Doctor, hospital groups organize to oppose single-payer in California

Aug. 28--A group of influential, deep-pocketed business and health care organizations that have long helped shape the legislative agenda in California have joined forces to oppose any future effort to craft a universal, single-payer health care system for the nation's largest state.

The main focus of the coalition, called "Californians against the costly disruption of our health care," is to kill any single-payer health care bill in the state Legislature, said Ned Wigglesworth, a political strategist for the coalition.

"As long as proponents plan to bring this back time and again, we think it's important to have a strong, unified presence to oppose it," Wigglesworth said, referring to Senate Bill 562, the 2017 single-payer bill pushed by the California Nurses Association that was shelved last year by Assembly Speaker Anthony Rendon.

The anti-single payer coalition includes powerful groups representing the interests in Sacramento of doctors, hospitals, insurers and businesses. Instead of single-payer, the coalition is expected to press for alternatives, which could include several legislative proposals on health care that failed this year and some under discussion, including expanding state insurance subsidies, allowing undocumented adults to sign up for Medi-Cal and creating a state-based individual mandate for everyone to have coverage.

Nurses, acknowledging their high-profile effort to create a government-financed single-payer system is dead (the end of the two-year session is Friday), said the union plans to introduce another single-payer bill next year. They say anything short of that is insufficient.

"We are working on a bill," said Stephanie Roberson, chief legislative director for the nurses association. "The California Nurses Association is in no way backing off pursuing legislation to achieve 'Medicare for all' next year. Speaker Rendon's act of shelving the bill last spring only strengthened our resolve."

She said the nurses are talking to various lawmakers about legislation heading into the new two-year term, but they don't yet have an author. She said she expects Lt. Gov. Gavin Newsom, the frontrunner in the California governor's race, to play a prominent role, should he be elected in November.

"We welcome the new leadership of our future governor, Gavin Newsom, with his commitment to this issue... We need political leadership and courage."

Newsom has voiced support for single-payer, but has also said he has concerns about whether California could overcome the steep challenges it would take to create such a system. It would cost an estimated $400 billion per year and, although it would eliminate insurance costs for health care consumers, it would also require large tax increases. It would also likely require voters to approve amendments to the state Constitution, and the state would have to secure several federal waivers from the Trump administration.

Doctors, hospital groups and insurers are gearing up fight back next year against any single-payer bill similar in scope to last year's proposal.

"I think you're going to hear our messaging loud and clear," said Charles Bacchi, president and CEO of the California Association of Health Plans. "It's going to be really focused around how expensive (single-payer) would be for California to do, and how disruptive it would be for people who currently receive health care coverage.

"The remaining uninsured is what we should address next," Bacchi said.

Health care industry groups were somewhat blindsided last year by the single-payer bill, authored by state Sens. Ricardo Lara and Toni Atkins, who is now leader of the Senate, representatives of doctor and hospital groups said. They've long opposed single-payer, but were not formally organized to push back against the nurses' single-payer proposal.

"The rapid advancement of SB 562 caught everyone by surprise," Bacchi said. "We were all individually talking about ways to improve our health care system and in the meantime, a really bad idea was speeding its way through the Legislature."

Allan Zaremberg, president of the California Chamber of Commerce, said that will be different next year.

"A lot of employers provide health care, and like their employees, they're satisfied with how health care is delivered," Zaremberg said. "From a business perspective, I think they'd rather have the administration (of health care) done through the private sector rather than the government."

Coalition members said they'll be focusing their early efforts on the Legislature and the next governor, but did not rule out spending on advertising and other public messaging. Key discussions will be focused on alternative potential proposals to contain escalating costs and expand coverage to everyone regardless of immigration status or ability to pay.

Opposing sides have heard what they've wanted to hear from Newsom in the gubernatorial race. The nurses see an ally in their fight, while Newsom's comments lately indicate deep skepticism about the ability to implement single-payer, industry representatives said.

"We have spoken to Mr. Newsom and if he's elected, we will continue to talk to Mr. Newsom," said Janus Norman, chief lobbyist for the California Medical Association. "We expressed our concern and he expressed his commitment to getting to a place where everyone is covered... He did it in San Francisco and he is dead-set on doing it as governor."

Newsom spokesman Nathan Click said in a statement, "As he did as mayor, Gavin Newsom will bring stakeholders of differing perspectives together to achieve a health system that is bold, affordable and works for everyone."

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