Capitol Alert

Why are California liberals pushing so hard to get rid of health insurance?

State Sen. Toni Atkins stood on a stage outside the Capitol last month and made the case for a Democratic-backed bid to transform California’s health care system into something that’s never been done in the U.S.

“People shouldn’t have to experience anxiety over whether they’ll be covered based on who’s in the White House,” Atkins, D-San Diego, told a crowd of nurses and health care advocates who were cheering her on. “It’s time to cover everybody once and for all.”

With Obamacare under assault in Washington by Republicans who see it as a broken system that hamstrings people with high premiums and inadequate access to medical care, Atkins and Sen. Ricardo Lara, D-Bell Gardens, are pushing a bill through the state Legislature that would replace Obamacare with a government-run system.

Everyone would be covered, including undocumented immigrants. Under the proposal, there would be no need for insurance companies; no more monthly premiums or out-of-pocket costs for doctor visits and prescriptions.

The authors haven’t said exactly how they’d pay the projected cost of $400 billion a year, although they acknowledge it would use existing health care money in addition to new taxes.

The bill passed the Senate last week without a funding mechanism in a rare legislative maneuver. Political support in the state Assembly is tepid. Gov. Jerry Brown isn’t behind it.

Eventually it would need two-thirds support in the Legislature and waivers from the Republican-controlled federal government. Yet the the authors are pushing ahead anyway.

“I think it’s going to be a real heavy lift,” said Paul Song, a doctor and co-chair of the Campaign for a Healthy California created to urge support for the measure, Senate Bill 562. “We’re hearing the governor is doing everything he can to make sure this never gets on his desk ... and we’re going to run into problems in the Assembly. But I think for the first time people are realizing our current health care system is not working, with or without the GOP.”

Advocates say they have their reasons for fighting what appears to be a losing battle.

Commonly referred to as single-payer health care, the idea is emerging as a key campaign issue in 2018 – especially for Democrats. The powerful California Nurses Association, the bill’s lead sponsor, and its allies have threatened to support challengers in primary races next year against lawmakers who don’t vote in favor of the measure.

“We want to get people who claim they’re Democrats on the record,” said Song, also a board member for a nonprofit advocacy group Physicians for a National Health Program, which has long pushed for such a system. “If they’re truly for it, they’ll vote for it. If not, there will be people who primary them based on that ... people are standing by potentially for 2018.”

Some suggest Lara and Atkins are interested in more than their longshot bid to completely reshape how health care is paid for and delivered for nearly 40 million people.

Lara is running for statewide office next year to become insurance commissioner. The nurses association, which donated $11,500 to his 2016 state Senate campaign, has endorsed him in that race.

With Senate leader Kevin de León termed out at the end of 2018, Atkins, the former Assembly speaker from 2014 to 2016, is considered a possibility to replace him. Nurses contributed $8,500 to her 2016 campaign.

“Atkins is a liberal seeking to become the next pro-tem,” said Rob Stutzman, a Sacramento Republican campaign consultant. “Lara is trying to be another Democratic insurance commissioner, and this issue works well for them before the June primary.”

Lara and Atkins say they are driven by the idea that health care is a human right, citing personal and family struggles with access to health care. But Stutzman said putting forth the proposal without a way to clear pay for it indicates politics are a factor.

“So much of this is being driven by the post-Trump election agenda on the left and the internal struggles in the Democratic Party, which are pushing everyone to the left,” he said. “That’s what people like Lara and Atkins are playing to, and you want the nurses as an ally. They’re probably the most liberal union in the country.”

Michael Lighty, director of public policy for the nurses, said the groundswell of public debate over health care reform is amplifying support for a single-payer system, also promoted nationally by Vermont Sen. Bernie Sanders.

“Nurses see this as the crucial moment in which we must act in California to protect patients,” Lighty said. “There is real urgency to get ahead of changes coming down from Washington.”

It’s unclear what, if anything, nurses stand to gain from a new system in which the government sets reimbursement rates for health care services and hospitals and providers.

Nurses say they they see problems in hospitals and clinics every day associated with people who delay medical treatment due to high costs or simply forgo doctor visits because they lack coverage. They say they support a single-payer system because it will lower the cost of health care delivery, expand access and improve outcomes.

“That’s insane,” said Micah Weinberg, president of the Economic Institute at the Bay Area Council. “A free, unlimited system with no medical management like what is proposed in this bill will lead to more people getting more things done that may have no value, driving up costs for everyone and in some cases leading to worse outcomes.”

Polling indicates the public is growing more keen on the idea of a single-payer type system. A Pew Research Center poll in January found 60 percent of Americans believe the government has a responsibility to ensure everyone has health coverage, the highest point in nearly a decade, and that figure is gradually rising.

Statewide, 57 percent of adults and 64 percent of likely voters support a single-payer plan, according to the Public Policy Institute of California poll conducted last month. Support falls to roughly 40 percent, however, if the plan raises taxes.

For now, advocates are focused on keeping pressure on to keep the bill alive. The more it generates public debate, the better, supporters said.

“The longer the bill stays moving through each step, the more the tension builds over people potentially losing their health care,” Song said. “This issue is not going away.”

That is building a case for a ballot measure, Song said. “We’re eventually going to have to go the initiative route.”

Angela Hart: 916-326-5528, @ahartreports