California's disappearing health care reform

The single payer health care bill has passed both of the state's legislative branches -- twice. Why is it now dead?

Published May 2, 2013 6:54PM (EDT)

A rally for single-payer healthcare outside of Blue Shield office, Beale St., San Francisco on 8/8/2007
  (Wikimedia Commons)
A rally for single-payer healthcare outside of Blue Shield office, Beale St., San Francisco on 8/8/2007 (Wikimedia Commons)

This article originally appeared on the L.A. Review of Books.

Angeles Review of Books
A VERY STRANGE THING HAPPENED to the California single payer health care bill this year. It disappeared.

This disappearance was no small thing. Single payer has actually passed both California legislative branches — twice — before being vetoed by Governor Arnold Schwarzenegger. The bill hasn’t exactly been obscure, if only because its initial sponsor was Senator Sheila Kuehl, famous long ago as Zelda on the television show The Many Loves of Dobie Gillis. Yet, where Vermont begins the year progressing toward its version of a single payer system and Pennsylvania unveils a study of how much money a similar system might save its people, the largest state in the union has no such legislative vehicle, despite the millions who will remain uncovered by “Obamacare” and reports of drastic health insurance rate increases to come.

The first indication of this astounding turn of events came when Senator Mark Leno, the bill’s sponsor since term limits ended Kuehl’s legislative career, informed supporters of his intention not to refile. As Don Bechler of the San Francisco-based Single Payer Now group recalls, “He said his colleagues had asked him, ‘What part of "No" don’t you understand?’”

The bill had failed the last two times Leno offered it in the Senate, and he suggested maybe it would be better if someone filed it in the Assembly instead.

But no one did — in either branch. Individual legislators begged off, claiming that their agendas were already set or they lacked the available staff time that sponsorship would require, but it was obvious to all who cared to know that the legislative leadership had put out the word: no bill was to be filed.

As Karen Bernal, chair of the California Democratic Party’s the Progressive Caucus, sees it:

The Legislature is focused on the implementation of the Affordable Care Act (ACA, aka “Obamacare”) only, and they simply aren’t going to deal with single payer this year. Those are the marching orders which, I think, probably come from three directions — the Governor, the legislative leadership and the White House. It’s understood by all that Assembly Member Richard Pan will not let a single payer bill out of the Assembly Health Committee.

But where the legislature presented a united front against any single payer legislation this year, the bill’s traditional supporters did not. Michael Lighty, director of public policy of the California Nurse Association (CNA), arguably the most important single payer supporter organization in the state, explained, “We were not for filing a bill this year for tactical reasons. Filing a bill that goes nowhere would make us weaker.” Instead, he argues, “We feel we need to take a really hard look at building a stronger base while working with the unions that are concerned with the implementation of ACA, address the shortfalls in ACA and help people understand that it needs to be supplanted by single payer.”

Lighty further argues, “Single payer is a ballot fight one way or the other. Even if we win it in the legislature, the insurance industry will put repeal on the ballot. The presidential election electorate is the largest and the most reflective of the widespread support for single payer, so let’s have a discussion of whether we can go to the ballot in 2016.”

If single payer supporters want to look for an upside to all of this, they may find it in the fact that a public discussion has finally begun about the insincerity of the legislature’s past support for the bill. As Lighty puts it, “A Democratic legislature will pass single payer when there’s a Republican Governor but not when there’s a Democratic Governor — unless he wants it.” He asks, “Why is Vermont in the position it’s in?” and answers, “Because they have the governor with it,” further arguing that in California too a “key is generating gubernatorial support, executive support on the state level.”

That may be it for silver linings. Right now, CNA’s strategic turnabout has shattered the former unity of the state’s single payer forces, with all of the single issue, single payer groups withdrawing from the CNA-staffed Campaign for a Healthy California. There is widespread feeling among those organizations that the union’s turnabout provided cover for legislators to walk away from single payer. While this seems undeniable, it also seems fair for Lighty to ask why CNA is being “vilified over a tactical difference, given its long-standing, unfaltering, unique level of support for single-payer?”

