https://advancedbenefitconsulting.com/s3e14-how-close-did-we-come-to-single-payer-healthcare-in-california

Host Dorothy Cociu interviews Faith Borges, Legislative Advocate for the California Agents and Health Insurance Professionals (CAHIP) and Dawn McFarland, VP of Legislation for CAHIP, on the latest and most serious threat to our current health care system in California, with the recent single payer healthcare bill, AB-1400, and the companion Assembly Constitutional Amendment, ACA 11. This was the second serious scare of single payer in 5 years for California, but this one was a double threat, as it included the funding source to pay for Single Payer in a constitutional amendment with nearly $290 Billion in new corporate and individual taxes. What happened, why did it happen, and why did it fail? Learn why this is a continuing threat in California; how we could lose our employer sponsored coverage, individual coverage, Medicare, Medi-Cal and all other forms of healthcare coverage in California!

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 We’re well into 2019 now, with a new California Governor, a new Insurance commissioner (both democrats supporting Single Payer), a blue wave (or tsunami!) in Sacramento, and now, in the House in Washington, DC. We’re pretty much used to the Blue in Sacramento, but the Congressional elections were a shock to most, with Republicans losing the House Majority and sending shock waves through our industry.  

On the federal side, we have Medicare For All heating up.  We all know that the Democrats picked up a lot of Congressional seats in the house this past November.  Even my own Congressional District, formerly a republican strong-hold until the retirement of Ed Royce, resulted in a very close race, with Democrat Gil Cisneros beating  out Republican Young Kim; the result was a lot of newly elected democrats into the House of Representatives, and Nancy Pelosi taking over as Speaker of the House.  The Senate, however, maintained its Republican majority. 

NAHU and CAHU refuse to let this discourage them, however, and instead want to focus on the opportunities this brings…  Opportunities to become important educators to the new Congressional members, and to catch them while they are new, to encourage them to learn more about the role of the Agent, and how we are advocates to our clients, who are individuals, small and large groups, and Medicare enrollees. (see Capitol Conference article, page 13). 

Key issues from the November elections in Congress showed that healthcare was the #1 cited issue among voters, beating the economy for the first time.  A clear majority of voters perceived Democrats as stronger on pre-existing conditions and voted accordingly, according to Janet Trautwein, CEO of NAHU. 

We all know Medicare for All is heating up in Washington.  The good news is, despite the media narrative on Medicare-For-All, voters signaled they wanted pragmatic, bipartisan solutions to the challenges in the healthcare system. 

According to NAHU’s recent webinar on the election recap (Live From NAHU, featuring Janet Trautwein, CEO), among competitive elections, 71% of Democrats who won (32 of 45) did not support Medicare For All.  Among Democrat pickups from Republicans, 86% of Democrats (30 out o f 35) did  not run on Medicare for All.  Only 2 of 967 ads run by Democrats in competitive House races since Labor Day mentioned Medicare-For -All.  So that’s something to build on. 

Medicare for All is a looming threat, but according to Janet Trautwein and NAHU, is largely undefined. 

A recent NAHU Operation Shout asked for NAHU members to participate in communicating with your legislators about Medicare-for-All.  According to this operation shout (see below), proponents of government-run healthcare, including single-payer and Medicare-for-All, will be on Capitol Hill advocating for programs that could threaten the private health insurance system. NAHU stated that it strongly opposes these efforts and is working with the Partnership for America’s Health Care Future to promote employer-sponsored health coverage and preserving Medicare, Medicaid, and other existing health programs. We are calling on all NAHU members to join us in our efforts to urge Congress to oppose any efforts to implement government-run healthcare.

NAHU’s message is that we, as an association, are committed to ensuring that every American has access to affordable, quality health coverage. We believe that the free market and public programs can bring down the cost of care and expand access to high-quality care for every American. But a one-size-fits-all healthcare system would lead to less choice and control over doctors, treatments, and coverage, and result in higher taxes for families, longer wait times, and lower quality of care for patients. We believe that instead of considering single-payer healthcare proposals, Congress should focus on bringing costs down for everyone, no matter where they get their insurance.

As Congress heard from advocates during the Medicare for All Week of Action from February 9-13, NAHU wanted to ensure they also hear from voices throughout the country who support access to affordable private health insurance choices.

NAHU asked that we all Contact our Senators and Representatives by sending an Operation Shout, urging lawmakers to oppose efforts to implement a single-payer healthcare system.  Hopefully, you all did that.  On Feb. 25-27, several of us were in Washington, DC sharing this message.  (See Capitol Conference coverage, page 13). 

So that is the federal side.  On the state side, our new Governor started his new role fast and furiously after he was inaugurated.  One of his first actions was of course signing a letter asking the federal government’s permission to mingle federal dollars and state funds into a single payer system.  According to CAHU’s President, Dave Fear, Jr., “This was a ceremonial request.  We know the Trump administration is not going to approve this request.” 

With a Democratic Super Majority in Sacramento, and every state-wide office filled by Democrats, a lot can happen in a short time.  Therefore, we have to remain vigilant, and be ready to act quickly when NAHU or CAHU asks us to.

With the governor’s top priorities announced immediately, California could be the first state to expand ACA’s financial assistance to middle-income families, and our state could create state buying power to purchase prescription drugs in a collaboration with the pharmaceuticals industry.  Of course, what is on the mind of all agents in California is  that Governor Newsom’s highest priority long-term is some sort of Medicare-for-All, Universal  Coverage or a public-private partnership for health care. 

AB 2472 in 2018 created an independent body charged with developing a plan by October 1, 2021, including options for advancing single payer in California. 

