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What Backers Say California's 'Medicare for All' Bill Is Missing

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What You Need to Know

  • Anthony Wright of Health Access California says he supports AB 1400 and its goals.
  • He has concerns about whether paying just 100% of the Medicare rates for all care would be adequate.
  • He also has concerns about a lack of revenue and consumer protection provisions.

California lawmakers are preparing to hold a second hearing on AB 1400 — the state’s Guaranteed Health Care for All bill — this week.

The single-payer health care bill, or “Medicare for All” bill, appears to have broad support from California state and local officials, but hospital and physician groups have united with insurers and employers in opposition.

The head of a major California health consumer advocacy group, Health Access California, has written to state lawmakers in support of the concept of creating a single-payer health finance system, but he also expressed concerns about the original version of AB 1400.

AB 1400 supporters face a tight deadline and may have trouble getting the bill enacted as a stand-alone piece of legislation during the current session. But the Health Access California comment letter could shape how lawmakers draft single-payer health care bills in California, and elsewhere in the United States, in the future.

AB 1400 Basics

Assembly member Ash Kalra, a Democrat who represents the San Jose, California, area, introduced AB 1400 with two other assembly members in 2021.

The bill would eliminate commercial health insurance and Medicaid coverage in California and replace those forms of coverage with CalCare, a government-run health plan.

In addition to paying for medical care, CalCare would pay for oral health care, audiology services, vision services, transportation for people with disabilities, and long-term care services. CalCare could also replace or crowd out the traditional Medicare program, Medicare Advantage plans and Medicare supplement insurance policies.

Commercial insurers could continue to sell some kinds of supplemental coverage, but they could not sell policies that covered any services that the California single-payer plan covered.

Members of the California Assembly Health Committee approved the bill by an 11-3 vote Jan. 11.

Members of the Assembly Appropriations Committee are preparing to consider the bill Thursday.

Under California rules, lawmakers have until Jan. 31 to approve the bill. If they approve the bill by that deadline, with a two-thirds majority in both the Assembly and the Senate, then the bill will appear on the ballot in the fall.

The Health Access California Letter

Anthony Wright, the executive director of Health Access California, emphasized in a comment letter on the bill that his group likes the thinking behind AB 1400.

“We are encouraged about the main intent of this bill, to advance our primary goal of quality, affordable health care for all,” Wright writes in the letter. “We support this bill and the goal of reaching a universal health system in California.”

But Wright also talks about what he and others at his organization believe were gaps in the original version of AB 1400.

Wright writes that the original version of the bill lacked a funding mechanism, other than a provision stating that it’s the intent of the California Legislature to develop a revenue plan.

Another measure, Assembly Constitutional Amendment 11, could address that gap, Wright says.

AB 1400 also talks about the state negotiating waivers from Medicaid, Medicare and Affordable Care Act rules from the federal government but does not talk about what the waivers could or should look like, Wright says.

Wright lists these additional concerns:

• An apparent lack of some of the kinds of consumer protection rules that now apply to California’s Medicaid program.

• Provisions that would appear to shift to CalCare paying providers based solely on fee-for-service arrangements.

• A ban on use of financial incentives, including incentives intended to improve the quality of care, for health care providers.

• A lack of cost control mechanisms for some types of health services, such as lab tests.

• A rate-setting provision that would set all health care provider rates at 100% of the Medicare reimbursement rates, without discussion about whether paying providers only Medicare rates for all services would be reasonable. Today, commercial plans often pay providers rates equal to about 200% of the Medicare rates.

• Lack of extra support for clinics and hospitals that serve the poor.

• Lack of provisions for moving the health care system from the current system to the CalCare system.

• An advisory committee dominated by health professionals, who would be appointed to their posts, rather than by elected officials, and without much of chance for consumer, patient or community representatives to participate.

Correction: An earlier version of this article gave an incorrect of Anthony Wright’s position on AB 1400. Although he has had some concerns about the bill, he supports the bill and believes that some of the concerns raised in his comment letter have been addressed.

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Pictured: An aerial view of San Francisco. (Photo: Jason Doiy/ALM)