IN
SUMMARY
A
bill for single-payer health care in California didn’t even get
a vote in the state Assembly after its author couldn’t round up
enough support before Monday’s deadline. Advocates are
incensed.
Despite,
or perhaps because of, an aggressive last-minute push by progressive
activists ahead of a crucial deadline, legislation to create a
government-run universal health care system in California died Monday
without coming up for a vote.
The
single-payer measure, Assembly Bill 1400, was the latest attempt to
deliver on a longtime priority of Democratic Party faithful to get
private insurers and profit margins out of health care. Because it
was introduced last year, when it stalled without receiving a single
hearing, it needed to pass the Assembly by Monday to continue through
the legislative process.
But
even the threat of losing the party’s endorsement in the
upcoming election cycle was not enough to persuade the Assembly’s
Democratic super majority to advance the bill for further
consideration, effectively killing the effort for another year.
After
several tense hours Monday afternoon, during which a scramble of
meetings took place just off the Assembly floor, Assembly member Ash
Kalra, the San Jose Democrat carrying AB 1400, announced that he
would
not bring up the measure for a vote.
Kalra
declined multiple requests to discuss his decision and whether he
would seek another path forward for his proposal. Following the floor
session, he waited on a members-only balcony outside the chamber
until a group of reporters was told to leave by a sergeant-at-arms.
“I
don’t believe it would have served the cause of getting single
payer done by having the vote and having it go down in flames and
further alienating members,” Kalra said on a Zoom call with
disappointed supporters later in the evening, in which he shared that
he believed the bill, which needed 41 votes to pass, was short by
“double digits.”
Stuck
between powerful interests
The
political obstacles to such a radical restructuring of the health
care system remain enormous, even in a state as putatively liberal as
California.
The
influential California Chamber of Commerce, which represents business
interests in the state, labeled AB 1400 a “job killer”
shortly after it was reintroduced in January, indicating it would be
a top priority to defeat. Its lobbying campaign — joined
by dozens of insurers,
industry groups and the associations representing doctors and
hospitals — included social media advertisements and a letter
to members denouncing
the “crippling tax increases” that would be needed to pay
for the system. After the bill stalled Monday, the chamber declared
it would be ready if ideas
from the “dangerous proposal” resurfaced.
Republicans
were eager to make it into an election issue
this
year. Though Kalra’s bill
was largely conceptual,
with a separate measure introduced to address the financing, they
attacked it as a massive tax hike on Californians. (Kalra proposed a
series of taxes on businesses and high-earning households to fund the
single-payer system, estimated by legislative analysts to cost
between $314 billion and $391 billion annually.)
A
4,000-page petition signed by voters who opposed AB 1400 sat in the
back of the chamber on Monday for Assembly Republican Leader Marie
Waldron of Escondido to use as a prop in a floor debate that never
happened.
Democrats
also faced a squeeze from the left flank of their party. Activists
with the California Democratic Party’s progressive caucus said
last week they would push to withhold endorsements from members who
did not vote for the bill. That ultimatum generated fierce anger in
the Assembly caucus from members who felt cornered, though many
refused to speak publicly about their frustration.
Backlash
from activists
The
decision not to bring up AB 1400 for a vote on Monday may have been
about protecting members from having to take a position one way or
the other on the bill, as Assembly Speaker Anthony Rendon did with
the last single-payer measure in 2017.
Legislation
to move the state toward a government-run health care system passed
the state Senate that year, but was held
by Rendon without a hearing
because
the bill included no plan to pay for it. That put him in the
crosshairs of single-payer supporters, who blasted him on billboards.
This
time, Rendon said he supported the effort, but he was not closely
involved in rounding up votes for AB 1400. He declined to answer
questions after the floor session on Monday and, in a statement, he
pushed
the blame onto Kalra.
“The
shortage of votes needed to pass this bill out of the Assembly
indicates the immense difficulty of implementing single-payer
healthcare in California,” he said. “Nevertheless, I’m
deeply disappointed that the author did not bring this bill up for a
vote today. I support single-payer and fully intended to vote yes on
this bill.”
The
explanations are unlikely to assuage the measure’s most
enthusiastic proponents.
The
California Nurses Association, the main sponsor of AB 1400, slammed
Kalra for “providing cover” for his colleagues
by
not holding a vote.
“Nurses
are especially outraged that Kalra chose to just give up on patients
across the state,” the association said in an unsigned
statement. “Nurses never give up on our patients, and we will
keep fighting with our allies in the grassroots movement.”
Amar
Shergill, chairperson of the California Democratic Party’s
progressive caucus, said he would
continue with plans to pull endorsements
from
Assembly members who did not publicly support the bill.
During
the Monday night call, he and other advocates repeatedly criticized
Kalra for setting back their movement and urged him to name the
members who were opposed. “We are protecting them from negative
scrutiny of a ‘no’ vote,” Shergill said.
Kalra
said it would give him more time to work on winning over colleagues
who were on the fence about AB 1400 and try again next year.
Where
was Newsom?
One
prominent Democrat who did not express support for AB 1400 was Gov.
Gavin Newsom, who ran for office in 2018 on a platform to create a
single-payer system in California but has since distanced himself
from that pledge.
During
a press conference in January to unveil
his budget proposal,
Newsom reiterated that he believed “the ideal system is a
single-payer system,” but dismissed questions about Kalra’s
approach.
“I
have not had the opportunity to review that plan, and no one has
presented it to me,” Newsom said at the time.
As
AB 1400 marched toward defeat, the governor remained mum. His public
remarks in recent weeks focused instead on several of his own budget
proposals that he said would bring universal health access to
California, including an expansion of Medi-Cal, the state’s
health insurance program for the poor, to all residents regardless of
their immigration status.
Kalra
said Newsom’s stance undermined the bill. He told
the Mercury News on
Tuesday that “it hurts when you’re trying to garner votes
for a policy that the governor is brushing aside despite a prior
commitment to it.”
The
distinction Newsom has drawn between universal access to health
insurance and an actual universal health care system has also
infuriated the nurses’ union, one of his earliest endorsers
during the 2018 campaign, who accused
him of
flip-flopping on single payer. It seems unlikely to cause him much
trouble in his upcoming re-election campaign, however, where he has
yet to draw a significant challenger.
