Ca. Senate Passes Single Payer

[kadee79]

It's a work in progress, but it's a start!!

California lawmakers approved a $400 billion-a-year program Thursday that would completely overhaul how Californians receive their health coverage by creating a single government-run, universal-care system for everyone in the state.

The state Senate approved the bill to create the Healthy California system 23-14, despite many lawmakers acknowledging that significant details remain unanswered, including how the state would pay for and provide care for its 39 million-plus residents. A legislative analysis of the bill warned that the $400 billion-a-year cost estimates “are subject to enormous uncertainty.”

SB562, by Sen. Ricardo Lara, D-Bell Gardens (Los Angeles County), now heads to the Assembly, where it’s expected to face tough opposition. A legislative analysis said that about $200 billion could be raised from a new 15 percent payroll tax, which would require a two-thirds vote from both houses. The other $200 billion could come from existing federal, state and local spending on health care. But the federal government would have to approve any changes to Medicaid funds for the program.

The total cost would surpass the state’s annual budget of $180 billion. Lara said ahead of the vote Thursday that the bill is a work in progress. However, he urged lawmakers to pass the bill to allow him to continue to work on it.

www.msn.com/en-us/news/us/single-payer-health-care-bill-passes-california-senate-heads-to-assembly/ar-BBBNFtd?li=BBnb7Kz

[souldoubt]

CA can't manage it's pensions, building the bullet train or maintain it's infrastructure so I'm sure this won't backfire horribly if it moves forward.  I know it's a long way from done and the details are yet to be finalized but if it's a 15% tax on wages my employer would be paying far more than they do now for our healthcare which is great. I fully expect our quality of healthcare would decline and this is just one more way to tax one group to pay for others. If this goes through and employer coverage goes away I'll be leaving the state.  

 

[Tennesseer]

Jun 2, 2017 10:04:25 GMT -5 deminmaine said:

As California goes, so goes the Nation goes.... eventually.

I thought it was you Maine folks who did that.

[Phoenix84]

Interesting. 

I'm sure this is going to bankrupt the state.  Nevertheless, this will be a good case study in how a single payer system would work in the U.S if it's implemented.

I'm just glad I don't live in California. 

[emma1420]

I need to start job hunting in California

[Wisconsin Beth]

Intetesting. I hope it passes because I'd like to see this tried out; figure out the problems and check for solutions.

California is big enough, both population wise and in density to generate useful data for the rest of the states.

[myrrh]

I agree it's very interesting. I am wondering how the law accounts for companies that employ people in multiple states as well as CA. Including the federal government.

I also wonder about prescription drug coverage. And does the law talk about eye docs and dentists? 

If copays, deductibles, and drugs are covered through the 15% payroll tax it might not be that much different for a lot of families as far as total cost (just estimating in my head what my family spends for medical stuff, not that I live in CA.)

[Deleted]

Will they be able to negotiate drug prices like the states who have statewide curriculum get to write the textbooks?  I'm guessing medicare still is medicare? I'm not sure if it will work piecemeal? 

[dondub]

Seattle RE will not be doubling due to any exodus because of this.

[kittensaver]

It WILL be interesting! I work for a non-profit agency that contracts extensively in public mental health (local, State and Federal), and we are watching this very carefully. There are still many things to be worked out . . . it's complicated. But with the federal match and especially with the ACA MCE (Medicare expansion) plus existing employer's portions, they should find a way to make it work. Stay tuned. 

Will every treatment and every medical condition be covered at an innovative, cutting edge, luxury level? Of course not. Will basic and life-saving services be available? Of course - - that is all that anyone has ever asked for. CA is ahead of the game because it has a long history of approved CMS waivers to write its own plan.

Costs should actually come DOWN when the political game of cost-shifting ceases. CA has already seen reductions in costs with the advent of the MCE provisions of ACA merely because previously uncompensated services to uninsured persons are now covered and didn't need to be shifted elsewhere. MCE has saved a lot of lives in CA and elsewhere. And the rich: they will continue to do what they have always done - - step outside the insurance system and pay cash for the services they want.

