Eric Ting, SFGATE Jan. 12, 2022 (SFGate.com)
On Tuesday night, a proposal to create a single-payer health care system in California took a big step forward when it cleared the Assembly Health Committee with an 11-3 vote.
Earlier on Tuesday, Gov. Gavin Newsom held a public event detailing a separate proposal to ensure “universal health care for all” in the state. When Newsom ran for governor in 2018, he campaigned extensively on the issue of single-payer health care.
With the push for “universal health care” in full swing in the state, below is a handy guide to what’s going on, how each proposal would impact you, and what the next steps are for each.
Wait, so there are two proposals for ‘universal’ health care?
Correct. The proposal in the Legislature, which establishes a new single-payer system, was put forward by Assemblymember Ash Kalra, a Democrat from San Jose. The other one, which expands Medi-Cal coverage to all eligible Californians including undocumented immigrants, is a proposal pushed by Newsom.
Neither Newsom nor Kalra seem particularly supportive of the other’s proposal. Newsom has stated that he has “not been briefed” on the Kalra plan, while Kalra called Newsom’s “compassionate” but inadequate.
“Do not mistake compassion for acceptance of a status quo that ultimately is fiscally unsustainable, unreasonably inefficient and morally indefensible,” Kalra said.
What would the Kalra proposal do?
Under that plan, private insurance would be abolished and medical expenses for all residents would covered by a single, government-run fund called CalCare. It is a true single-payer health proposal similar to the one Vermont Sen. Bernie Sanders ran on during his 2020 presidential campaign.
“What we’re trying to do is get rid of these dozens of buckets of funding — whether it’s private insurance, whether it’s employer, whether it’s Medi-Cal — put it into one bucket,” Kalra said.
Like Sanders, Kalra and supporters say that streamlining the process and removing private insurance from the equation would lower costs of care. CalCare would provide access to any doctor in the state, regardless of network, to all Californians, regardless of income, immigration status or any other classification.
How much would the Kalra proposal cost and how would it be paid for?
An analysis conducted by the UC Labor Center estimates a single-payer system could cost the state $222 billion a year, and Kalra put forward a series of tax hikes to pay for the bill.
The four proposed tax hikes are: a 2.3% excise tax on businesses after their first $2 million in income, a 1.25% payroll tax on employers with more than 50 workers, another payroll tax of 1% for employees that earn more than $49,900 annually, and finally, a new 0.5% income tax for Californians making more than $149,500 annually, which increases 2.5% for residents making more than $2.5 million annually.
Those tax increases, which require a constitutional amendment, would have to be approved by two-thirds of both chambers of the Legislature as well as the voters.
What are the next steps for the Kalra proposal?
Because the bill, Assembly Bill 1400, was first introduced last year, it must clear the Assembly by the end of January or die on the vine.
It has strong opposition from the California Chamber of Congress, the California Medical Association and other powerful special interest groups. Some Democrats have also criticized it for a lack of specificity on financing, possibly jeopardizing its chances of actually becoming law.
What would the Newsom proposal do?
Newsom’s plan, which is part of his annual budget proposal, would expand full Medi-Cal coverage to all low-income Californians, regardless of immigration status.
Currently, undocumented immigrants who meet the income requirement (less than $36,156 annually for a family of four) and are under the age of 26 are eligible for Medi-Cal, and low-income undocumented immigrants over the age of 50 will become eligible in May. Those between ages 27 and 49 currently qualify for only emergency room and pregnancy coverage under Medi-Cal.
How much would the Newsom proposal cost and how would it be paid for?
Newsom says the plan would cost $614 million for the upcoming fiscal year and $2.2 billion annually after that.
The state is currently armed with a budget surplus of at least $31 billion.
What are the next steps for the Newsom proposal?
The Medi-Cal expansion is just one piece of his larger $286.4 billion proposal for the 2022-2023 fiscal year.
We are in the very early stages of the budgeting process. Cap Radio has a timeline on the 6-month budget building process.
Eric Ting is SFGATE’s politics editor. He is an East Bay native who has a Master’s degree in journalism from Stanford University. Eric did his undergrad at Pomona College, where he majored in politics and minored in economics. Email: firstname.lastname@example.org