While we don’t expect specific legislation to be introduced in 2019, it’s definitely on the horizon… estimated time of arrival unknown at this time….

At every OCAHU meeting, I get the same questions… Do we need to worry about single payer now?  When?  What can we do to stop it or change it?  What is CAHU doing to protect our industry?

CAHU remains a active part of a coalition to fight the single payer fight. We urge members to sign up for the latest developments at https://protectcahealthcare.org/coalition-sign-up/.

What should members do?  According to Dave Fear, Jr, CAHU President, members should “support efforts that move towards universal coverage, not single payer.”  We should actively “support legislation that improves access for ALL Californians and continue efforts to improve transparency and reduce costs.” 

“The best thing that all of us can do is to become a member, and if one already, be sure to renew your membership, start or increase contributions to CAHU PAC, and sign up for and participate in CAHU voter-voice efforts and Adopt-A-Leg programs,” said Dave Fear, Jr. 

Overall, the main thing is that we believe “Our industry is alive and well,” said Dave Fear, Jr.  “Medicare-For-All is a more realistic approach, but it is still a ways off in the future, if at all, and a more favored approach than true single-payer models like SB 562, both in the state and nationally.  If Medicare-for-All does become a reality, agents have been a huge part of a robust Medicare market and would be essentially applying the model more broadly.”

Another thing you can all do, which is something that is inexpensive and fun, is to join us on Thursday, March 14th at JT Schmids in Anaheim, starting at 5 pm, for the OCAHU March Sports Trifecta, which is a fund-raiser for CAHU PAC, to help us raise money to fight single payer and other negative legislation in California!  See the ad for this on page 6, and register now!  ##

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The post-election concern about Single Payer legislation in California is very much warranted…  because as many at CAHU have stated recently, we now are experiencing the “perfect storm” in Sacramento for Single Payer.  We have of course a newly elected Governor and Insurance Commissioner, plus Democratic majorities in both houses, so many are concerned that it’s the perfect beginning to  what the Democratic party has been wanting for some time… Single Payer healthcare. 

The Blue Wave may have started slowly, but grew increasingly strong and hit California hard in November.  Democrats of course, as we all know, swept the statewide elected offices once again.  But will this have much impact on us?  What should we most be concerned about at this point?  To help answer these questions, or at least ponder them, I asked a few OCAHU and CAHU leaders for their comments. 

“The California Blue Wave was really just a blue wave in Orange County and a small part of Fresno,”  stated Brad Davis, CAHU V.P. Public Affairs.  “ For the rest of the state, there weren’t any surprises—it felt more like a shift in the tide.”  

We here in Orange County are familiar with the election swings, and as Brad Davis stated, the Blue Wave hit Orange County hard, as we lost prominent Republican  Orange County Congressional incumbents (Mimi Walters lost to Katie Porter and Dana Rohrabacher lost to Harley Rouda),  plus the loss of Republican candidate Young Kim to Democrat Gil Cisneros in Dist. 39, Ed Royce’s long-held seat,  and Darell Issa’s retirement, which resulted in the win for Dem. Mike Levin.  All this resulted in Orange County, a previous strong-hold for conservative republicans in the past, now has for the first time since the 1930s, not a single Republican in Congress. 

On the state side, the State Assembly now has (as of Nov. 6, 2018) 55 Democrats and 25 Republicans, moving to 60 Democrats and 19 Republicans in 2019-2020, and the State Senate moves from 26 Democrats and 14 Republicans to 29 Democrats and 11 Republicans in 2019-2020.  

“The industry should be aware that the flood gates have opened, “  stated Rob Semrow, OCAHU V.P Legislation.  “ I  think that we will see a large number of revisited as well as new ideas and initiatives be brought forward.  The super majority will have the ability to move ideas forward without much hesitation or pushback.” 

And it’s that super majority that many members are indeed concerned about.  A super majority gives the party veto and override power that a regular majority does not have, as I’ve discussed in previous Single Payer columns and related articles in the COIN. 

“I don’t really see much of a change with a blue wave in California,” said Dave Fear Jr., CAHU President.  “This state was already run by Democrats top to bottom and that did not change.  They did pick up super-majorities in both houses, but as long as the governor is a progressive democrat, I don’t see them using their veto override on any issue.”  

“CAHU has been working in a Democratic majority and supermajority for the last 8 years and we are getting pretty good at finding the right angles to push our agenda,”  commented Brad Davis.  Our members should remain concerned about a push for single payer health insurance, as the CNA and other organizations have promised to introduce a Bill to accomplish this.  CAHU has already aligned itself with a large coalition against single payer that will be funding some research and white papers to address the unintended consequences of a government-run healthcare system.  The more our members can continue the narrative of how detrimental the cost would be to taxpayers and the amount of quality doctors and services we will lose as a result, the better that will be for our consumer clients and agent members.” 

Rob Semrow, OCAHU VP Legislation, stated “I think that single payer, in some fashion or another, will get a boost in discussion and consideration.  There will be little to stop it or push it back.” 

CAHU President Dave Fear Jr. stated that he was recently on  a call with the Single Payer coalition and listened to Bernie Sanders and other prominent single-payer supporters provide a post-election update.  “I will summarize by saying that they will not let cost or Trump or common sense stop them. You will see a push similar to  what happened in California with SB 562 on the federal level in the House of Representatives.  They plan to make Democrats support it or turn on them to do the same thing to Senators.”

What can we do? 

“We expect to find CAHU making new bedfellows in a joint effort to lobby against new taxation,” stated Brad Davis.   “The incoming leadership seems to have an appetite to find new and creative ways to tax its citizens.  For example, a new tax on services (including the advice of an agent) would have a profound effect on our ability to deliver services.  CAHU has had to expand the scope of its efforts beyond just healthcare in order to protect the agent members from many different adverse affects.” 

