorporated into SB 770 as the first step in a process which directs the Secretary of the California Health and Human Services (HHS) Agency to:

  • Pursue waiver discussions with the federal Center for Medicare and Medicaid Services (CMS) to facilitate the creation of a unified healthcare financing system;
  • Establish a Waiver Development Workgroup of diverse healthcare system stakeholders appointed by the Governor, Speaker of the Assembly, and President Pro Tempore of the Senate; 
  • Provide quarterly reports to the chairs of the Assembly and Senate Health Committees on the status and outcomes of waiver discussions with the federal government and on workgroup progress;
  • Submit a complete set of recommendations regarding the elements to be included in a formal waiver application, as specified, by no later than June 1, 2024

Single payer advocates are building an outreach and public education campaign to bring into legislative discussions health justice advocates from varied contexts: labor, expanding coverage for undocumented residents, reforming Medi-Cal, and rate-setting for health systems. This marks a critical broadening of our advocacy base. It will foster decisions on unsettled key policy and financing issues from the Healthy California for All Commission that the Legislature will support.

SB 770 and CalCare (AB 1690), the comprehensive single payer bill sponsored by the California Nurses Association, are on complementary tracks. The first legislative goal would be passing the collaborative engagement and advisory process in SB 770, to be followed by consideration of a comprehensive single-payer program, including the proposals in CalCare, which is slated to be considered in 2024.

It’s vital that advocates support the process. We must repeatedly highlight the broad and deep political support for single payer, and contribute to the resolution of key political, legal, and technical issues to support state single payer. SB 770 provides an essential opportunity and a path to guaranteed healthcare.

We have an historic opportunity to achieve political success for single payer – let’s seize the moment!


Mr. Lighty is President, Healthy California Now.

© Health Justice Monitor
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