The one major thing that could derail all of this is - of course - the feds. MCE is a big player in this plan and if 45 and his ilk decide to carry their intense-spite-for-all-things-Obama into this arena, then we're all screwed, not just CA. Stay tuned.

Edited to add: when Canada rolled out its single-payer plan, they did it gradually (province-by-province). If we're gonna go single-payer in the country, a state-by-state approach seems equally rational. It's got to start somewhere!

[Phoenix84]

Jun 2, 2017 12:10:46 GMT -5 myrrh said:

I agree it's very interesting. I am wondering how the law accounts for companies that employ people in multiple states as well as CA. Including the federal government.

I also wonder about prescription drug coverage. And does the law talk about eye docs and dentists? 

If copays, deductibles, and drugs are covered through the 15% payroll tax it might not be that much different for a lot of families as far as total cost (just estimating in my head what my family spends for medical stuff, not that I live in CA.)

Yeah, as someone who works for the feds, I was wondering that too.  And what about military personnel who have their home in California? 

And Oped has a point, how is Medicare going to work under this proposed system? 

And of course the biggest question of all is "how are they going to get $200 billion+ to fund this thing?"  Personally I'd like answer to that question before they pass a bill, but obviously the California legislature is okay with passing bills and working out funding and other pesky details later. 

I highly doubt the federal government is going to be riding to the rescue with bags of money.

[Phoenix84]

Jun 2, 2017 13:09:28 GMT -5 kittensaver said:

It WILL be interesting! I work for a non-profit agency that contracts extensively in public mental health (local, State and Federal), and we are watching this very carefully. There are still many things to be worked out . . . it's complicated. But with the federal match and especially with the ACA MCE (Medicare expansion) plus existing employer's portions, they should find a way to make it work. Stay tuned. 

Will every treatment and every medical condition be covered at an innovative, cutting edge, luxury level? Of course not. Will basic and life-saving services be available? Of course - - that is all that anyone has ever asked for. CA is ahead of the game because it has a long history of approved CMS waivers to write its own plan.

Costs should actually come DOWN when the political game of cost-shifting ceases. CA has already seen reductions in costs with the advent of the MCE provisions of ACA merely because previously uncompensated services to uninsured persons are now covered and didn't need to be shifted elsewhere. MCE has saved a lot of lives in CA and elsewhere. And the rich: they will continue to do what they have always done - - step outside the insurance system and pay cash for the services they want.

The one major thing that could derail all of this is - of course - the feds. MCE is a big player in this plan and if 45 and his ilk decide to carry their intense-spite-for-all-things-Obama into this arena, then we're all screwed, not just CA. Stay tuned.

Edited to add: when Canada rolled out its single-payer plan, they did it gradually (province-by-province). If we're gonna go single-payer in the country, a state-by-state approach seems equally rational. It's got to start somewhere!

The U.S lasted for 200+ years before the ACA and MCE, so I don't see how we'd all be "screwed" if it were to go away.

[kittensaver]

Jun 2, 2017 13:42:59 GMT -5 Phoenix84 said:

Jun 2, 2017 12:10:46 GMT -5 myrrh said:

And of course the biggest question of all is "how are they going to get $200 billion+ to fund this thing?"  Personally I'd like answer to that question before they pass a bill, but obviously the California legislature is okay with passing bills and working out funding and other pesky details later. 

LOL! And just for the record, so is Congress! They just voted (a second time) to squeek by the hot, unfunded mess that is Trumpcare, so - get your own federal house in order before you start criticizing an entity at the State level who is doing something that is not. one. iota. different. [aka - "we'll work out the details later"]

[kittensaver]

Jun 2, 2017 15:59:09 GMT -5 @anne81 said:

I believe it has no cost containment at all.

Just FYI - the former and current Medicaid 1115 waivers have extensive cost containment measures already written into them, aka, they already exist at the State level.