“I think the game plan for single payer is similar to what we saw before,”  commented Dave Fear, Jr.  “The far left and the nurses will not accept the excuse ‘I support single payer but…’ from democrats.  I think they will try to use social media and grass roots efforts to force elected representatives to take a public stance.  They are leaving no room for moderates.”

“[Our members] need to stay involved and stay engaged,” said Rob Semrow.  They have to stay vigilant and communicate with their consumers/clients. We are their advocates and if we are removed, they will have to do much more for themselves than they are used to or comfortable with.” 

“Members have to know their stuff on why single payer is not the best solution for our state or country,” said Dave Fear Jr.  “They need to be able to talk about cost, and lack of competition and lack of innovation associated with government-run health care.  CAHU will continue to provide information to its members on single payer and other government run systems to help in that debate.”  

Please stay tuned for further updates!  ##

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Single Payer Update—November, 2018
By:  Dorothy Cociu, RHU, REBC, GBA, RPA, OCAHU V.P Communications and Public Affairs

In the meantime, I thought I would provide you with some information to give to fellow agents and our employer clients during this temporary lull in the single payer movement. 

CAHU has provided us with a lot of tools to help fight SB 562 and other single payer initiatives.  I’d like to  print some of these helpful tools in the COIN this issue, to remind you that they are available when we need them.  First, there is a sample letter to legislators that you can give to your employer clients to send out… The elections will be just days after this issue comes out… We may need some of these tools right away if certain elections go against our industry’s wants/desires/needs…  So I’m anticipating you may be grasping for things to tell your clients or share with them if that happens…

SAMPLE EMPLOYER LETTER

(PUT ON LETTERHEAD)

(INSERT DATE)

Dear Senator: 

I am a constituent and an employer in your district and OPPOSE SB 562 (LARA and ATKINS) that seeks to establish a $400 Billion government-run universal single payer health care bureaucracy that is paid for in large part by employers and will result in significant California job losses. 

The State Senate estimates SB 562 will cost at least $400 Billion per year, with a minimum of $50-$100 Billion in new payroll taxes with no cap on the wages subject to the new tax. Though the financing mechanism for this measure has not yet been specified, past legislative attempts at government run health care have proposed major increases in payroll and income taxes on businesses and individuals. Payroll tax increases would lead to thousands of job layoffs as existing business and employers would be forced to cut costs in order to meet the new tax burdens caused by SB 562. As a result of this bill, California would have the highest state taxes in the United States, forcing business to relocate out-of-state.

Universal government-run health care system funds must compete with other claims on government funding, such as education, welfare, water, transportation and infrastructure. With limited public funds, whatever the government can’t pay for will be on the backs of employers and employees. California should not impose such an unfair burden on California employers, which hinders my ability to fairly compete in the marketplace, whether that is in California or other states and globally. 

I believe that you, as my elected representative, should instead focus on positive changes to reduce the cost of health care services, reduce the costs to doing business in California, and OPPOSE adding a new $400 Billion government dispensed universal single payer health care programs that will burden the remaining business in California.

Please vote “NO” on SB 562 (LARA and ATKINS) each time it comes before you for a vote. 

Next, I’d like to print the SB 562 talking points that CAHU has published on it’s website for our use…

TALKING POINTS

SB 562 would establish a state-run single-payer health care system. All Californians will lose their current health plans, to be replaced by government run health care, with benefits yet to be determined, to be serviced by a government-run entity populated with political appointees yet to be identified, to include provisions yet to be named – all paid for by a doubling of your annual tax bill.

SB 562 forces California businesses and individuals to hand over at least $107 Billion in new state taxes per year to pay for a government run health care system. Economic analyses estimate it will take $400 Billion annually, more than double the annual state budget, to set up and operate single payer as set out in SB 562. At a time when California has recovered somewhat from the Great Recession, and residents were just mandated to pay $69 billion in higher taxes for long-neglected education, water and transportation infrastructure repairs and upgrades, SB 562 will harm residents with a limitless price tag and no guarantee of better health care for anyone.

HERE IS WHY

• Single-payer mandates a government-run monopoly on all health care services in California. It eliminates all private insurance, Medicare, Medi-Cal, Long Term Care, Covered California, and the valuable advocacy services of insurance professionals and advisors.
• By eliminating employer-paid health coverage, single-payer shifts health care costs to employees.
• Single-payer will increase taxes for businesses and individuals by at least $107 Billion annually.
• A single-payer system like that laid out in SB 562 makes California less attractive to doctors and health care providers. Our best providers would leave the state, and new providers would have no incentive to practice in California.
• Single-payer puts an estimated 540,000 of Californian’s workforce on the unemployment line.
• By giving Californians the highest state taxes in America and making California a less attractive place to do business, business will likely leave the state.
• While single-payer plans offer all citizens some kind of medical insurance, they cannot guarantee access to medical care.
• While SB 562 proponents claim “You can keep your doctor”, the reality is that providers cannot be forced to participate in single payer.
• SB 562 as drafted has no realistic mechanism to control health care costs, fraud or abuse of medical services, as a result health care costs will skyrocket.
• Single-payer ultimately controls costs by rationing health care. Citizens in countries with single-payer models often wait months to see a doctor or specialist or to receive much-needed medical treatment.
• Single-payer means zero choices for consumers, discourages creativity, efficiency, quality, innovation and advancements in medical care. 
• In government-run health care systems there is never enough money to provide timely care or the latest technology. That’s because health care funds have to compete with other claims on government funds, such as education, welfare, water and transportation infrastructure.
• There is no guarantee that proponents will be successful in obtaining $225 Billion in federal waivers, if they do not, more taxes will be needed from all Californians to meet that $225 Billion shortfall in funding.
• There are at least three separate issues that need voter approval to address state constitutional barriers. These include Prop 98 Education Funding mandates, the Gann Budget Limit and Prop 30 from 2012 that guarantees certain funding to counties.

