STOP AB1400

AB-1400 Guaranteed Health Care for All

Introduced by Assembly Members Kalra, Lee, and Santiago

This bill, the California Guaranteed Health Care for All Act, would create the California Guaranteed Health Care for All program, or CalCare, to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that CalCare cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children’s Health Insurance Program, Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program. The bill would require the board to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to CalCare, which would then assume responsibility for all benefits and services previously paid for with those funds.

If passed, the Guaranteed Healthcare For All Act would create a single-payer health insurance system, eliminating the existence of private insurance and handing over total control of our medical freedom to the discretion of the state government.  In a supposed effort to assist struggling Californians, CalCare intends to create a comprehensive, universal healthcare system that would preclude the role of private health insurance.  Interestingly, a recent survey reports that nearly 93% of Californians are insured, causing us to question the necessity and efficacy of this bill.

To read full bill text please click here

If A.B. 1400 wasn't already alarming enough, Assemblyman Kalra has introduced a Constitutional Amendment, ACA 11, which specifies the imposition of an "excise tax, payroll taxes, and a State Personal Income CalCare Tax at specified rates to fund comprehensive universal single-payer health care coverage." In other words, the adoption of ACA 11, in association with A.B. 1400, would result in the revocation of your right to private health insurance, rolling out an array of new taxes because of it.

What does this mean?

• CalCare intends to create a comprehensive, universal healthcare system that would preclude the role of private health insurance. The bill could eliminate commercial health insurance and Medicaid coverage in California and replace those forms of coverage with CalCare, a government-run health plan.
• This bill would create the CalCare Board to govern CalCare, made up of 9 voting members, 5 of which are appointed, not elected.
• Medical Freedom will essentially be eliminated through standardized healthcare.
• 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 November.

Brief Talking Points:

1. Medical Inequality: Instead of being able to allocate funds and resources to the 7% of people who need healthcare, our state government would be responsible for the medical needs of every Californian, with a majority of those people being fully capable of paying for their own insurance, causing the state to pull the extra resources from those who really need help
2. Unsatisfactory standard of healthcare
   --  Being responsible for the healthcare of so many people, the government would begin to allocate resources as a politician would, ranking the seriousness and necessity of care and treating those people first, creating long wait times and overcrowded hospitals, going so far as to denying care.
   -- The VA is a basic example of a single-payer system with a poor standard of care...
3. Similar ideas have been tried and failed in other states. 

-- Escalating costs. The initial estimate for Green Mountain Care in Vermont  in 2011, was that it would save $1.6 billion over ten years. However, there were still numerous unknowns, such as what benefits patients would receive and their specific cost-sharing requirements. It ended in 2014. “In a word, enormous,” is how Governor Shumlin described the tax hikes needed to fund single-payer. “As we completed the financing modeling,” Shumlin lamented, “it became clear that the risk of economic shock is too high to offer a plan I can responsibly support…”
-- Fragmented coalitions. Union members, community activists, disability rights advocates, and the Vermont Workers’ Center (a group of single-payer supporters) all initially rallied to support the legislation. However, the new law unleashed a torrent of lobbying by these organizations trying to ensure the new law benefited their members before the new health care system was set to be implemented in 2017.
-- unions pressed hard for generous benefits
-- Employers wanted coverage for out-of-state employees
-- Small businesses were terrified of huge tax increases
-- Large businesses pushed back strongly on the cost of the new plan
-- Self-insured companies lobbied against tax increases, as they resented the prospect of being taxed more to help others get coverage
-- These groups also failed to educate the public on the trade-offs a single-payer system would entail, including the huge tax increases.

Regressive impact on families. Nearly all private employers, but particularly small businesses, would pay more under the new health plan. The taxes required to provide the coverage Governor Shumlin promised would have shifted costs onto employers, who could then shift those costs onto their employees. While many employees would receive better coverage under this new plan, other employees faced a new financial burden as these new costs would likely come out of their wages.

Call to Action: 

We need EVERYONE to contact the Assembly Health Committee and their assembly member with your questions regarding this bill. We are asking all assembly members to oppose on AB1400. 

What are some questions you want to be asking your Legislator regarding AB1400?

• Would our access and ability to choose our type of medical interventions be affected? 

• If we are limited to what our choices are, would this affect informed consent?

• If healthcare needs to be expanded to those currently not covered, why not extend our existing medi cal insurance program to those individuals?

• Would patients be able to sue their physicians in this single payer system?

• Why would there be 5 governor appointees, and not elected by the people?
  Among the 9 board members, one must be a nurse and another must be a member of a labor union
  What about the need for individuals with experience in medical insurance?

• How would universal healthcare honor religious based healthcare?

Need more questions or arguments to help you customize your email?

AB1400: Other States (List of Arguments against)

Article: https://www.thirdway.org/report/single-payer-health-care-a-tale-of-3-states

Bill Specific Questions:

"163)Requires CalCare to establish a single standard of safe, therapeutic, and effective care for all residents of the state by the following means:
a) The board to establish requirements and standards, by regulation, for CalCare and health care providers, consistent with this bill and with the applicable professional practice and licensure standards of health care providers and health care professionals established under existing law, including requirements and standards for, as applicable:
i) The scope, quality, and accessibility of health care items and services."