[OldCoyote]

Is that 15% on top of what they pay already?   Holy Crap!!

[kadee79]

OC, but when you no longer have to pay premiums either on the exchanges or through your employer...it has been said that it will end up being MUCH cheaper.

I also posted this on another board and one gal there works in a large hospital in Ca.  She brought up some interesting points.  She has employees who don't live in Ca. but work in Ca.  How will that work...will they pay the 15% for something they can't use due to where they live or will they be able to access it due to paying in?  And will certain segments be exempt from the tax due to already having VA coverage or other government insurances?
So there are a LOT of kinks to be worked out, but hey...we have to start some where and this is the first thing that has made any sense at all and will get the most folks covered for the best prices.

So ABO, don't count any chickens before they hatch with the RE market in your area.

[zibazinski]

Well, it's going to be interesting.

[Deleted]

If they are smart, the new law will have an exemption provision for people that live out of state... but also restrict them from "free of charge" use of the hospital.

Not sure how they would word it, but you know what I mean.

[Mardi Gras Audrey]

As someone who works in healthcare in CA, I think this will be an absolute nightmare.  

Dealing with Medi-Cal (CA version of Medicaid) is already a nightmare.  They are unresponsive, have horrible coverage, and have horrible reimbursement rates.  They are, in my opinion, the worst plan to deal with (Medicare is second).

The fascinating thing is that Medi-Cal has been dumping people onto "managed care Medi-Cal" for the past few years. These managed care plans are at the county level and are separate privately owne/operated entities that the state contracts out their Medicaid patients too.  Depending on the county, some of them are run by the same corporations that do the private employer or ACA plans (Some counties have Medicaid plans from Anthem Blue Cross, Healthnet, or Kaiser).  It is a nightmare for anyone who moves counties (If you move, you are under a different county and have to signup with the new plan... so you are on one plan (with one company), move (go back to state covered for a few days), then get dumped on a different plan with a different company.  So you insurance can change 3 times in a month by moving 20 miles. 

I was told by a Medi-Cal employee that the state doesn't want to manage health care (that is why they were trying to everyone off of state run MediCal and onto these managed care plans). they wanted the only people on state MediCal to be foster children and pregnant women (now, even preg women are on the managed care unless you just got coverage).  If the state can't handle the people they already have on Medicaid, how will they manage the health coverage for everyone?

[Deleted]

Jun 2, 2017 10:04:25 GMT -5 deminmaine said:

As California goes, so goes the Nation goes.... eventually.

Very true, I can't think of how many times we switched something at work for CA and 2-5 years later the nation folllowed.

[Mardi Gras Audrey]

provider availability is going to tank if they think they can just pay medicare or medicaid rates. I speak to people every day who have those insurances and cant get  provider to take them. my o/gyn wont take patients with medicaid (even as secondary insurance) because they pay poorly and are a PITA to deal with. My ob group is one of the larger ones in our area, I cant imagine the other docs absorbing those patients

[djAdvocate]

Jun 2, 2017 12:10:46 GMT -5 myrrh said:

I agree it's very interesting. I am wondering how the law accounts for companies that employ people in multiple states as well as CA. Including the federal government.

I also wonder about prescription drug coverage. And does the law talk about eye docs and dentists? 

If copays, deductibles, and drugs are covered through the 15% payroll tax it might not be that much different for a lot of families as far as total cost (just estimating in my head what my family spends for medical stuff, not that I live in CA.)

the details of the law are not worked out.  it is a work in progress.

and nobody should get too optimistic OR pessimistic, yet.  this is a very early legislative hurdle.  after this, it goes to the House, and then to referendum.  it needs significant majorities all of the way.  and if anyone thinks that the healthcare industrial complex is just going to sit back and watch, they are as crazy as Democrats were thinking they had the last election locked up. 

and every Republican in the US thinks that CA is going bankrupt.  but the only ones going bankrupt are you folks that lack proper health insurance.  you might put those rocks down, or put some nice metal shutters up on those windows.