Single-payer initiatives have failed in every state, including Vermont and Colorado, due to the multi-billion dollar price tag. Most Californians want the legislature to focus on positive changes to reduce the cost of health care and to provide for a competitive health insurance marketplace in a public/private partnership.

Let’s hope we don’t need any of these tools, but if we do, we hope this is helpful!  ##

Editor’s Note:  Please check the CAHU website regularly at www.cahu.org!

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As I write this in late August, we are now at the very end of the legislative session, and are in anticipation of what is to come in the general election on November 6th.  I am reporting primarily on the legislative updates provided by Faith Borges at the CAHU Health Care Summit August 9th.

In the final month of the session, the legislature reconvened from Summer Recess on August 6th, and August 17th was the last day for fiscal committees to meet and report bills to the Floor.  Final floor sessions for this year were held August 20-31, with August 24th being  the last day to amend bills.  August 31st is the last day for each house to pass bills and Final Recess begins. Another important date is September 30th, which is the last day for the Governor to sign or veto bills. By the time you read this, many of these dates will have passed.

The best way to update you on Single Payer is to discuss in part the political preview of what’s to come in the fall.  Obviously, there is a general election on November 6th.  The Governor’s race will heat up and all statewide offices are up for election.

In the Assembly, only one Assemblymember termed out in 2018, and 5 of 6 Assembly races are competitive between the two political parties.  In the state Senate, 5 Senators termed out in 2018 and, there was one vacancy to replace Senator Mendoza that has been filled by Vanessa Delgado (D).  The Orange-County based Josh Newman (D) was recalled and replaced by Ling Ling Chang (R), which I reported on in the last issue of the COIN.  The importance of this is that with this recall, there is no longer a Democratic Supermajority in the state Senate.

Leadership in the Legislature is key to establishing and delivering legislative priorities, according to Faith Borges.  In the Senate, President Pro Tempore is Toni Atkins (D– San  Diego), who as you’ll recall, co-authored SB-562, and the Senate Minority Leader is Laguna Niguel’s Republican Patricia Bates. The Assembly Speaker is Anthony Rendon (D– Lakewood), and the Assembly Minority Leader is Brian Dahle (R-Bieber).

The Omnibus Health Trailer Bill (AB 1810) became law on June 27th.  The health care portion of the budget compromise, according to Faith Borges, authorizes an all-payer claims data base and establishes several new health care councils, and declares the legislative intent to establish a health care system that “provides coverage and access through a unified financing system for all Californians.”  This law should tell you where the Legislature would like to go relating to a single payer or a universal health care system. A committee has been created to look at universal health care financing by October, 2021.

Also notable, the Assembly formed a Select Committee on Health Care Delivery Systems and Universal Coverage as a way to explore the issues linked to SB 562, although no additional hearings are scheduled at this time

At the CAHU Health Care Summit, Faith Borges and the panel on The Future of Single Payer in California featuring political consultants Ned Wigglesworth & Rob Stutzman, observed that though there were many public health benefits that resulted from the creation of the ACA, it also put more pressure on the public with more out-of-pocket expenses. These costs have made the public more aware of health care financing, and there is a general consensus that there is a healthcare financing problem.  However, no one has viable answers as to how to handle the cost of a single-payer system at the state level, so the panelists felt that it was not yet “ripe” in the legislature.  They all felt, however, that this issue of single payer will resurface after the November elections, and primarily, after we see what likely Governor Newsome will signal to the legislature and stakeholders that he is willing to authorize and approve financing for.    Newsome has been very quiet on the issue in the past few months, and he has noted to the press that single payer is NOT something he can do with just a signature.  The “we’re working on it” line is often used. Additionally, the topic will likely be pursued at the federal level with ‘Medicare for All’ likely to be a big topic in 2020 during the presidential and house elections, according to Rob Stutzman.

Bottom line is, there are policy issues, cost issues and constitutional issues with implementing single payer at the state level.  How do proponents  repurpose existing funds into a new state pool?  Employers currently provide a large percentage of the health care coverage in this country.  How would they and could they get that money into such a pool?

According to Ned Wigglesworth, there are others besides the nurses that will likely pursue this topic.  The Democratic Party platform, various unions and others are on record for supporting single payer.  All, however, are concerned about where the money will come from.  Will proponents look for other deep pockets, such as the super-rich as Bernie Sanders proposes?  It is highly doubtful that President Trump would support a path to put Federal funds into a state system.

Another key race for all of us is the Insurance Commissioner race.  SB 562 Joint Author, Senator Lara is running for Insurance Commissioner against Steve Poisner, a former Republican, running as an Independent. Poizner is the industry-backed choice, having served it well during his previous tenure as Insurance Commissioner from 2007-2011.  The framing of single payer as a right versus a political liability is a strong theme in this close race. 

On August 28th, the Sacramento Bee announced a coalition of influential, well financed, business and health care organizations, including CAHU “that have long helped shape the legislative agenda in California and have joined forces to oppose any future effort to craft a universal, single-payer health care system for the nation’s largest state. The main focus of the coalition, called ‘Californians against the costly disruption of our health care,’ is to kill any single-payer health care bill in the state Legislature, said Ned Wigglesworth, a political strategist for the coalition.”

