California’s single-payer bill dies

California’s single-payer dreams have been dashed again.

Legislation to create what would be the nation’s first government funded state-run health care system failed to get a vote Monday on the Assembly floor, effectively ending the push for single-payer this session.

High drama surrounding CA AB1400 (21R) by Assemblymember Ash Kalra (D-San Jose) had made it the highest-profile piece of legislation remaining from last year.

Kalra, who declined to speak to reporters after the floor session ended, said in a statement that the measure did not have enough votes on Monday, its deadline to clear the Assembly.

“Although the bill did not pass the Assembly by today’s deadline, this is only a pause for the single-payer movement; our coalition, including the mighty California Nurses Association, will continue the fight for accessible, affordable, and equitable healthcare for all Californians,” his statement said.

The political repercussions of upending California’s health care system were hard to overstate. The stakes were especially high given that Gov. Gavin Newsom, who campaigned for governor on the promise of single-payer, has been notably uninterested in the bill. Newsom has instead been touting his proposal to extend Medi-Cal to all income-eligible undocumented adults.

AB 1400, sponsored by the California Nurses Association, would have all but eliminated private health care and replaced it with a centralized state-run financing system known as CalCare, a plan that legislative analysts estimated could cost between $314 billion and $391 billion a year.

“Despite heavy opposition and substantial misinformation from those that stand to profit from our current healthcare system, we were able to ignite a realistic and achievable path toward single-payer and bring AB 1400 to the floor of the Assembly,” Kalra said. “However, it became clear that we did not have the votes necessary for passage and I decided the best course of action is to not put AB 1400 for a vote today.”

Kalra had proposed paying for the plan with a constitutional amendment, CA ACA11 (21R), which would impose tax hikes on businesses and high earners. ACA 11 faces long odds as it needs a two-thirds vote in each house as well as voter approval.

While AB 1400 had a Monday deadline to clear the Assembly, the funding legislation has a longer time frame. Amendments added by the Assembly Appropriations Committee clarified that CalCare could not be implemented without the necessary revenue mechanisms in place.

Tensions over the bill have pitted not only Republicans against Democrats, but progressive Democrats against moderates with the left-wing factions promising repercussions against those who fail to support it.

The California Medical Association, the California Association of Health Plans, the California Hospital Association, the California Chamber of Commerce and numerous other business and medical forces have joined forces to lobby against the bill. Supporters included the California Labor Federation, the California Teachers Association, a number of local governments and health advocacy organizations.

The California Nurses Association reacted with outrage, releasing a statement saying that “Kalra chose to just give up on Patients across the state.” The nurses also accused the lawmaker of “providing cover for those who would have been forced to go on the record about where they stand on guaranteed health care for all people in California.”

The California Democratic Party’s left wing factions had vowed to block endorsements for members who didn’t vote in favor of AB 1400. That ultimatum may potentially have cost the bill support among some moderate Democrats.

Assembly Speaker Anthony Rendon, who in 2017 took heat for failing to advance a single-payer effort he described as “woefully inadequate,” said he was “deeply disappointed” that Kalra didn’t bring the bill up for a vote.

“I support single-payer and fully intended to vote yes on this bill,” Rendon said in a statement Monday. “With time, we will have better and more successful legislation to bring us closer to this goal. I expect more and more of my colleagues to sign on, so we can make California a health care justice leader.”