California Commission Affirms Unified Financing

April 22, 2022

Summary: The Healthy California for All Commission issued a final report laying out the huge benefits to be derived from “unified financing” – one payment mechanism for all health care. Costs down, health care up. The impressive affirmation of fundamental principles plus technical findings bolster efforts for single payer.

Key Design Considerations for a Unified Health Care Financing System in California
Report to the Healthy California for All Commission
April 2022
[HJM bolding]

[T]he concept of unified financing [UF] describes a statewide system to arrange, pay for, and assure health care in which:

• All Californians will be entitled to receive a standard package of health care services;
• 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.

The analysis done in connection with the Commission’s work found that:

• Under almost all scenarios analyzed, in the first year of implementation unified financing is expected to result in lower total health care expenditures than under the status quo;
• If, as expected, UF reduces the rate of growth of health spending, savings over time would be achieved under all scenarios examined, even when long-term care services and supports (LTSS) are included as covered services;
• Assuming that the federal and state governments support UF at the level they would have supported under status quo fragmented financing, the savings from UF will accrue to California employers and households, who will on average pay less to support UF than they pay in the status quo;
• Financing can be stable over time, but will depend on controlling cost growth and securing agreements with the federal government about the rate of growth in federal payments.

Next Steps …

4.   Role of Health Plans: Evaluate whether health plans under the status quo add value by furthering access, affordability, quality and equity while accounting for excessive administrative costs and profits and burden on providers. If health plans are retained and reimagined under UF, what functions would they perform?

5.   Uniform Clinical Data Record: [E]xplore the potential benefits …

Comment by: Jim Kahn

Don’t let the precise technical prose fool you – this is a full-throated endorsement of the critical core of single payer: unified financing for universal coverage. That is, replacing our cacophony of insurance products and uninsurance with 100% coverage with standard comprehensive benefits saves money while protecting family health and finances.

The Healthy California for All Commission is an outgrowth of AB 1400, and has been working hard since January 2020, guided by the State of California and supported by University of California experts. The single payer voice within the Commission was strong, and came through in this report’s principles and findings.

Importantly, the report (Fig. 1) confirms that savings from simpler administration and lower drug prices (15.4%) exceed increases in utilization (11%, or 7% if income-related copays). This is the pivotal dynamic and irresistible appeal of unified financing: streamlining permits more health care, with net savings. It is the “free lunch” so rare in economics.

Thus, we move a little closer to single payer. The report lays out important next steps, both technical (e.g., better data on health spending) and bureaucratic / political (e.g., seeking federal waivers and cooperation).

Two tasks from the report excerpt above warrant emphasis:

Role of Health Plans: “excessive administrative costs and profits and burden on providers … if retained and reimagined, what functions?” Exactly. Health plans are an expensive & inexcusable drain on our current system. There is no evidence of net benefit. They should be eliminated entirely (in deference to direct fee-for-service), or radically restructured into claims processors.

Uniform Clinical Data Record: Ooh, I get to talk geeky. Currently we struggle with incompatible electronic health records and claims files. Assembling this information into one integrated data system would enhance patient care, research on treatment effectiveness, and detection of fraud and waste. Gotta love top notch data!

There remain many challenges ahead. But today I feel really good about the great State of California so clearly and unequivocally confirming the principles we’ve been fighting for.