The California Nurses Association responded to the introduction of this heavy-weight coalition by stating that the union plans to introduce another single-payer bill next year and that anything short of that is insufficient. So looking ahead, we’re seeing a lot of pressure in the legislature, and maybe some progress on single payer, but still there are BIG questions to address on cost and other important coverage issues.

Stay tuned for much more news in the next issue!  ##

Author and Editor’s Note:  Special thanks to Faith Borges, California Advocates, for her assistance with this article.   

Originally published in the County of Orange Insurance News (The COIN), Published by the Orange County Association of Health Underwriters, Sept/Oct. 2018. 

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May-June 2018

As Editor of the COIN, I wanted to thank all of you that have contacted me to thank me and OCAHU for the articles, town hall meetings and overall education on the Single Payer fight here in California.  At your request, I wanted to continue to provide you with updates on the Single Payer fight, and to help OCAHU and CAHU to educate our members and readers, as well as their employer clients on the important issues related to this topic.

CAHU is going to be starting a social media campaign soon to educate members and the general public on key concepts related to this issue.  I’m sure you’ll be hearing much more about this immediately following our visit to Sacramento in mid-May for Capitol Summit, where we will be meeting with legislators to share with them our views.  But in the meantime, I wanted to start our own OCAHU campaign.  OCAHU will be continuing a regular column on the Single Payer Fight, until this issue is over and we’ve won our battle!

The Glossary

I want to begin with some basic concepts that CAHU now has available in a document you can pull down from both the  CAHU and OCAHU websites, called simply, The Glossary.

It became apparent to the CAHU Communications Committee (which Nolan Warriner, OCAHU Social Media Chair, and myself are part of), that the general public, as well as some of our members, are not 100% clear on some basic concepts and terms related to this fight.

The Truth is In The Details… The Differences Between Single Payer, Healthcare for All and Universal Coverage

The most important of these concepts is in the definitions… What are the differences between Single Payer, Healthcare for All, and Universal Coverage, or Universal Health Care?  These are basic concepts that we all must be aware of, and pass on during this important fight.

It’s also important that you understand that NAHU, CAHU and OCAHU are very much in support of Universal Access to Health Care.  This concept is a broad term for a program that makes some level of basic coverage available to all.  Although this is often perceived as a done through a government-run health program, it also allows for private insurance as a choice to the consumer.  What CAHU wants to promote is Universal Access to Health Care through private insurance programs, not a government-run health care program.  THIS IS THE MESSAGE!

Back to the definitions… Universal Health Care refers to providing every citizen with health care coverage.  Although universal health care generally means a national public insurance program, there are varieties of ways of achieving this; some of which are predominantly public, and others which are a mixture of public and private elements.  To understand examples of these differences, please refer to the Glossary provided by CAHU, which is again available on both the CAHU and OCAHU websites.  The glossary compares Canada, United Kingdom, Germany, and Japan.  I think it’s important that our members become much more educated on the realities of the plans provided throughout the world.  There are some countries that do a nice job of combining the concepts of a government-run program with private sector options.  Should we be in a situation where Single Payer were to pass in California, either through the legislature or as a ballot measure, we need to be prepared to be in a position to offer suggestions for compromise, so that our industry does not die.

Back to the definitions and details…

Single payer is a system in which all residents pay the state, via taxes in amounts determined by the state, to cover all healthcare costs for all of its residents, regardless of income, occupation, or health status.  A single payer plan here in California would end all of the individual’s options to buy or not buy health coverage from private insurers based on their needs and ability to pay.

Both the Healthy California Act and the New York Health Act are true single-payer plans, which would eliminate all  private and public insurance programs, including Medicare, Medi-Cal, Veteran’s health care, and other programs.  The funding of a single payer system comes from all or a portion of the covered population via new taxes.

Remember, in 2017 CAHU reported (covered in the November-December, 2017 issue of the COIN (page 15, URGENT NOTICE:  CALIFORNIA ATTORNEY GENERAL PROPOSED MEASURE TO ESTABLISH FUND FOR HEALTHCARE EXEMPT FROM REVENUE RESTRICTIONS; California Healthcare Roadblock Removal Act- Given Green Light for Signature Gathering for Single Payer Health) that the Attorney General had put forth a proposal initiative to establish a fund exempt from revenue restrictions, which would clear the way for collecting signatures and pass taxes for single payer health. We’ve since seen a massive campaign (samples printed in the March-April, 2018 issue of the COIN –Single Payer Is Not Dead, page 23 and actual text from an email campaign rallying support and actions on page 24) from the supporters spreading the word about single payer… Our fight is far from over!

We’re asking that you please stay tuned for future issues of the COIN, as well as the CAHU social media campaign, which should kick off immediately after Capitol Summit in May… You will be asked to join the campaign using certain hashtags, such as #singlepayer-the truthisinthefacts or #singlepayer-intheknow.  Please act when we ask you to… Please help us spread the word to the general public, and help us win this fight! 

For the complete Glossary, go to the OCAHU website, or CAHU website to print or download a copy.  And please, pass it on!  ##

 Author’s Note:  Websites referred to are ocahu.org and cahu.org. 

Originally published in The County of Orange Insurance News (The COIN), May-June, 2018, published by the Orange County Association of Health Underwriters.  Additional printing in multiple CAHU newsletters and other industry publications.

The post Single Payer Update – Understanding the Terms & Concepts appeared first on Advanced Benefit Consulting.

In case you were thinking we’re safe… everything’s going to be fine… you may want to think again.  And perhaps open your eyes a bit wider to see what’s going on around us.

