California seeks to establish single-payer healthcare system for 10th time since 1994


Hannah Saunders


After Assembly Bill 1400 was pulled from the floor prior to a vote last year, Asm. Ash Kalra (D – San Jose) and advocates are again pushing this year to pass a bill that would establish universal healthcare coverage in the state of California. AB 1400 from the previous session is now AB 1690.

“I’ve been a longtime supporter of single-payer healthcare—long before I was in the Assembly,” Kalra told State of Reform. “[AB] 1690 is what’s known as an intent bill, so it expresses the intention for our state to adopt a single-payer healthcare type system, but it doesn’t have the specificity of [AB] 1400 of exactly what that system would look like.”


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Kalra is working in collaboration with the California Nurses Association (CNA) to grow the universal healthcare movement in the state, educate the public, and learn more about the position of his new colleagues—some of which are new to the legislature.

In 1994, CNA pioneered the fight towards guaranteeing healthcare as a right for all Californians by advocating for an unsuccessful ballot measure, Prop. 186, which would have implemented a single-payer system in the state. In 1999, the state passed Senate Bill 480, which mandated a state-sponsored study of ways to achieve universal healthcare.

A year later, California received $1.2 million in federal funding for the Health Care Options Project (HCOP), which analyzed three single-payer and six incremental multiple-payer proposals. In 2002, analysts found that the single-payer system would be the most cost-effective, while also offering the best coverage benefits with the highest quality health outcomes.

HCOP provided support for the introduction of SB 921, the state’s first single-payer bill, in 2003, but it failed to pass. SB 840, another single-payer bill, passed the legislature in 2006 and 2008, but was vetoed by Gov. Arnold Schwarzenegger both times. Most recently, SB 810 failed to advance in the legislature in 2009 and 2011; SB 562 failed in 2017; and AB 1400 failed to advance in 2022.

“This year, I see it more as an opportunity rather than a challenge,” Kalra said. “I see it as an opportunity to grow the movement for single-payer healthcare, and better understand how we can strategically get it to the governor’s desk because that’s ultimately the goal—is to get it to the governor and have him sign it, and we still have a long way to go to get there, but every year it’s about building more and more momentum, and more of a foundation for its success.”

Health Care for All — California (HCA) is an organization dedicated to establishing universal healthcare through a single-payer public financing system, which it says would provide the most cost-effective way to guarantee the same, high standard of care for all. According to HCA, the current healthcare system is greatly dependent on employer-based and for-profit health insurance, and millions of Americans have little to no coverage. 

HCA states that the costly and unequal insurance plans have contributed to bankruptcy, homelessness, and preventable disease and death. Additionally, inflated insurance and healthcare costs place unfair demands on businesses and taxpayers. 

“We have millions of people who are uninsured, or underinsured, yet we’re paying way more than anyone else,” Kalra said, adding that financial profits go directly to insurance companies, pharmaceutical companies, and hospitals, while neglecting to contribute to patient care or reduced healthcare costs. 

CNA data shows that the average premium for employer-provided family coverage has increased by 43% over the last decade, amounting to $22,463 per year in 2022. CNA states that these rates have increased at a higher rate than wages or inflation, and that the average deductible among all covered employees increased by 95%. Furthermore, the average coinsurance rate, or percentage billed after paying a deductible, for specialty care and hospital admissions is 20%, while the average copayment is $344 for each hospital admission.

“We are an outlier in the world,” Kalra said. “Most other countries, certainly wealthier countries, already have some form of a single-payer healthcare system, and we have to stop listening to the noise being created by the industry that somehow those healthcare systems are inferior, and recognize that we are the ones that have an inferior healthcare system.” 

While AB 1690 is an intent bill that doesn’t list out specifics, key features of a single-payer healthcare system includes universal coverage for every individual regardless of age, ethnicity, employment status, income level, health conditions, and marital or immigration status. 

All medically necessary care, including outpatient visits, hospitalizations, ER visits, surgeries, dental, vision, hearing, prescription drugs, mental, reproductive, home health services, hospice, and substance use recovery would be covered. Under a single-payer healthcare system, individuals would not be restricted when it comes to obtaining providers, plus deductibles and copays would be diminished.

Opposition to universal healthcare in the US stems from costs—specifically concerns about increased taxes and federal costs. Additional arguments include lengthy wait times to receive care, and increased government control in the lives of individuals. 

Kalra said that some of the effort’s main opponents in California are those involved in the healthcare industry who stand to lose profits if an initiative like AB 1690 passed.

“The insurance companies are profiting wildly off of our current system, so they’re not going to agree that there’s a need for it because it completely undermines their existence as an industry that is completely taking advantage of Californian and American families,” Kalra said. 

“It’s no surprise that there are people opposed to it, because the industry is incredibly wealthy, and they put out information to spread fear amongst the people. The reality is we have the most expensive healthcare system in the world, and we have far from the best outcomes.” 

Kalra mentioned how the estimates of savings of a single-payer healthcare system continue to change, and that from recent studies he has reviewed, he said that single-payer healthcare systems could save the state of California billions of dollars, and Californian families, individuals, and businesses tens of billions of dollars. 

“That’s a very general number, but the reality is if families don’t have to pay for copays and premiums, and businesses don’t either and instead just have one flat rate they have to pay the state, there’s no doubt that that amount will be predictable year in, year out, and will be lower than what Californians are currently paying,” Kalra said. 

When comparing the US healthcare system to single-payer healthcare systems in other countries, Kalra acknowledged how Canadians—who have good universal healthcare—for example, sometimes travel to the US to receive specialty care. At the same time, most Americans living within the US are unable to access those specialists due to cost.

“I think that we have a pretty high quality healthcare system if money is no object, but that’s not the case for most Americans,” Kalra said. “If people are comfortable with the fact that most Americans are going to suffer at the expense of the wealthy, then that’s fine—I disagree with that. I think that we should have a healthcare system like most countries in the world, that looks out for the interest of everyone, regardless of your wealth, or whether you’re employed or not.”

In recent years, Americans have been traveling north and south of the border into Canada and Mexico to obtain life-saving medications that are unaffordable within the US. Additionally, more Americans have turned to the black market and social media to obtain life-saving medication that they are unable to afford. 

“Oftentimes that medication is made by American pharmaceutical companies,” Kalra said. “They have no problem robbing us blind, and yet we’ll sell to the rest of the world at a discounted rate. It’s daylight robbery in terms of how they look at us as their profit centers, not as patients, not as customers, but purely as much profit as they possibly can and not be part of the solution.” 

While he’s determined to establish a single-payer healthcare system in the state of California, Kalra plans to use AB 1690 as a way to engage in meaningful dialogue. He does not expect the bill to be up for a vote this calendar year, and in the fall, plans to evaluate how to approach the bill for 2024.