The single-payer health care debate has been relatively quiet in California since Senate Bill 562, The Healthy California Act, was tabled by the Speaker of the Assembly at the end of July. But the conversation is about to heat up again in California—and at the national level. For employee benefit advisors who aren't fascinated by the legislative process, or who think we have a long way to go before a concrete policy could actually be implemented, the single-payer debate can be a distraction. But it's important to be aware of the issue, since it could have a major impact on the current employee benefits landscape. Here are four things all advisors should know about the current state of single-payer in California and beyond.
1. California Senate Bill 562, The Healthy California Act, is not dead. The bill was approved by the State Senate on June 1, 2017, and then moved on to the State Assembly. In a surprise move, Speaker of the Assembly Anthony Rendon delayed the bill in the Assembly Rules Committee for further discussion and debate. It will be revisited in January 2018, and could continue its progress through the state legislature and ultimately land on the governor's desk for approval in 2018. It's important for advisors to know that this particular bill proposes an extreme form of universal coverage known as single-payer, which would eliminate the private insurance industry in California, including health insurance carriers, brokers and employer-sponsored benefits. It would replace not just health insurance (including Medicare and Covered California), but dental, vision, workers' compensation and long-term care insurance, with a state-run program.
2. On August 24, 2017, Speaker Rendon announced that he was establishing an interim Select Committee on Health Care Delivery Systems and Universal Coverage, made up of Assembly members. The Committee will hold informal hearings to discuss various methods of health care delivery and funding, including Medicare for all, single-payer, hybrid systems and Affordable Care Act expansion. The committee will hold a number of hearings now that the legislative session ended in September. While the Committee doesn't have the authority to move SB562 forward, it will certainly bring more attention to the issue.
3. A ballot initiative called the “California Healthcare Roadblock Removal Act” was submitted by Enact Universal Healthcare for CA, Inc. to California Attorney General Xavier Becerra on August 18, 2017. The ballot initiative process gives California citizens a way to propose laws and constitutional amendments without the support of the governor or the Legislature. The initiative was assigned Initiative #17-0019 and is currently awaiting title and summary. The language of the initiative proposes a single-payer type system in California, but it is poorly written and incomplete, and may be sent back to the author before it can move ahead. If the Attorney General decides to make it an active measure, supporters will collect signatures with the intention of getting it qualified for the November 2018 ballot, where the residents of California will approve or deny it.
4. At the national level, Vermont Senator Bernie Sanders introduced his highly anticipated “Medicare for all” bill in September, after Congress reconvened. His plan is an expansion of the current Medicare system, which is a federally funded basic level of health care. While he has acknowledged that his proposal is unlikely to pass a Republican-controlled Congress, his popularity, along with widespread frustration about the failed reforms to the Affordable Care Act, will propel this issue into more of a national debate.
While it's clear the idea of some type of universal health care system is gaining popularity, there is also a lot of confusion about what these various proposals would actually do, and terminology is consistently being misused by many, including the media and those leading the charge. It's important for advisors to understand the difference between “universal care” (which would provide a basic level of care but also leave room for private insurance), “Medicare for all” (expansion of the current federal program) and “single-payer” (a government-run plan with no private insurance option). It's also important for advisors to understand that supporters of universal health care see this as a social movement, and they are passionate and vocal about this issue. Advisers must become active participants in this debate, using rational, informed voices with clients, colleagues, legislators and even friends and family, since this is an issue that could have an exceptional impact on our businesses and our industry.
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