As we discussed with attendees in the December, 2017 meeting update, Single Payer is anything but dead.  In fact, the grassroots efforts to support it are stronger than ever.  We have two different fronts working on Single Payer in Sacramento; the SB 562 legislative push and the Ballot push.  This is far from over!

Rob Semrow mentioned in his Legislative Update that you need to look at the website he mentioned, www.healthycaliforniaact.org, as you may not be aware of the activities that are happening right now!

Some of our board members are on the distribution lists and have received incredibly disturbing emails (disturbing, that is, to everyone in the insurance industry; the agents, the carriers, and even physicians), which are calls to arms from their grassroots organizers and volunteers.

They have chapters in nearly county, and say on their website that if they aren’t in your county, they’ll organize one.

Health Care for All is asking supporters to take action and fight the fight.

As you’ll recall, on February 17, 2017, just over a year ago, Senators Ricardo Lara and Toni Atkins introduced SB 562, The Healthy California Act.  Advocacy for this bill is led by the Healthy California Campaigned, which is composed of the AllCare Alliance, the Campaign for a Healthy  California (CHC), and Labor United for Universal Healthcare.

They are asking their supporters to take action by 1) Connecting with HCA (ie, become a member and donate funds, as well as volunteer with your local chapter or start your own; 2) Inviting a speaker and hosting a party with neighbors, family, friends and colleagues, or getting them a spot on the meeting agenda of your club or church groups; 3) Sending letters/emails and/or make phone calls; 4) Getting the word out by putting together your own personal list and forwarding information to your contacts when there is important news or they want you to act; 5) Seeking endorsements by asking businesses, city councils, school boards and prominent individuals in your community to endorse SB 562.  They have created sample endorsement letters, a sample endorsement resolution, and a guide to the endorsement process with a web link; 6) Arranging a screening of a healthcare film.  They are promoting “Now is the Time,” which is available to purchase on DVD or available fro the movie’s website.  They will even let you borrow it for your chapter; 7) Staying up to date by connecting with them on Facebook and Twitter.

They also have a California Education Fund, which is a nonprofit 5019c)3 educational organization dedicated to expanding knowledge and understanding of health care in California.  They are seriously soliciting donations, which are tax deductible.  The entire focus is to educate the public about the advantages of universal healthcare financed by a single payer mechanism.

Seriously, you need to check it out. You need to go to their website (which we’ve been suggesting you do for months) and really see it, understand it, and hopefully, give you motivation to help us fight this.

If any of you don’t believe that this is a serious threat to us, you need to check this out for yourself.

If you don’t have time to go to their website right now, make a mental note to go later, but in the meantime, take a look at page 24, as I’ve copied and pasted an ACTUAL EMAIL that they recently sent out to gather support.  You won’t believe it until you see it.  So look at page 24 now!  Then come back and finish this article!

What can we do to fight this?  Go to their website and see what they are “selling” to the public at  www.healthcareforall.org.  If you’re a member of OCAHU/CAHU, read what we send out to you in the COIN, in emails, etc.  Come to meetings and bring others you know in the industry that may not be members.  If  you’re not a member, you need to become members!  Listen when Rob Semrow gives updates and when we do panel and other presentations here at OCAHU, as well as  CAHU, on single payer.

Most importantly, talking to each other is preaching to the Choir.  We know this would be bad for California, but other consumers don’t!  Talk to your clients, talk to employees at open enrollment meetings, talk to your church groups, rotary clubs, professional associations and other groups.. They are!  So we need to, now!

We need to have a single voice, use the same message.  Rob Semrow, Juan Lopez, Ryan Dorigan and I have had now 3 meetings on this… and we’ll continue to.  Rob can give you talking points, or you can find them on the CAHU website.  CAHU has provided us with a ton of helpful material.  Use it!  If you need a speaker at a meeting, contact one of us!  Health Care For All is doing it all over California!  We need to also!

Most importantly, give to CAHU PAC!  We need funds to fight this fight, or we’ll all be out of jobs, and California will be in a single payer mess!  We all know how much this would cost, but these grassroots efforts from the opposition aren’t talking about cost.  They are talking about how great it would be to have a universal, single payer healthcare system. They are not mentioning the fact that it would cost over $400 Billion dollars, more than double our current entire state budget!

If you don’t know how to do that, go to the CAHU or OCAU website, or contact the OCAHU PAC chair (or CAHU VP PAC). .

Let’s work together to fight this fight, and  win! ##

Author’s Note:  The referenced section above is included here: Single-Payer-Not-Dead-Supplement.pdf

Originally published in the March-April issue of The County of Orange Insurance News (The COIN), published by the Orange County Association of Health Underwriters and reprinted in multiple industry association publications. 

The post Single Payer is Not Dead! Wait Until You See What They Are Up To! appeared first on Advanced Benefit Consulting.

As reported in the November-December, 2017 issue of the COIN, an urgent notice was published regarding the California Attorney General’s proposed measure to establish a fund for healthcare exempt revenue restrictions, which gave the green light for the state legislature to begin gathering signatures for a single payer health plan.

Attorney General Xavier Becerra (D) issued a formal Title and Summary to Proposed Initiative 17-0019 on October 24, 2017, originally titled The California Healthcare Roadblock Removal Act, now titled “Establishes a Fund for Healthcare in California Exempt from Revenue Restrictions.”

So what does all of this mean?

The California Healthcare Roadblock Removal Act seeks to amend the California Constitution to establish a fund that is exempt from revenue restrictions, and basically would allow the state to enact a measure to impose $400 billion in new and redirected taxes with only a simple majority vote.  What would this accomplish?  The bottom line is, this is a blatant political move. It is an effort by a lesser known progressive group to eliminate “roadblocks” to future enactment of a single payer system in our great state of California. Without the roadblocks, it paves the way for a possible single payer  health plan in California.

