by Maureen Cruise Health Care 4 All-Los Angeles

Assembly Bill 1400 Guaranteed Health Care for All, otherwise known as Cal Care, was the 7th attempt at securing California single-payer legislation. The problem has not been policy or finance. Those are clearly achievable with very favorable results for our population’s health and for the state’s economy. Twenty-two financial analyses of US single payer proposals over the past 30 years have concluded substantial savings every time. (Cai et al PLOS Jan. 15, 2020)

The US is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. Despite overall health care costs 2.5 times that of other nations,  the U.S. multi-payer system leaves uninsured or underinsured residents subject to medical debt, bankruptcies, or delay and denial of health care. The US is #1 in unnecessary death and #1 in preventable disabilities among developed nations.

The obstacle to achieving health care justice is the same as for so many issues of great public importance that are left to languish in limbo. We suffer under a questionable political system labeled a “democracy” that does not guarantee representation of our needs.  AB 1400 is an opportunity to tip the scales in favor of a system where constituents reclaim our right to decide how our tax dollars will be spent and to insist our money be spent on our most urgent needs.

When health care is treated as a commodity,

a price tag is placed on the value of life

and only those with the means have the right to live.

     By the time you read this, CalCare AB 1400 will have either passed the Assembly  or been rejected by the majority Democrat assembly. If it had stayed alive, it would’ve had to pass two senate committees by August 12, then a senate floor vote where  amendments will be proposed and possibly adopted.  AB1400 would then have been sent  back to the assembly for concurrence and must pass the full assembly by August 31 to end up on the governor’s desk for his signature, required by September 30.  But unfortunately none of that will come to pass, because the bill was pulled by its author when enough votes could not be lined up for passage.

If Cal Care became state policy, an appointed 9-member Cal Care Board would begin determining the financing needed, preparing the application for federal waivers, employing necessary staff, and fleshing out delivery of benefits, contracts, participation standards, and price negotiation. There would be  a 17-member Public Advisory Committee made up of constituents, health professionals, and public health advocates. Cal Care also establishes a Long Term Services and Support commission to address needs of seniors and the disability communities.

There would’ve been another hurdle before Cal Care could have been implemented. The reform would only have taken effect once the revenue source is secured.  Cal Care required that the legislature determine fiscal viability, adopt a financing plan and establish the Cal Care Trust Fund. A second bill has just been introduced to fulfill those mandates.  ACA-11 is a state constitutional amendment that proposes  progressive taxation and a cost control system to secure funding for the Trust Fund. But all that is moot now, since the defeat means no such trust fund was established.

ACA-11 authorizes a simple legislative majority vote for taxes, and removes the obstacles of the Gann Limit and Prop 98 by declaring these designated taxes for a Cal Care Trust Fund are not allocated through the general fund. It must pass each chamber by 2/3, then go on the Nov. 8 CA ballot to secure a majority popular vote.

Modeled on the federal Jayapal Bill, Cal Care had some essential features not found in other state single payer bills.  Information, resources and the text are at  Cal Care Toolkit tile.

The core Cal Care principles are:

  1. Universal Coverage including all California residents regardless of immigration or any other status
  2. A publicly-funded, independently-delivered program for all residents, removing the caste system of tiered care. Medicare, Medi-Cal and employment plans are combined into one Cal Care program. Corporate insurance is abolished
  3. Comprehensive benefits include medical, dental, vision, hearing, durable equipment, mental health, prescription drugs and more.
  4. Freedom to choose your own providers, hospitals, clinics. No networks. No HMOs or ACOs. No insurance industry approvals or denials for care.
  5. Progressive-tax funded, eliminating individual premiums, deductibles, co-pays. Pharmaceutical, medical devices, provider fees and hospital prices will be negotiated by the state.
  6. Cal Care eliminates administrative waste and profits by removing the insurance industry from the system, so transition funding is included to support employment opportunities for displaced insurance workers.
  7. Patient care is based on need as determined by a patient and the provider of your choice. Cultural sensitivity and funding to guarantee patient-centered care to diverse populations.

Cal Care is effective because when the Governor, you, the unhoused, our neighbors and legislators all are in the same system of care, three things will happen. We will all have everything we need.  It will be high quality.  Our health care system will never face budget cuts. Protecting our lives and well-being with quality health care will be a priority in California.

AB 1400 Cal Care will remove the racial and economic health disparities damaging families and neighborhoods. AB 1400 apportions health care funds according to health care needs with the goal of erasing disparities, equalizing health status and elevating positive health outcomes throughout the state.

Cal Care provides extra funding for reparations to underserved communities, especially urban and rural areas which have suffered neglect. Additional investments are provided to eliminate health care “deserts” where communities lack sufficient local care facilities and residents suffer obstacles to needed care. These are often culturally, linguistically, or racially defined communities of working people, often immigrants, with low wages, high health needs and limited access to services. This inequity has resulted in a 12- 15 year difference in life expectancy between different areas of our state. Cal Care is  a solution to this travesty.

Local governments and businesses now are burdened with administrative complexity and escalating costs for employee health. So 26 cities including L.A. officially support Cal Care AB 1400, recognizing that state sponsored financing of health care will rescue underfunded city budgets.

Both employees and employers do better when health benefits aren’t tied to employment. CalCare frees workers to choose jobs and win better wages in place of funds siphoned away by the insurance industry for profit. Workers and their families will enjoy sustained health care unrelated to employment. Employers will benefit from savings they can use to reinvest or hire more workers. Unions benefit because negotiations can focus on worker safety, satisfaction and conditions rather than health benefits.

The state would save the billions extracted by the insurance industry for profit and wasteful overhead. The last state analysis showed $27 billion savings with single payer. Our state treasury could cover other essential expenditures.

Californians overwhelmingly support the transition to a single-payer health care system: 57% of Californians supported replacing private insurance with guaranteed coverage provided by the government—even before the Covid-19 pandemic caused millions of Californians to lose jobs and work-provided health insurance.

AB 1400  was practical, morally imperative and fiscally responsible. Cal Care would have saved lives and money. It’s about solvency or impoverishment, health or disability, life or death. The security and health of our population and the financial sustainability of our state are at stake. Lives will be lost that depended on passage and implementation of AB 1400 Cal Care and ACA-11.

To join the effort go to  Cal Care Toolkit tile. Please do your part. We must figure out how to hold accountable the Democrats whose opposition doomed CalCare, even though they were never even forced to cast a public no vote.

Maureen Cruise RN, Co-Director, Health Care for All – Los Angeles Chapter Team


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