New York and California are Trying to Make Single-Payer Health Care Work for All States

It’s no surprise that Americans are desperate for an alternative to the current healthcare system. While America spends more than any other country on healthcare, the quality of care ranks lower than many other countries. According to the World Health Organization, life expectancy in the United States is 79.3 years, the lowest rate compared with 30 other highly developed countries.

Yet while momentum is growing across the country for transformative healthcare reform, the prospects of passage in Washington remain dim.

In response to congressional gridlock, a number of states are now pushing for state-structured single payer healthcare systems. The proposals range from little more than rhetoric to fleshed-out legislation. On the campaign trail, Democratic candidate for Maryland Governor Ben Jealous is pledging to fight for Medicare-for-All should he be elected in 2018, while New York and California both have live, robust single payer bills in their respective legislatures. (Such proposals have unnerved Congressional Republicans, including Sen. John Kennedy, R-LA, who unsuccessfully tried to pass legislation banning states from enacting single-payer systems.)

The potential pitfalls of enacting single payer on the statewide level are real, and complex.

Republicans often point out that Sanders’ home state of Vermont abandoned its single payer plan in 2014 after then governor Peter Shumlin said it would be too burdensome on Vermont taxpayers. The plan would have cost roughly $2.5 billion in its first year, an enormous burden for a state that only brings in about $2.7 billion in total tax revenue per year. The state considered paying for the plan with an 11.5 percent payroll tax on employers and income tax up to 9.5 percent, but eventually threw the proposal in the trash.

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Yet while Vermont struggled to balance the books due to its small population and tax base, two of the most populous states in the country -- California and New York -- are now trying to make the numbers work.

“New York and California represent absolutely the best possible scenarios for single payer in this country,” wrote Meghan McCardle in Bloomberg. “For these states, size is helpful because they don’t have to worry so much about people, companies or doctors moving to other states when confronted with the high taxes and limited choices of your new health-care system.”

New York’s bill passed the State Assembly last year but has stagnated in the Senate.

California’s proposal, on the other hand, passed the Senate last year but was shelved in the House. However, the California proposal -- SB 562 -- is now seeing a renewed push for passage from advocates and legislators.

On January 18, the California House took testimony on the bill as supporters and detractors packed the filled into overflow rooms to hear debate. According to the Los Angeles Times , a group of powerful healthcare associations are angling to kill the bill, which has also become a flashpoint in the state’s gubernatorial race to replace Democrat Jerry Brown.

California Lieutenant Governor Gavin Newsom, who is running to replace Jerry Brown, has endorsed the single payer legislation.

“There’s a lot of mythology about the cost of single payer,” he said at a recent debate. “That somehow we are adding on top of an existing multi-payer system, when in fact it’s about reallocating existing resources and using them more effectively and more efficiently by replacing the existing multi-payer system. The fact is we are already spending 367.5 billion a year on healthcare, according to UCLA, in this state. Seventy percent of it borne by the taxpayers. A single payer system drives down the cost of healthcare.”

California’s passage of single payer would still be a big gamble, and could undermine the idea of universal healthcare on a national level if it fails. As former Vermont Governor Peter Shumlin told Vox in 2014, "If Vermont gets single-payer health care right, which I believe we will, other states will follow. If we screw it up, it will set back this effort for a long time."

Still, the debate is healthy, and is further exposing Americans to new ideas for a system that, in its current state, is universally loathed. Other innovative healthcare ideas are also being implemented in the states. In 2017 alone, more than 400 laws reforming healthcare in various ways were enacted in 47 states and Washington D.C., according to the National Conference for State Legislatures. The laws ranged broadly in size and scope. Some expanded treatment eligibility for opioid addiction, while others increased the use of telemedicine. A number of states, including Vermont and Utah, are currently pushing proposals to reduce the price of prescription drugs by importing medicine from Canada.

If you are interested in the healthcare policies being implemented in your state legislature, explore this comprehensive database of state legislative health proposals. Then share your reactions with your state legislators.