Single Payer Bill Back in the Mix

The normally sedate audience at an Assembly health committee hearing broke into spontaneous applause last week as Senate member Mark Leno (D-San Francisco) stepped to the microphone. Leno was introducing SB 810, which would establish a single-payer health care system in California.

The burst of applause came from a busload of supporters in the hearing room. It has been a long, hard fight for single-payer advocates. Twice the idea has been approved by the state legislature, and twice it has been vetoed by the governor.

The single-payer system would bypass health insurance companies in California, handing the authority and responsibility of health care administration to the state. With passage of a national health care reform law, some expected the single-payer idea to wither on the vine. But at last week’s Assembly Health Committee hearing, it was alive and well.

“We don’t have a health care system in California,” Leno said. “We have a risk management system. It is a system that’s all about the bottom line of a for-profit market middleman. And the system is broken.”

But it’s that current system that national health care reform is trying to fix, Marti Fisher of the California Chamber of Commerce said. “The federal legislation provides universal coverage, so this is unnecessary. Let’s give federal health care reform a chance to work.”

Advocates said that, however the federal reform plan goes, it will be missing one basic and important element.

“For-profit insurance companies made $12.2 billion last year alone,” Leno said. “I don’t blame them, they’re a corporate entity. Their business is to make money. But the state’s business is caring for the health of Californians.”

The chair of the health committee, Bill Monning (D-Carmel), said the national reform law has a waiver for state innovation which, he said, makes single-payer legislation “as timely as it’s ever been.”

Steve Lindsay, representing the California Association of Health Underwriters, focused on the cost. The Senate Appropriations Committee projected a revenue shortfall of approximately $42 billion for the program. If that holds true, Lindsay said, “the budget deficit today would be $64 billion, about three-quarters of the entire budget.”

And committee member Audra Strickland (R-Moorpark) pushed that idea a step further — if the program did have a budget shortfall, the state would have to borrow funds, she said.

“Where would you borrow from?” she asked. “What happens when your costs exceed your revenue? You want to issue bonds to contain this behemoth.”

Leno said the $200 billion currently spent on health care in California could fund the program. He said SB 810 is the first step toward limiting health insurance company profits by turning health care administration over to California.

“This bill merely puts policy in place,” Leno said. “We recognize that the finance piece would require a two-thirds vote.”

The bill, which has already passed the Senate, is now headed to the Assembly Committee on Appropriations.

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