[Shooby]

Good luck with that!  Expect a mass exodus of health care providers when the thing collapses on itself!  But, i know, if we just pass a bill, then somehow the Magic Money just appears!  

[OldCoyote]

How will this be any different from Obamacare?

The farther it goes the worse it gets!

[dondub]

TrumpDon'tCare will fix everything bigly.

[Deleted]

TrumpDon'tCare will just make the problems of ObamaDon'tCare worse... unless he (and the rest of the Republicans) live up to their promise of "better, cheaper, and covers everybody"... something that the current bill that was passed by The House fails at on two of the three counts (it fails "better" and "covers everybody"... because it isn't and doesn't).

[djAdvocate]

Jun 4, 2017 21:09:14 GMT -5 @richardintn said:

TrumpDon'tCare will just make the problems of ObamaDon'tCare worse... unless he (and the rest of the Republicans) live up to their promise of "better, cheaper, and covers everybody"... something that the current bill that was passed by The House fails at on two of the three counts (it fails "better" and "covers everybody"... because it isn't and doesn't).

precisely what the OP proposes to do.  you might point out to the haters that you support single payer, Richard.

[Deleted]

Jun 5, 2017 18:11:43 GMT -5 djAdvocate said:

Jun 4, 2017 21:09:14 GMT -5 @richardintn said:

TrumpDon'tCare will just make the problems of ObamaDon'tCare worse... unless he (and the rest of the Republicans) live up to their promise of "better, cheaper, and covers everybody"... something that the current bill that was passed by The House fails at on two of the three counts (it fails "better" and "covers everybody"... because it isn't and doesn't).

precisely what the OP proposes to do.  you might point out to the haters that you support single payer, Richard.

It shouldn't need to be pointed out at this point, because I've already made dozens of posts stating that.

But here's another one just for gits and shiggles:
I support single payer for "general/basic" healthcare. It's the only reasonable and logical way to do healthcare.

That's why the government can't figure it out... it's reasonable AND logical... what does the government know about either of those two things... much less when they are combined?

[djAdvocate]

Jun 5, 2017 19:44:12 GMT -5 @richardintn said:

Jun 5, 2017 18:11:43 GMT -5 djAdvocate said:

precisely what the OP proposes to do.  you might point out to the haters that you support single payer, Richard.

It shouldn't need to be pointed out at this point, because I've already made dozens of posts stating that.

But here's another one just for gits and shiggles:
I support single payer for "general/basic" healthcare. It's the only reasonable and logical way to do healthcare.

That's why the government can't figure it out... it's reasonable AND logical... what does the government know about either of those two things... much less when they are combined?

all of the haters are rallying around you, thinking otherwise.  perhaps they haven't been paying attention.

but i have.

NOTE: the best government run healthcare systems work in precisely the way you described (underlined).  why should the US settle for anything less?  we are, after all, the greatest nation on Earth. 

the only reason we have failed thusfar is that the government is not representing "the people".

[Deleted]

Jun 5, 2017 21:36:59 GMT -5 djAdvocate said:

Jun 5, 2017 19:44:12 GMT -5 @richardintn said:

It shouldn't need to be pointed out at this point, because I've already made dozens of posts stating that.

But here's another one just for gits and shiggles:
I support single payer for "general/basic" healthcare. It's the only reasonable and logical way to do healthcare.

That's why the government can't figure it out... it's reasonable AND logical... what does the government know about either of those two things... much less when they are combined?

all of the haters are rallying around you, thinking otherwise.  perhaps they haven't been paying attention.

but i have.

NOTE: the best government run healthcare systems work in precisely the way you described (underlined).  why should the US settle for anything less?  we are, after all, the greatest nation on Earth. 

the only reason we have failed thusfar is that the government is not representing "the people".

The government hasn't "represented the people" for decades.

ETA: and we shouldn't have to', but we must "settle for" ... "less" because stupidly, voters can't stop using ignorant criteria for why they vote for whom they vote for.