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Universal health care bill collapses without vote in California

The bill's author couldn't wrangle enough support from his fellow Democrats and nixed it minutes before a floor vote.

SACRAMENTO, Calif. (CN) — California’s push to create the country’s first single-payer health care system dissolved quietly late Monday as the bill’s progressive author nixed a scheduled vote due to a presumed lack of support in the heavily Democratic state Assembly.

Assemblyman Ash Kalra acknowledged he was unable to wrangle enough votes before a key legislative deadline, citing “substantial misinformation” from a group of well-funded opponents. Nonetheless, Kalra claimed there’s still a viable path to universal health care in the nation’s most populous state, even though he couldn't secure a majority vote in a chamber dominated by members of his own party.

“Despite heavy opposition and substantial misinformation from those that stand to profit from our current health care system, we were able to ignite a realistic and achievable path toward single-payer and bring Assembly Bill 1400 to the floor of the Assembly,” Kalra said in a statement. “However, it became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today.”

By abandoning Monday’s vote, Kalra freed Assembly Democrats — and Governor Gavin Newsom — from having to take a formal position on the polarizing topic in an election year.

The decision didn’t sit well with Assembly Speaker Anthony Rendon, who said he was disappointed.  

“The shortage of votes needed to pass this bill out of the Assembly indicates the immense difficulty of implementing single-payer health care in California,” Rendon, D-Lakewood, said in a statement. “I support single-payer and fully intended to vote yes on this bill. With time, we will have better and more successful legislation to bring us closer to this goal.”

Though voters rejected a universal health care initiative in 1994 and lawmakers most recently snubbed the idea in 2017 due to a lack of funding, the single-payer vision has leapt back into the Golden State’s political agenda.

Coined the “Guaranteed Health Care for All Act,” AB 1400 proposed a single-payer program to be administered and overseen by a new state agency known as CalCare. Kalra, D-San Jose, reintroduced the bill this month and two committees quickly signed off, setting up a presumed showdown on the Assembly floor.

Supporters, including the California Nurses Association and cities like San Jose, Sacramento and Long Beach, jumped behind the effort. In support letters, newspaper editorials and committee testimonies, the proponents said the switch to universal health care would trim existing administrative costs, coalesce the state’s buying power and reduce labor union strikes that often stem from disputes over health care benefits.   

The bill’s main sponsor ripped Kalra’s decision, accusing him of “providing cover” to more moderate Assembly Democrats.  

“Nurses condemn this failure by elected representatives to put patients above profits, especially during the worst surge of Covid-19 yet,” the California Nurses Association responded. “Nurses are especially outraged that Kalra chose to just give up on patients across the state.”

As was the case with recent single-payer attempts, the daunting price tag likely derailed the latest version.  

According to the most recent estimates, adopting single-payer could cost between $314 and $391 billion annually. Further, if the federal government signs off and contributes to California’s transformation, the state will have to come up with at least $158 billion to launch AB 1400.

To help fund the transition, supporters proposed raising taxes on businesses and residents through an accompanying ballot measure. They said the tax hikes paled in comparison to the over $400 billion Californians currently spend on health care and that single-payer would save the state money in the long run.

But a familiar coalition of critics consisting of hospital groups, insurers and the GOP lined up to fight the idea of government-run health care, casting it as the “largest tax increase in state history.”

“This bill was fiscally irresponsible, unsustainable, and was not functional. Worse, it would have caused more harm. Common sense prevailed,” said Assemblyman Vince Fong, R-Bakersfield.

Adding to the intrigue was whether Governor Gavin Newsom would get behind the single-payer push or the corresponding tax hike during an election year. Pundits predict several tight congressional races and expect California to factor heavily into who takes control of the House in 2023.   

Newsom, who promised to pursue a single-payer system on the campaign trail in 2018, declined to endorse AB 1400 at this early stage in the legislative process. Instead, the former San Francisco mayor has introduced drastically cheaper plans to extend subsidized health coverage to all residents regardless of immigration status.

The nurses association said Monday’s setback won’t kill the grassroots movement for single-payer health care. “Kalra, the main author of the bill, chose not to hold a vote on this bill at all, providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California.”  

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