The proposed initiative has many purposes.  To summarize, the initiative:

• Establishes the “Healthy California Trust Fund”, a health care trust fund independent of the state General Fund.
• Prohibits the use of any funds in the “Healthy California Trust Fund” to be disbursed or loaned for any other purpose other than health care.
• Permits the state to transfer any funds, including federal funds, into the “Healthy California Trust Fund”.
• Amends the California Constitution to circumvent and disregard past voter-approved initiatives, including the requirement of a 2/3 vote of both houses of the legislature to pass tax increases (Prop.13, 1978), the Gann Spending Limit which limits spending from tax revenue (Prop. 4, 1979), the minimum guarantee of state General Fund revenue to education (Prop. 98, 1988) and the state requirement to set aside revenues to pay debts and save for a rainy day (Prop. 2, 2014).

As stated in the update in the last (November/December, 2017) issue, this constitutional amendment would make it easier to increase state tax revenues dedicated to healthcare spending.  This measure would have absolutely no limits or oversight.  According to Dave Fear, Jr., CAHU President-Elect, this “ is an attempt to remove the reason many elected officials give to single payer zealots when asked if they will support single payer.  The answer by many Senators, Assemblymembers and state leaders is: ‘I support single payer, but I don’t think it is fiscally feasible.’  This is one group’s attempt to solve the many problems in trying to enact single payer in California.”

“This is one of the more concerning aspects of the proposed initiative,” stated Jim Morrison, CAHU V.P. of Legislation.  “They are so focused on passing Single Payer that they are willing to throw out all checks and balances related to the budgeting process and how new taxes are implemented.”

As you’ll recall from my article in the July/August, 2017 (“The SB-562 Storm Continues to Build…  Can We Stop It?”)  issue of the COIN, Single Payer in Sacramento is political. I’ll quote some of my comments from that article, below.

“It’s not that the Democrats in our Capitol think SB-562 is a good bill.  From everything the California Association of Health Underwriters (CAHU) and others can see, they aren’t all that convinced it’s a good bill… So much so that they didn’t bother to add any financing to the bill in its current form… but that doesn’t seem to matter.  They need it, they want it, and they plan to get it… An all-encompassing single payer bill that rolls all health products and services, as well as work comp, into one big government mess.  And they have the majority in the legislature to do it.

It’s a world like no other.  It’s a world of egos, a world of politics, a world where the majority of the legislators are in their first terms and they want to make a statement.  And they don’t care who they take down in the process.

No one wants to go against the party.  They all have something to prove, and they teamed up with the Nurses Association, whose union has political motivations, it seems, to go out and try to prove it, at literally any cost.  And wow, what a cost.  Multiple studies now offer a cool $400 Billion (yes billion with a “B”) price tag, which is more than twice that of the entire current California state budget.  Oh, and another important fact, it passed the California Senate in May and was sent to committees in the Assembly, where we have had some brief and temporary relief on, with Senate Speaker Anthony Rendon (D-Lakewood) announcing on June 23rd that he would hold it in committee for now, pending Senate work on the bill and a funding mechanism, but he also stated that he is a true supporter of Single Payer and expects this bill to be on the November, 2018 ballot.  So this is far from over….”

And now, with this California Healthcare Roadblock Removal Act initiative, they have a funding mechanism.  An initiative that would allow for a way to collect taxes for Single Payer legislation in California.

Yes, some at CAHU are skeptical and feel that this initiative won’t pass, but honestly, I truly feel that with the political environment in Sacramento right now, if this one doesn’t pass, say, for example, because no one knows of this organization or how they will fund the signature gathering, etc., I fear that they will just keep trying, until they find a way to do this!

It’s important to note that the supporters of this measure, and single payer, are mobilizing.  Get ready for a big fight the first quarter of 2018!  They have opened offices in every county, and some multiple offices in a county, so pay attention, and be ready to respond when we ask you to!

The bottom line is, “this would throw out all the California statutes, constitutional amendments and elections by going around everything that has happened in the state of California since its inception 167 years ago and saying basically, we shouldn’t have to follow those rules because we want to enact single payer,” continued David Fear, Jr.  “I agree with David’s points on this,” stated Jim Morrison.  “ This group is trying to amend the state Constitution so they can increase the likelihood of getting a Single Payer bill passed.”

This is alarming to CAHU because it makes it easier to enact Single Payer in California and, in a nut-shell, ends the entire health insurance industry! Oh and yes, Agents will be out of a job!  If you want to see it in writing, simply read page 16 of the bill! But,  don’t worry, agents, because there will be retraining and assistance with job transition!  Yay!  (And yes, that is complete sarcasm!).

This measure requires the proponents to gather nearly 600,000 signatures by early May.  It sounds simple enough, but it may lead to some difficulties.  The process of gathering signatures is time consuming and very expensive.   Just think about the paid persons with clipboards outside of Target and Home Depot. It is actually difficult to do and most proposals do NOT qualify. The organization that filed the initiative is called “Universal Healthcare for CA, Inc.” a virtually unknown organization, and little is known about any funding that they have to obtain the nearly 600,000 signatures within the allotted 180 days. The CNA (which does have resources- man power and money) is not currently in support of this initiative. So, we could, I suppose, be thankful for that.  However, we can’t assume that not knowing who they are or what they are about, or who is funding them or how, is a good thing for agents and the healthcare industry.

“It’s only easy to do if you have millions and millions of dollars to pay people to get those signatures,” stated David Fear, Jr..  “This group is an unknown and unless they partner with a large wealthy group quickly, they will have a tough time qualifying.  However, I would not be surprised to see some “enlightened” progressive billionaire step in and help in the process.”

