Single-payer health care advocate
A representative of Health Care for All, a group that supports a single-payer coverage system, talks to people attending a recent California Democratic Party convention in Sacramento. Photo by Laurel Rosenhall for CALmatters

By Dan Walters | CALmatters Columnist

When the Legislature reconvenes and the campaigns for governor heat up next year, Californians will be hearing a lot — and a lot of hot air — about universal health care.

Making California the first state to guarantee health care for every resident has become a touchstone issue — and a divisive one — for the state’s dominant Democrats.

The state Assembly will take up — or possibly ignore — a universal health care bill that the Senate passed this year.

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Assembly Speaker Anthony Rendon applied brakes to Senate Bill 562 in June, saying it “was sent to the Assembly woefully incomplete and has “potentially fatal flaws…including the fact it does not address many serious issues, such as financing, delivery of care (and) cost controls.”

That stance generated a torrent of personal invective from the measure’s advocates in the Democratic Party’s left — or Berniecrat — wing, driven by the California Nurses Association.

There’s a similar divide among the Democratic candidates for governor, with Lt. Gov. Gavin Newsom the most insistent advocate of expanding coverage.

Like Rendon, Newsom’s chief rivals, former Los Angeles Mayor Antonio Villaraigosa and Treasurer John Chiang, endorse universal health care in principle, but are leery about how it would be financed.

Dan Walters
Dan Walters

A Senate Appropriations Committee analysis pegs costs of universal coverage at $400 billion a year, but suggests that half could be covered by redirection of existing federal, state and local government health care spending.

It added that “about $200 billion in additional taxes would be needed to pay for the remainder,” but also noted that half or more of that burden could be offset by eliminating direct health care costs now borne by consumers and their employers.

To put that in perspective, even $100 billion in new taxes would be the equivalent of a one-third increase in the $300 billion a year now levied by state and local governments.

In theory — one advanced by advocates — the two-thirds “supermajorities” in the Legislature and the governor could levy new taxes of that magnitude.

In practice, however, even if the supermajorities survive the recent spate of sexual harassment resignations and next year’s elections, there’s virtually no chance of such a vote.

Rendon knows that passing universal health care without a system of paying for it would invite scorn from the media and the public, but passing it with immense new taxes would put some of his Democratic members in political jeopardy.

If, however, Democrats are serious about having universal health care insurance there’s another, perhaps easier, way to do it.

A new report from the federal government’s Centers for Disease Control says that with the advent of Obamacare, which expands the Medi-Cal program serving the poor and offers subsidies for others, California’s medically uninsured population has dropped from 17 percent in 2013 to 6.8 percent in 2017.

That means that there are about 2.7 million Californians still lacking some form of medical coverage, although many, if not most, receive rudimentary, albeit uncompensated, care in charity clinics and hospital emergency rooms.

As many as half of them would be eligible for government paid or subsidized care, and covering them is potentially doable under existing programs, according to Covered California, the state’s Obamacare implementation agency.

The remainder, mostly, are maybe a million-plus undocumented immigrant adults who are, by law, ineligible.

It’s not necessary for the state to seize control of California’s entire medical care system if the real bottom line goal is covering those undocumented immigrants. It could be done for about $10 billion a year, which is a lot less than $100 billion.

However, advocates would have to publicly acknowledge that covering them is what this conflict is all about and take whatever political heat it generates.

It’s a test of whether universal coverage is a real goal, or merely political symbolism.

CALmatters is a public interest journalism venture committed to explaining how California’s state Capitol works and why it matters. For more stories by Dan Walters, go to