In many respects, the California single payer movement has been a classic example of a community labor coalition, with all of the tensions and imbalances inherent in such organizations. In this one CNA is the titan, with resources — and responsibilities — that many of its allies do not have. Nevertheless, to the extent that Lighty correctly assesses the level of organization that will eventually be required to push a California single payer system over the top — and there seems little to argue with here — the single payer movement’s past unity will have to be rebuilt.

Karen Bernal, for one, empathizes with the frustration she sees underlying CNA’s altered approach. “I would prefer that there were a bill again this year,” she says, “but I can understand why the CNA is not backing one, in that none of the other unions have really been backing CNA on single payer in the sense that they won't apply any pressure to the leadership or Brown, even if they support it on paper.”

But of course the interests and perspective of a single organization are rarely identical to those of a coalition. Could CNA be right in deciding that, since passage of single payer is not likely this year, pursuing it anyway would not constitute the best use of its members’ dues in the current legislative session? Absolutely, and this is CNA’s decision to make, right or wrong. But does this automatically mean that dropping a legislative strategy makes sense for the single payer movement as a whole? Absolutely not.

There are at least two problems with CNA’s current approach. The first lies in the end game. While Lighty is no doubt right in saying that the matter will finally be decided on the ballot, there’s a world of potential difference in the circumstances leading up to that point. The argument that the ballot is not the appropriate way to legislate carries great weight when voters are asked to adopt a sweeping change of great complexity. Also, insurers would much rather pick a hole — or two or three — in a largely unknown bill than be forced to overturn something already vetted in the legislative process. Forcing the insurance industry to overturn a law already on the books would be vastly preferable to asking the electorate to create the new system.

The second problem lies in the road leading up to that end game. For now, Don Bechler says that his organization will just keep “going out there and putting out the word on single payer and try to get someone to introduce it in January 2014.” Why is a bill important? Says Bechler, “We’ve got something to talk about. If someone says, ‘How does it work?’ it’s in the bill. If they ask, ‘What’s in the bill?’ There’s an answer.” With the state’s new health care exchange, the agency charged to carry out the ACA’s reforms, having just issued a report that the new law could bring a 26.5 percent average rate increase for individual plan premiums — 30 percent for those making more than $45,960 — the situation cries out for a viable alternative. This year, however, there will be none.

In the meantime, in the spirit of the new truth telling that the bill’s non-filing seems to have opened up, there are a few other things that ought to be said. Today, California has a Democratic Governor and two-thirds Democratic majorities in both legislative branches. This is a situation widely considered to be as good as it gets in the realm of pragmatic progressive politics. And yet CNA believes that the legislative process is not a viable arena for its health insurance reform agenda. Remember that the initiative process first came to California because the Progressives and the labor movement considered the legislature a wholly owned subsidiary of the railroads and other special interests. Are we coming to a similar conclusion 100 years later?

And while we’re on the legislature, anyone who thought that legislators were elected to answer only to their constituents and their own consciences apparently needs to rethink this. An individual legislator changing his mind on filing a bill is one thing. But when the entire legislature acts in lockstep —or more properly speaking doesn’t act — the invisible grip of the legislative leadership is all too obvious.

Finally, there’s the shocking ease with which single payer legislation was disappeared from the Sacramento agenda. The bill’s supporters seemed too stunned to act. Except for a last minute, too little, too late effort in San Francisco, there was no evidence of any mass mobilization to get individual legislators to file a bill. When you can’t even persuade a single legislator to buck the leadership, it’s hard to see how you beat the health insurance industry.

(Author’s note: As a past member of the Massachusetts House of Representatives, I was stunned to hear that there was a plan afoot to disappear the California single payer bill, and even more amazed when that plan was carried through. Such a development would have been inconceivable in my legislative experience, if only because Massachusetts has the “right of free petition,” which means that individual citizens can have their bills filed even if their legislators don’t support them.)


Tom Gallagher was the Small Business Endorsement Coordinator for Proposition 186, the unsuccessful 1994 initiative to establish a single payer health insurance system in California. He participated in the last ditch San Francisco effort to get a bill filed.

By Tom Gallagher

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