Democratic Lt. Gov. Gavin Newsom is drafting a health care plan for California that he plans to unveil as a core component of his gubernatorial run, based in part on the universal health care program he signed into law when he was mayor of San Francisco.
Newsom, seen as a strong contender in the increasingly crowded field of candidates vying to succeed Gov. Jerry Brown in 2018, is staking out an ambitious plan to rein in rising health care costs, expand universal access to people across the state regardless of income or immigration status, and preserve coverage for the estimated 5 million Californians who risk losing their insurance under President Donald Trump’s changes.
“I think we can learn a lot for the state of California from what we did with Healthy San Francisco,” Newsom said in an interview. “We had the resourcefulness, the resources, and the boldness and audacity to try something new. It’s not necessarily something that can be adopted in all 58 counties, but it can be adopted .... where the majority of California’s population is.”
The idea would likely require substantial state and federal funding.
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Newsom has enlisted health experts to begin working on a blueprint for a universal health care system for California that seeks to improve on the Affordable Care Act, as well as prevent millions from potentially losing health care access under the Republican proposal now under consideration.
The Republican proposal, called the American Health Care Act and championed by House Speaker Paul Ryan, would remove the individual mandate requiring people to have insurance and replace it with financial incentives for people to retain continuous health insurance. It would also gradually eliminate funding for Medi-Cal, the state low-income health care program that covers about 14 million Californians, and provide tax incentives to people based on age rather than income level.
State Insurance Commissioner Dave Jones and health advocates warn that millions of people would lose health insurance and premiums would skyrocket under the plan. Newsom also characterized it as disastrous, but said regardless of Republican efforts to repeal and replace Obamacare, California should seek reforms that build on the federal law.
Healthy San Francisco, created in 2007 under a broader law known as the Health Care Security Ordinance, is a universal care system that finances health care for residents within the city’s borders. It centers on the importance of primary care and routine checkups to help control costs; mandates that employers contribute to their employees’ health care; includes a citywide public insurance option; and adopted a provision even before Obamacare that people with pre-existing conditions can’t be disqualified for coverage by insurance companies.
Patients can use their coverage at the city’s network of primary care clinics, as well as at public and private hospitals.
“It was a very big deal,” said Anthony Wright, executive director of Health Access California, an advocacy nonprofit. “At the time, there were only three places having this conversation – San Francisco, Hawaii and Massachusetts with Romneycare. What San Francisco did is provide an example for California of health care reform that offers public care and coverage alongside having individuals and employers buying into the system.”
Newsom said he is working with Mitch Katz, an architect of Healthy San Francisco who today heads Los Angeles County’s health care system, to develop a plan.
An effort in the California Legislature, meanwhile, proposes that the state adopt a single-payer model. State Sen. Ricardo Lara has authored a skeleton bill that states simply, “It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state.”
Lara suggested discussions about how California should proceed will likely extend beyond this year and into next, during the height of the 2018 governor’s race.
“We’re going to see how far we can get this year – we’ll see, given the uncertainty in Washington and Republicans’ continued efforts to dismantle the Affordable Care Act,” Lara said. “The timing couldn’t be more important to have this important discussion in California. We want to have an alternative ready, and be ready to respond to whatever happens with the federal government ... and prevent Congress from ripping health care away from millions of people.”
Newsom said he supports a single-payer model, but he wants to go further.
“I believe what we did in San Francisco can and should be replicated far and wide,” Newsom said. “I’m enthusiastic about it. We were working on it before Trump, but now there’s an imperative.”
Newsom will likely gain political support for his cause from by the powerful California Nurses Association, which has sponsored the health care bill by Lara and Sen. Toni Atkins, D-San Diego. The nurses handed an unusually early endorsement to Newsom in the race to succeed Brown.
Past efforts to adopt a single-payer system in California, including a 2005 bill by former state Sen. Sheila Kuehl, have been unsuccessful. Sally Pipes, president and CEO of the conservative Pacific Research Institute, said a single-payer system in California would be “disastrous.”
“I think it’s a tremendous mistake,” said Pipes, also a Thomas W. Smith fellow in health care policy. “Californians would face an even greater tax burden ... and when government controls the amount of money being spent on health care, the demand is even greater so you get longer waiting lists and rationed care.”
Newsom said not all of what San Francisco did can be replicated across the state – especially in more rural areas that lack the medical provider infrastructure, but the state can develop region-specific reforms to expand universal access.
“I think that it’s inevitable in this country that, after all the trials and errors, we find ourselves face-to-face with a Medicare-for-all conversation,” Newsom said. “That’s what we are pursuing.”