Some states see opportunity for single-payer health care

As Republicans continue to push reforms reducing the government's role in health care, some opponents are emboldened in their support for the opposite approach, one that would greatly increase government involvement.

Progressive politicians and activists see a future in single-payer health care, the term for a government-run health insurance program that would be available to any American. While a Democratic-backed federal bill has no future in the GOP-led Congress, backers have had more success at the state level.

On Thursday, Senate Republicans unveiled their plan to overhaul the Affordable Care Act. By Monday, the Congressional Budget Office estimated that 22 million fewer people would have health-care coverage by 2026; a similar plan that the House passed was expected to leave 23 million Americans uninsured and increase out-of-pocket costs for the sick and elderly.

Following the election of President Trump, Jimmi Kuehn-Boldt of Palm Springs, Calif., began advocating for single-payer health care with the grassroots group Courageous Resistance. At 63, he doesn't expect anything to take effect before he's eligible for Medicare in a little more than a year, but he said he's worried about seeing care for others deteriorate if Republicans are successful.

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The Senate proposal makes any talk of single-payer, either in Washington or Sacramento, "just as important, if not more than before," he said.

"We've got to see how it's fleshed out in Washington, but we can still move forward here," Kuehn-Boldt said.

More than 100 Democrats in the House have signed on to a single-payer bill introduced by Rep. John Conyers of Michigan called Medicare for All because it would eliminate the current 65-and-older requirement for Medicare. Sen. Bernie Sanders of Vermont has talked about introducing his own plan.

In California, where Democrats hold strong majorities and the governorship, a bill to create a statewide single-payer program passed the state Senate on June 1.

But that momentum stalled last week when state Assembly Speaker Anthony Rendon, a Democrat from Lakewood, Calif., announced he was holding the bill in committee until further notice.

In a statement, Rendon called the bill, SB 562, "woefully incomplete."

"Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters," Rendon said.

The plan would provide broad coverage, including the essential health benefits spelled out in the Affordable Care Act. The bill states that enrollees would not pay co-payments or deductibles.

State Sen. Toni Atkins of San Diego, one of two Democratic sponsors of the bill, has said that even if the Affordable Care Act remains intact, the state can do more to cut costs and improve access.

Atkins issued a statement June 22 calling the U.S. Senate health bill more than mean, as Trump reportedly called it, but "simply wrong."

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"We will continue to demand the quality health care we all deserve," Atkins said. "If Congress passes this bait-and-switch, we will fight here at home to ensure that Californians remain covered.”

Price remains a major question for California's plan and has made the bill a nonstarter for some Republican lawmakers. A recent estimate put the cost at $400 billion annually with half of that needing to come from new revenue.

Gov. Jerry Brown, a Democrat who also roundly criticized congressional Republicans on Thursday, has not said if he would sign a single-payer health plan into law.

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In addition, lawmakers in New York have been hammering out their own single-payer plan.

The state’s legislation, called the New York Health Act, passed the Democrat-led Assembly three times before 2017, but it repeatedly stalled in the Republican-leaning Senate, which represents more rural upstate New York vs. the urban New York City metro area and mirrors the U.S. political divide.

Debate over federal health care law this year prompted a renewed push to pass the New York Health Act, but it once again passed the state Assembly only to die in the Senate. The legislative session adjourned this past week.

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New York Assemblyman Richard Gottfried, a Democrat from Manhattan, has championed the single-payer push in his state. He described it as an example for states to expand the federal Medicare program for the elderly to the entire population.

“What is going on in Washington is making it clearer than ever that the only way Americans can get access to health care is through Medicare-for-all legislation starting in the states,” Gottfried said.

Dr. Oliver Fein, chairman of the New York metro chapter of a single-payer advocacy group called Physicians for a National Health Program, focused Thursday on Republican-led efforts to cut money for Medicaid, the joint state-federal health program for millions of poor and disabled.

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“That is likely to be a huge destabilizing factor not just for the patients themselves, the people who will be denied coverage, but frankly for the whole hospital system because hospitals really do depend on Medicaid income,” Fein said.

Both Fein and Gottfried spoke about Congress’ plans to overhaul health care in terms of re-energizing efforts for single-payer systems despite opponents questioning how states would overcome cost and logistical hurdles.

New York’s single-payer plan calls for income-based tax increases to pay for expanding state-run health coverage with the wealthy shouldering a larger percentage of the cost.

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While the single-payer tax increases have drawn criticism, lawmakers, hospital leaders and voters have held numerous rallies in New York to voice concerns about how proposed cuts to Medicaid could leave the state with a major budget hole.

Gottfried pointed to mounting opposition to Congress’ push to overhaul health care as potentially being the long-awaited catalyst needed to ignite single-payer plans.

“Whatever the Republicans in Washington do is going to take billions of dollars out of health care in New York state, and the only way New York can afford to fill those gaps and protect ourselves is with the New York Health Act,” Gottfried said.

Barrett Newkirk reports for The (Palm Springs, Calif.) Desert Sun; David Robinson reports for The (Westchester County, N.Y.) Journal News. Follow them on Twitter: @BarrettNewkirk and @DRobinsonLoHud