While Washington Fiddles, CA Leaders Forge Ideas for Universal Healthcare

There’s no way to make up for those lost employer contributions other than to introduce “very visible taxes,” Oberlander said. And that’s not the only reason why a single payer plan would be controversial. “A lot of people are satisfied with what they have,” he said.

The trade group for insurers in California does not support the single-payer idea.

“A single-payer system would make the quality of our health care worse, not better,” said Charles Bacchi, president and CEO of the California Association of Health Plans. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”

Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said Lanhee Chen, a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.

A single-payer system would need federal approval and likely have to overcome other bureaucratic hurdles even if approved in the state. As it stands, no state has such a system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.

Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.

One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program costing about $200 billion each year. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.

Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.

“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”

Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.

“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.