• How accessible will heath care items and services be? Are residents guranteed to have a hospital 15 miles from their home? What is the standard for "quality?" Please list specifics of what every resident will receive covered under CalCare.
• In what circumstances will a person be denied CalCare coverage?
• What is the definition of "safe"? What is the definition of "effective"?

165)Requires a participating provider to furnish information as currently required by OSHPD and permit examination of that information by the board as reasonably required for purposes of reviewing accessibility and utilization of health care items and services, quality assurance, cost containment, the making of payments, and statistical or other studies of the operation of CalCare or for protection and promotion of public, environmental, and occupational health.

• Will personal medical history/data be shared if the board deems it is for "protection and promotion of public, environmental and occupational health?
• Will the board deem a person a threat/risk to public health if they do not comply to their rules?
• What legal actions can be executed with use of this data? How does this protect privacy rights? As stated above in Section 50, they list "others" are a group of unnamed people who can have access to your medical records.

182)Permits the board to take any additional actions necessary to effectively implement CalCare to the maximum extent possible as an independent single-payer program consistent with this bill. Specifies the intent of the Legislature to establish CalCare, to the fullest extent possible, as an independent agency.

• Define "any additional actions necessary to effectively implement CalCare to the maximum extent possible". 

209)States that the provisions on authorized collective negotiation does not allow a strike of CalCare by health care providers related to the collective negotiations.

• If healthcare providers are unable to elect the board, cannot have a say and are unhappy with collective negotiations, why is this bill seeking to prohibit their constitutional right to protest?

Other Notables:
The California Medical Association (CMA) states in its opposition that this bill would completely upend the existing health care delivery system and replace it with a single health plan governed by a board of nine unelected individuals. This would transform the practice of medicine in unknowable ways, without any input from those who practice medicine. CMA states this bill contemplates consolidating Medi-Cal, private insurance and the Covered California exchange into a single health insurance product provided by the state — without the constitutional protections that are essential to ensuring that an adequate, guaranteed amount of resources will be allocated to a single-payer system to ensure its viability. Without these needed protections and given the volatility of California’s tax revenue from year to year, a single-payer program could default to a system that it is unable to provide timely access to quality care for the beneficiaries it would cover and would mean higher taxes for heard-working families with no increased access or quality of care for patients. CMA concludes that this bill would throw patients and the entire health care system into chaos at a time when stability is needed to guide California through the COVID-19 pandemic and its aftermath.

Health plans and health insurers state in their opposition that California has done a tremendous amount of work in enacting comprehensive network adequacy requirements that ensure patients get access to timely, quality care. Imposing a single-payer health care system could actually harm these existing consumer protections. The state must focus on filling the gaps in the current health care system, including investing in workforce development and increasing access to care in rural areas, but this bill does nothing to address those issues. This bill would also mean the loss of thousands of jobs from California’s economy. Health plans employ over 160,000 Californians and more than an additional 100,000 Californians are employed in insurance-related jobs. These are very good paying jobs that would no longer exist should this bill pass. In addition, to implement this bill, the state would have to apply for numerous waivers from the federal government relating to Medicaid, CHIP, Medicare, and the commercial market. None of the existing waivers is meant to implement this type of system and it is unknown whether the federal government would approve waivers for such an effort or fund such a broad expansion of state government-run health care coverage. They conclude that instead of overhauling the health care system for an unworkable and unproven proposal, we should focus on improving what’s working while fixing what’s broken in health care.

"13) PREVIOUS LEGISLATION. Since 2003, there have been five single payer bills and one bill to fund single payer, as follows:
a) SB 562 (Lara) of 2017 died in Assembly Rules Committee. The Senate Appropriations Committee analysis of SB 562 indicated the following on the cost to implement it:

i) Total annual costs of about $400 billion per year, including all covered health care services and administrative costs, at full enrollment;

ii) Existing federal, state, and local funding of about $200 billion could be available to offset a portion of the total program cost; and,

iii) About $200 billion in additional tax revenues would be needed to pay for the remainder of the total program cost. Assuming that this cost was raised through a new payroll tax (with no cap on wages subject to the tax), the additional payroll tax rate would be about 15% of earned income. It is important to note that the overall cost of those new tax revenues would be offset to a large degree by reduced spending on health care coverage by employers and employees. Although precise estimates of total spending for employer sponsored health insurance are not available, the best available information indicates that existing spending is between $100 and $150 billion per year. Therefore, total new spending required under the bill would be between $50 and $100 billion per year. b) SB 810 (Leno) of 2011 failed passage on the Senate Floor in 2012. c) SB 810 (Leno) of 2009 was not taken up on the Assembly Floor. d) SB 840 (Kuehl) of 2007 was vetoed by Governor Schwarzenegger. In his veto message, the Governor cited a Legislative Analyst's Office analysis that estimated the bill to cost $210 billion in its first full year of implementation and cause annual shortfalls of $42 billion, and he could not support a bill that placed an annual shortfall of over $40 billion on California’s economy. e) SB 1014 (Kuehl) of 2007 would have imposed a payroll tax to fund the single payer system. SB 1014 was heard in the Senate Revenue and Taxation Committee but no vote was taken. f) SB 921 (Kuehl) of 2003 was never heard in the Assembly Appropriations Committee."