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Does the future look like the Better Care Reconciliation Act, or the Healthy California Act?

By Tom Baxter

As befalls many an ambitious bill when legislatures head into the home stretch, the Healthy California Act got the hook last Friday. But as confusion mounts in Washington, there are good reasons you should know about this bill which sounds like a brand of smoothy.

The Healthy California Act would have replaced Obamacare and/or the Republican health care plan with a statewide, single-payer system in which the state would negotiate prices with health care providers and every resident of the state would be covered. It passed the California state Senate, but last week Assembly Speaker Anthony Rendon pronounced it “woefully incomplete” and stuck it in the Rules Committee for the rest of the session, which ends for this year in September.

This is the first year in a two-year session, so the bill could be brought back next year. Given the current status in Washington of what in its current form is called the Better Care Reconciliation Act, there’s no reason to think it won’t. About the only sure signal from Washington is that things are about to get worse, leaving California with increasing incentive to go its own way.

According to a legislative analysis, a single-payer system like the one outlined in the bill would cost $400 billion a year, which even by California standards is an eye-popping number. The California Nurses Association, which is the main sponsor of the single-payer bill, paid the University of Massachusetts at Amherst to conduct its own study, which estimated the cost at a slimmer $331 billion a year. Since Californians already spend $368.5 billion on a system which leaves millions uninsured, the group argued, the bill would actually result in a savings of $37.5 billion.

An official of the nurse’s group called Rendon’s decision to yank the bill a “cowardly act,” but it seems to have been generally understood this was a first swing at the idea. In polls, Californians like the idea of a single-payer system but they don’t want to pay higher taxes to get it.

The Healthy California Act sounds like just the opposite of the Senate’s attempt at a healthcare bill, which like the House version slashes taxes and eliminates care for millions, while propping up the private insurance market which the California bill envisions eliminating. But the effect of what Republicans in Washington are contemplating will be to put enormous responsibilities on the backs of the states with no clear guideposts for coping with these new demands. The Healthy California Act is just the first version of how the states might respond.

It was a milestone of sorts when the New York Times ran a story on its front page Saturday about how middle-class retirees could be forced out of nursing homes by the proposed changes in the Medicaid system. That marked the emergence at last of the true third rail in the health care debate. There have been suggestions the final version of the Republican bill could include some provisions for families to assume some of the nursing home costs now paid for by Medicaid.

Since for most families, Medicaid doesn’t kick in until the older patient has exhausted all the savings that might have been passed on to a younger generation, this idea is particularly explosive. It would catch some wealthier families which have found imaginative ways to exhaust an older member’s bank account, but it would force many more, less affluent families into excruciating choices. That’s why something like the Healthy California Act may not sound so flaky as time goes by.

Remember that Medicaid was paying for most nursing home beds when Barack Obama was still a child. Both the House and Senate healthcare bills have been more about rolling back Medicaid than repealing Obamacare.

Here’s another anachronism which has seeped into the healthcare debate. The idea that enough of a consensus exists around the need for a broad restructuring of corporate business tax structure to bring it in line with world standards has been around for a long time, and much longer than Obamacare. Yet the reason Congress can’t get to any portion of tax reform is that the question of the taxes imposed to pay for Obamacare have to be dealt with first.

Why, exactly?

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Tom Baxter

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern Political Report, an online publication, for four years. Tom was the consultant for the 2008 election night coverage sponsored jointly by Current TV, Digg and Twitter, and a 2011 fellow at the Robert J. Dole Institute of Politics at the University of Kansas. He has written about the impact of Georgia’s and Alabama's immigration laws in reports for the Center for American Progress. Tom and his wife, Lili, have three adult children and seven grandchildren.


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  1. Jim Scott June 27, 2017 9:47 am

    Why have we accepted, with no real examination of the premise, that ANYONE has a right to the services of another individual? If I have a right to medical services, who is to say that I also should not have a right to automobile care, lawn care, and having my house cleaned every week on Fridays?

    We all know we have the right to PURSUE Life, Liberty and Happiness – but do we have the right to have it DELIVERED to us? What gives me the right to medical services that someone else has to PAY for?

    And what gives anyone the right to enact a law that took my 560.00/month medical insurance plan and convert it to a plan that just three years later costs me over 1700.00/month (over 2000.00/month if comparing apples to apples).

    And who has the RIGHT to call that ‘The Affordable Healthcare Act’?Report

  2. Noel M. June 27, 2017 12:29 pm

    Jim, a single-payer system like the one California is looking at, mirrors all the key pillars of American society that are treasured and used by both conservatives and liberals alike. Military, police, firefighters, FBI, CIA, diplomacy, border control, schools, roads, playgrounds, national parks, libraries, CDC disease control… the list goes on and on and on.

    Making healthcare into a single-payer system would simply mirror all of those existing areas of what we know as American civilization. And it would do it at a lower price for all and coverage for all.

    Why is that thought so problematic? If you find it problematic, please look at your feelings about any of our other institutions listed above, and see if your theories still hold up.Report

  3. Allen Wilkes June 27, 2017 12:45 pm

    All of the items you espouse as being the ‘model’ for healthcare are jerked around mercilessly in the political process.

    I do not want my medical decisions to have anything to do with politics. Healthcare is expensive enough already. Who wants the medical equivalent of 2000.00 hammers and 20,000.00 toilet seats?

    Public safety? It cannot be any other way. I don’t want to get estimates for extinguishing a house fire. But my personal health? 95% of medical decisions are not emergencies.

    Obamacare has been a disaster. I lost my doctor AND my plan. And my costs have skyrocketed over 200% since it was passed.Report


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