“In most cases,” continued Jim Morrison, “groups like this use professional signature collection firms.  This costs money and we do not know what kind of resources this group has at this point.”

This constitutional amendment would make it easier to increase state tax revenues dedicated to healthcare spending.  CAHU’s press release on this notified CAHU members that this measure would have no limits or oversight.  Why is this lack of limits and oversight such a concern to CAHU?  “All business groups, tax payer advocates and many other informed Californians that have nothing to do with the healthcare debate will weigh in on this issue and persuade even the least informed Californians that allowing a group to tax and spend without any control is not a good idea,” commented David Fear, Jr..

Remember, approximately $400 billion is estimated to start a single payer health plan in California.  The current entire budget for the state of California, as you’ll recall, is less than $200billion.  SB 562 itself contained no funding mechanism or revenue source.  “The estimates [in cost] range from $337 to $400 billion for the first year,” commented Jim Morrison.  “These are [as we stated] more than double the entire current state budget.  In addition, there are major assumptions that the Federal Government will willingly provide all current and future funding for Medicare and Medi-Cal to meet roughly half of the budget.  The remaining balance would come from a number of new taxes, including sales, gross revenue and payroll.”

The Senate Appropriations Committee estimated the cost of such system to be approximately $400 billion and estimated a 15% payroll tax increase to fund it. CNA commissioned a funding study which recommended a sales tax which would increase the already highest state sales tax in the country by another 2.3% and would be the biggest sales tax increase in the history of California. In addition to this massive sales tax, which would not alone be sufficient to fund this program, the study proposed a 2.3% gross receipts tax or a 6.6% payroll tax. So, Californians, don’t believe what you read about this being a “free system.”  It’s certainly not free.  It is in fact, the most expensive state initiative we have ever encountered.

The state Legislative Analyst (LAO – the California Legislature’s Nonpartisan Fiscal and Policy Advisor) is required to prepare a fiscal analysis of all proposed initiatives within 50 days of the Attorney General’s office receiving them. Its analysis of the Initiative indicates that the establishment of a health care fund, in and of itself, would have no notable fiscal effect on the state government.  However, the LAO notes, within the first paragraph of its report, that the initiative “would amend the Constitution to allow and facilitate future, but unknown legislative actions that could substantially increase state healthcare spending and associated tax revenues.”

The Single Payer fight is far from over.  We have a lot of work ahead of this.  If this reaches the ballot, which it likely will, remember, regardless of the facts on our side, the emotions of California Consumers can and will get in the way.  They hear “free health care” and they run with it.  Consumers don’t check facts.  They listen to sob-stories on the news and listen to celebrities, who can afford any health care they want and need, with or without insurance, preach to the masses about how bad our healthcare system is, and how we need single payer.  We need to teach them that FACTS DO MATTER, and that we are the ones to bring them to the forefront.  And when it comes to a fight, CAHU will not back down.  CAHU will fight the fight, and be the grass-roots mechanism to defeat this and any other measure thrown at us.

“Single-payer initiatives have failed in every state. With the recent successful model that was just used to defeat a single payer ballot initiative in Colorado by nearly 80%, CAHU is fully prepared to engage in all related efforts, should this initiative qualify for next year’s ballots in California,” commented Stephanie Berger, CAHU President.

“A large number of items need to fall into place for this to even have a chance,” commented Jim Morrison.  “The Federal Government would have to cooperate, several statutes would need to be amended, and a number of new taxes put into place.  This faces some significant hurdles to even come close to being implemented.  That being said, we must continue to educate and work with our legislators to improve the current system.”

How do we educate the public?  Any way and anywhere we can, from Chamber of Commerce meetings to churches, from school functions to social media… We need to remind them that our healthcare system is NOT broken.  It could use some improvements, and we know how to do that.  We don’t have to trash the entire system and replace it with single payer.  There are better options, within our control and within our industry, that can solve the problems.

“I think the best path is to continue to be a valued resource for your clients,” stated Jim Morrison.  “Support CAHU to improve the system, and use the tools CAHU has prepared to do so to educate the public.”

Remind them that research has been done, and research shows that our healthcare system is still great, according to California residents.  “In statewide polling commissioned by CAHU, results overwhelmingly confirm that Californians are happy with their current health care provided in a public private partnership,” commented Faith Lane, Legislative Advocate for CAHU. “Additionally, even among those who support single payer, 75% become less likely to support it knowing the cost to Californians in new taxes. We are standing on the higher ground should proponents choose to take single payer to the polls next November.”

So, where do we go from here, and how do CAHU members, non-member agents and other industry representatives help in this fight? First, join CAHU if you haven’t already. Check the website for resources to communicate the latest info and key messaging. The CAHU website is  updated frequently.   CAHU has, and will continue, to provide timely communication on updates, resources such as one page talking points and opportunities to engage members.  But you need to be a member, and you need to be involved in this fight, because if you aren’t, we could fail, and we simply can’t afford that.

Author’s Note:  I’d like to thank the Board of the California Association of Health Underwriters and California Advocates  for their assistance with this article, background information and comments.  I’d like to thank individually Stephanie Berger, President, Faith Lane, Legislative Advocate, Jim Morrison, VP Legislation, and David Fear, Jr., President-Elect. Without your assistance, this article could not have been written.

Editor’s Note:  The opinions in this article are those of the author and those of the contributing experts.  They are not necessarily the opinions of the Orange County Association of Health Underwriters, the California Association of Health Underwriters, or the National Association of Health Underwriters.     ##

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