California Democrats are reviving the promise of single-payer health care

from Jeanne KuangCalMatters

This story was originally published by CalMatters. Sign up for their newsletters.

California’s Democratic candidates for governor can’t stop talking about single-payer health care — again.

The idea of ​​a government-run universal health care program to replace private insurance as the sole payer of health care costs faces as many obstacles as ever. It took a back seat after Gov. Gavin Newsom and Democratic lawmakers failed to do so, with some balking at the estimated $392 billion in annual costs.

Health advocates have since turned their attention to what lies ahead The Trump administration is cutting Medi-Calexpanded public health coverage for low-income residents. However, the progressive rallying cry of “Medicare for all” has become a staple of Democratic platforms. Few of them offer any specifics about how they would do it.

Climate activist and Democratic gubernatorial candidate Tom Steyer opposed single-payer when he briefly ran for president in 2020, but changed his mind in December. The billionaire candidate told party delegates at their convention last month that because he is not beholden to corporate interests, “I can state the simple fact that we need a single-payer health care system in California.”

Former Orange County U.S. Representative Katie Porter endorsed the policy in a video and told party delegates that as governor she would “deliver single-payer health care.” Porter, a longtime supporter of single-payer in the past, had declined to commit to the issue last year due to concerns about feasibility, told Politico she didn’t think the idea was “realistic in the next few years.”

State Superintendent of Public Instruction Tony Thurmond, former Superintendent Betty Yee and former U.S. Health and Human Services Secretary Xavier Becerra also said they supported it.

Bay Area Rep. Eric Swwell, who polls show is tied for the lead in the race with Porter, Steyer and Republican front-runners Steve Hilton and Chad Bianco, would instead focus on creating a public option, a spokesman said, an alternative that tries to cut costs by creating a state plan to compete with private insurance. This model is a more moderate approach as it aims to provide a more affordable coverage option, but allows employers to retain their private coverage if they choose.

Newsom’s broken promise

Creating single-payer in California would require the federal government’s approval for the state to redirect federal dollars that currently pay for Medicare, Medicaid and veterans health insurance, which the Trump administration will almost certainly deny. It would also likely require a major increase in state taxes, although advocates say it would save the state money in the long run through lower drug prices and administrative savings and save Californians out-of-pocket costs.

Daniel Panush, a consultant who has worked on health care policy in the Legislature for two decades, said those two factors lead him to believe that Democrats’ constant promises to establish single-payer health care are generally just “ambitious.”

“It’s easy to make promises,” he said. “We all want to see the plan.”

Also, it’s California in a budget deficit for the fourth year in a row, and existing public health programs face imminent danger from the Trump administration’s cuts. More than 500,000 Californians are expected to lose Medi-Cal coverage this year, rising to 1.8 million in the future, and hundreds of thousands more are expected to lose coverage through the Covered California marketplace after federal premium subsidies expired last year.

Single-payer advocates like Rachel Lynn Gish, a spokeswoman for the consumer group Health Access California, say it’s “inevitable” it will be part of gubernatorial candidates’ platforms. But she is not particularly hopeful about its short-term prospects. While advocates want to see single payer in the long term, she said, “we also want to see short-term solutions: how (candidates) will start from day one to protect Medi-Cal, Covered California, coverage for immigrants and LGBTQ care.”

“Sometimes it feels like single-payer is the future of California’s health care system and it always will be,” said Daniel Zingale, a former strategy adviser to Gov. Gavin Newsom who is well known on the issue.

During his 2017 campaign for governor, Newsom said the Californians “It is my firm and absolute commitment, as your next governor, that I will lead the effort to achieve it.” The position earned him the endorsement of the California Nurses Association, but it remains one of Newsom’s biggest broken promises.

The governor created a commission in 2018 to study single-payer and sought a federal waiver to allow it, which was not an undertaking with the first Trump administration. Since then, he has continued to support all the efforts of the nurses’ union.

Democratic lawmakers also failed to bring the issue to his desk, with one attempt publicly imploding in 2022 after the lawmaker Ash KalraSan Jose Democrat, they could not muster enough legislative support and he did not want to alienate colleagues by forcing them to vote. He tried again in 2024, but MPs killed him before he could reach parliament.

Over the past eight years, Newsom has changed his strategy to address “universal access” to health care, providing subsidies for Covered California and gradually expanding Medi-Cal to cover some undocumented immigrants. That has resulted in more than 94 percent of state residents having health insurance, a practical effect that advocates like Health Access applaud despite their long-standing support for single-payer.

And the Newsom administration took some smaller steps toward single-payer, with the governor signing into law in 2023 a law requiring the state to study the types of waivers the federal government would need. A public report on the matter was due to be published in November, but has not yet been published.

The idea has always put progressive Democrats at odds with powerful private interests such as insurers, hospitals, doctors and the California Chamber of Commerce, which generally opposes tax increases, wants to preserve employers’ choice of insurance companies and doesn’t want the state to spend on “a new, cumbersome government bureaucracy,” spokesman John Myers said.

Why single payer continues to fail

Now that Newsom has been fired and out of office at the end of this year, those running to replace him are making the same big promises. The same groups are opposed.

“There’s a reason such proposals have failed to gain traction in the past: The effort is more symbolic than serious,” Myers said.

Democrats pushing for single payer aren’t worried. A spokesman for Porter did not respond when asked how he would do single-payer despite previous failed attempts. As for Steyer, spokesman Danny Wang wrote in a statement that he “knows the battle will not be easy” against “Washington politicians and corporate interests who profit from high health care costs.”

Steyer’s campaign supports the policy outlined in Kalra’s bill, which lawmakers reintroduced this year. The bill would have the state take on the role of private insurance with every Californian eligible for coverage and require the state to seek federal waivers to help fund the program. As for state funding, the bill states that the Legislature will come up with the revenue once the policy is created.

Kalra supported Steyer along with the nurses’ union. He dismissed criticism that he did not include a source of state funding, saying the state should create the policy before waiting for a friendlier federal administration to request a waiver to help fund it.

“We can do two things at once, we can push back against Trump and the Republican health care cuts by taking immediate action to ensure that Californians still have access to health care and start charting the path to what we want to see post-Trump,” he said.

With premiums increasing every year, “it seems like almost a softball when it comes to Democratic politics at this point … to at least honestly explore support for it.”

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.