California's single-payer experience and progress

This presentation will describe the California approach to refining and passing legislation to create a state single-payer system. First, it will outline the differences between state and federal legislation, and explore the challenges in adapting ideal single-payer provisions to the state environment. Second, the presentation will provide an update of efforts of the statewide single-payer coalition, the Campaign for a Healthy California.

PNHP California has established a technical advisory group (TAG) to review and refine SB810, the current single-payer bill, in collaboration with other single-payer groups. The TAG is charged with improving bill language with regard to a number of health policy considerations, from the role of HMOs in a single-payer system, to the definition of profit and the impact of incentives, to coverage and benefits. The TAG is also exploring the feasibility of commissioning a new single-payer financing study for California, which recently proved effective to advance legislation in Vermont.

Single-payer has been introduced in the California legislature each year since 2003, twice reaching the Governor's desk and being vetoed. However, the movement continues to grow. California's legislative approach differs from federal efforts and those of other states due to the nature of California law. Key strategies derive from the way California deals with bills with tax implications plus the existence of an alternative legislative pathway, the ballot initiative process. Other differences are due to the unique characteristics of providers/stakeholders in the California healthcare system and the need to adapt the bill language to accommodate those realities.