Instead, he has created a commission to study the concept and asked the Biden administration for permission to collect federal money that flows to the state via the Affordable Care Act, Medicaid, and Medicare, which California could use to help finance a single-payer system. But Biden can’t simply approve the request — California would need complicated federal waivers and approval from Congress.
Newsom has shifted to a platform of “universal healthcare,” which includes Medicaid coverage for all income-eligible unauthorized immigrants and state-funded subsidies for Californians who buy health insurance from Covered California, the state’s Obamacare insurance exchange.
Newsom said in January that he has long believed single-payer is “inevitable” but signaled that the federal government should take the lead.
Kalra decided not to bring his bill up for a vote in the state Assembly, saying on Jan. 31 that he couldn’t muster enough support.
“It makes it harder to get the votes you need when I’m trying to convince my colleagues that there’s an absolute path to success,” Kalra said. “We have a governor who campaigned on single-payer, and if we’re going to successfully have single-payer healthcare in California, at some point we need his engagement and it needs to be genuine.”
Kalra said he’s considering introducing another bill next year but conceded that he must shift his strategy to bring more Democrats and unions into the campaign.
These are lessons other states are heeding.
“There’s no question that had California passed a single-payer healthcare plan, we’d be in a position in the state of Washington to say, ‘Look what California is doing,’” said Andre Stackhouse, campaign director for Whole Washington, an advocacy group trying to get a single-payer initiative on the ballot next year.
Stackhouse worked on behalf of California’s single-payer campaign this year, helping with a phone-banking campaign to pressure lawmakers. He’s part of a new national coalition called Medicare for All Everywhere, a group of organizers and volunteers working to identify why single-payer efforts fail and how to overcome political and lobbying obstacles.
California was a key test, he said. “We’ve learned all the ways Democrats can kill a bill, but we can’t spend all of our time grieving this loss and the huge setback that it is,” Stackhouse said.
For instance, a major goal for the movement is to persuade more unions to join the fight. Although the nurses union is leading the battle in California, other unions are against single-payer.
“As trade unionists, we believe everybody should have healthcare, but there’s a big fear that we’re going to lose the benefits that we have,” said Chris Snyder, political director for the local International Union of Operating Engineers in Northern California. “We have our own healthcare trust fund, and we don’t want benefits that we’ve fought for for decades to be taken away or watered down.”
Lack of union support is a major problem in New York, where Democratic Assembly member Richard Gottfried has introduced a single-payer bill in every legislative session for the past 30 years.
“What is keeping the bill from moving in the legislature is opposition from public employee unions,” Gottfried said. “They feel they have negotiated excellent coverage, so we need to convince them that the New York Health Act is as good or better than what they have now.”
Gottfried said he has been negotiating with teachers, sanitation workers, and other trade unions on legislative language that would provide “more explicit guarantees” that union members would receive better coverage without paying more out-of-pocket than they already do.
It’s not clear if the measure will get a vote this year.
“Whichever state goes first will help build momentum for other states,” he said.
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.