The debate over enacting a single-payer health care system in California turned vicious this week, as state Assembly Speaker Anthony Rendon received death threats after he removed the bill from consideration.
The Healthy California Act gained traction in the state legislature as President Donald Trump and congressional Republicans have tried to dismantle the Affordable Care Act at the national level. The proposal sought to create a universal health care system for Californians in which the government, rather than private insurance companies, would pay for care.
The proposal was popular among voters, and drew support from the likes of the California Nurses Association and Lt. Gov. Gavin Newsom, a Democrat who’s already declared his candidacy in the 2018 gubernatorial race. The legislation quickly advanced through the state Senate, which passed the bill in early June.
But Rendon, much to the chagrin of the bill’s supporters, opted to pull it last week despite his support for a single-payer system, calling the plan “woefully incomplete.” He urged the state Senate to “fill the holes” and send the Assembly a “workable” bill next year.
“Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill,” he said in a statement on Friday. These include its failure to address “many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters” to make the bill “a genuine piece of legislation,” he said.
Rendon’s decision prompted swift backlash among California progressives, and even drew condemnation from Sen. Bernie Sanders (I-Vt.), who said he was “extremely disappointed” that the Assembly wouldn’t get to vote on the bill. Supporters organized protests at Rendon’s district office in Los Angeles County, as well as outside the state capitol in Sacramento. Some single-payer supporters held signs depicting the California state flag’s grizzly bear stabbed in the back with a knife that reads “Rendon.”
The backlash took a decidedly ugly turn on social media.
“I pray someone checks his schedule for baseball practice,” one person tweeted about Rendon, an apparent reference to the attempted assassination of members of Congress earlier this month at a Virginia baseball field just outside Washington.
“This is a good way to get guillotined in a public square,” tweeted another.
Rendon, 49, confirmed in a Thursday statement that he and his family had received death threats since he shelved the bill.
“I’m a grown-up in politics, so those are things I can handle,” he said.
What upset him more, he said, was the “false hope” the bill’s backers gave to families at risk of losing health care coverage should Congress succeed in its efforts to repeal Obamacare.
“It is shameful how the proponents of SB 562 have provided false hope to people who are suffering,” he said. “The sponsors need to decide if they are serious about having a policy discussion about how to do this.”
Bonnie Castillo, associate executive director of California Nurses Association, said the group would “never condone any sort of threats or harm to come to anyone.”
The group’s concern is that Rendon acted “unilaterally,” and that sidetracking the bill “is actually a threat to our patients and Californians at large,” she told HuffPost.
A legislative analysis released prior to the bill’s state Senate passage showed it would cost an estimated $400 billion annually — more than double the state’s $180 billion annual budget. According to the analysis, $200 billion would be offset through existing federal, state and local funds. The other half would come from tax revenues, which the analysis suggested could come from a 15 percent payroll levy.
But another analysis of the bill, conducted by the University of Massachusetts Amherst’s Political Economy Research Institute and funded by the California Nurses Association, projected a single-payer plan would actually save the state $37 billion. It estimated that the current system costs the state $368.5 billion annually while a single-payer system would cost $331 billion. That analysis suggested paying for the system through new sales and business taxes, or a combination of payroll and sales taxes.
The bill itself did not include a tax proposal or any specific funding mechanism. But proponents of the legislation argued that by pulling it, Rendon stopped lawmakers from being able to work out those details.
“Why do we elect legislators if not to legislate?” Castillo asked.
The nurses association plans to continue to pressure Rendon to return the bill to this year’s agenda, and will canvass in his district this weekend.
Still, several roadblocks loom to implementing a single-payer system that are beyond the legislature’s control.
One is Proposition 98, a voter-passed law that amended the state constitution to require a certain percentage of the state’s tax revenue be spent on K-12 education. Unless the provision was suspended, it would require nearly half of the tax revenue from the single-payer program to go toward education funding.
There’s also the issue of California’s so-called Gann Limit, another voter-approved measure that limits growth in spending by state and local government. If estimates of a single-payer plan’s costs are accurate, it almost certainly would run up against that limit.
Both of those issues would likely need to be addressed through ballot initiatives.
It’s also unclear whether Gov. Jerry Brown (D) would sign the legislation into law. He’s appeared skeptical of single-payer plans in the past.
“Where do you get the extra money? This is the whole question,” he said in March.
Additionally, the federal government would need to approve a waiver to allow California to redirect federal funds for the Medicare and Medicaid programs to a single-payer system. It’s far from certain that the Trump administration, which has openly attacked the state, would do so.