July 6, 2017

San Francisco Bay Area Physicians for Social Responsibility (SF Bay Area PSR) continues to raise the progressive physician’s voice to help ensure the passage of state bills whose aims are to protect human health and the health of the planet. In 2017, issue areas range from slowing down or stopping global warming and protecting disproportionately impacted communities from toxic air pollution, to stopping gun violence and calling for more robust right-to-know for workers and other consumers when it comes to cleaning and cosmetic products.

In many cases, the California state legislature continues to show leadership on issues related to health and the environment even as they are under attack at the federal level. A big legislative ticket item this year in the state legislature has been universal health care. Authored by Ricardo Lara and Toni Atkins, SB 562 (Lara/Atkins)would create a system in California so that everyone in the state can receive comprehensive health care. It passed the state Senate but as of June 23 is on hold in the Assembly. Since this is the first year of a 2-year legislative session, members of both houses will have more time to flesh out significant details like financing to make it a more viable and sustainable health care delivery system. As health care is increasingly under attack at the federal level, the importance of this bill in serving as a model for other states and in providing health care for all Californians cannot be underestimated.

Call the office of Assembly Speaker Anthony Rendon at (916) 319-2063 and say you support SB 562 and health care for all. You can also thank Senators Toni Atkins and Ricardo Lara for their efforts to bring universal health care to California by emailing them to the attention of their staff: Megan.Baier@sen.ca.gov.

Calls for the creation of a single payer or universal health care system are not new to the state of California. Twenty-five years ago, state Senator Nick Petris (Oakland), in conjunction with Insurance Commissioner John Garamendi, created a plan for universal coverage that passed the legislature but was vetoed by Governor Pete Wilson. In 1994, voters in California considered Proposition 186; unfortunately, that single-payer initiative lost in the face of strong industry opposition. But the proposition helped to educate and raise the awareness of this vital issue, fostering a movement for single payer health care that continues today.[i]

Since 1994, there have been additional legislative efforts focused on adopting a comprehensive universal health care system. In 1998, then state Senators Barbara Lee (Oakland) and Diane Watson (Los Angeles) introduced SB 2123, calling for establishment of a universal single-payer system in the state. This bill resulted in a study to compare different models of financing universal health care, including single payer. In 2002, the Lewin Group and AZA Consulting found that more people could be covered for more services for less money with a single-payer system. A few years later, the Lewin Group reported that a single-payer system in California would save the state $34 billion over 10 years while covering all Californians with comprehensive health care.

In the 2000s, State Senator Sheila Kuehl (Los Angeles) authored single-payer bills in the 2005-2006 and 2007-2008 legislative sessions that passed both houses of the state legislature but were ultimately vetoed by Governor Arnold Schwarzenegger. Since then, legislators have championed other single-payer health care bills, but these unfortunately did not make it to the governor’s desk for possible signing (or veto!).

The federal Patient Protection and Affordable Care Act (ACA) championed by President Obama is far from perfect but “is credited with reducing the number of uninsured by about 20 million. “[ii] Additionally, it prohibits exclusions, denials, and higher charges based on pre-existing conditions.

Fast forward to 2017. Californians overwhelmingly support the ACA. In a recent poll, about 2/3 of Californians said they support the law, and about 56% said they fear losing their health care coverage if the current administration and Republican-led Congress get their way.[iii]

There is good reason for concern. Under the House of Representative’s plan to “repeal and replace” the ACA, it’s estimated that 13-23 million more people would become uninsured by 2026.[iv]

Additionally, even though insurers are prohibited from denying health care coverage based on a pre-existing condition, the House’s American Health Care Act has no prohibition from charging more for that coverage. The mechanisms to compensate for more expensive health care plans for people with pre-existing conditions—additional federal funds and high risk medical insurance pools—are thought to be insufficient to cover what could become exorbitant and unaffordable health care costs. More than one in four Americans between 18 and 64 has a pre-existing condition.[v] Since the House passed its own version, thirteen Republican men in the U.S. Senate have been meeting behind closed doors to come up with its particular “repeal and replace” approach.   On Thursday, June 22, the Senate revealed its secret plan. According to the New York Times, although the Senate plan offers more financial assistance for low-income individuals to help defray the costs of health insurance, it “would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid.”[vi]   The billions of dollars eliminated from the ACA’s expansion of Medicaid for the benefit of low-income individuals would effectively be handed over to the economically affluent in this country through a broad tax cut. And, like the House bill, the Senate bill defunds Planned Parenthood, with profound negative implications for meeting women’s reproductive and other health care needs.

Fortunately, California is not waiting to see how its residents will fare in the Republican dismantling of the Affordable Care Act. SB 562 (Lara/Atkins), the Healthy California Act, would create a program to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that the program covers a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including, but not limited to, the state’s Children’s Health Insurance Program (CHIP), Media-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program.

SF PSR supports this bill. We stand ready to do what we can to join colleagues in Physicians for a National Health Program (PNHP) and other allies by engaging in the health care debate at both the federal and state levels to make sure that everyone receives the health care we all need and deserve.

[i] http://www.healthcareforall.org/what-single-payer-movement-california; https://www.healthcareforall.org/sites/default/files/files/downloads/background_history_of_california_single_payer_legislation_1998-2017_april_0.pdf

[ii] Urban Institute, Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live? (Dec 2016) http://www.urban.org/sites/default/files/publication/86761/2001041-who-gained-health-insurance-coverage-under-the-aca-and-where-do-they-live.pdf

[iii] http://www.sacbee.com/news/politics-government/capitol-alert/article157060594.html

[iv] http://www.cnbc.com/2017/06/13/watch-president-donald-trumps-comments-on-health-care-reform-replacing-obamacare.html

[v] http://www.politifact.com/north-carolina/statements/2017/may/04/robert-pittenger/does-new-version-ahca-protect-coverage-pre-existin/ https://www.washingtonpost.com/news/fact-checker/wp/2017/05/04/heres-what-you-need-to-know-about-pre-existing-conditions-in-the-gop-health-plan/?utm_term=.009add814ef7

[vi] https://www.nytimes.com/2017/06/22/us/politics/senate-health-care-bill.html