THE STATE Senate at the start of June passed legislation that would create a single-payer health insurance system in California.

The measure, which was sparse on details, was written as a replacement for the Affordable Care Act should it be repealed by Congress and President Trump. However, after it reached the lower house, Assembly Speaker Anthony Rendon pulled the bill from consideration.

Dubbed the Healthy California Act, it would have provided universal health coverage for every Californian under a single-payer system operated by the state government and funded in large part by taxes on state residents.

But Rendon said the measure was “woefully incomplete,” and added: “Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not 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 SB 562 a genuine piece of legislation.”

He said it would sit moribund in the Assembly Rules Committee and urged the Senate to revisit the legislation for next year and flesh out the details. This is what could carry over into the legislation if it’s brought up in 2018 again:

  • No cost-sharing requirements, deductibles or premiums.
  • Paid for by increased taxes.
  • The program would create an independent public agency to run it.
  • Coverage would be available to all California residents, regardless of immigration status.
  • It would bar health insurance companies from selling plans or offering benefits that would be covered by the program.

The system would cover “all medical care determined to be medically necessary by the member’s health care provider.” The HCA would guarantee coverage of the Essential Health Benefits mandated by the ACA, which include:

– Ambulatory (outpatient) patient services

– Emergency services

– Hospitalization

– Pregnancy, maternity and newborn care

– Mental health and substance abuse disorders, including behavioral health treatment

– Prescription drugs

– Rehabilitative and habilitative services and devices

– Laboratory services

– Preventative and wellness services

– Chronic disease management

– Pediatric services (including dental and vision care)

It would also cover:

– Diagnostic imaging and other diagnostic and evaluative services

– Medical equipment, appliances, and assistive technology including prosthetics, eyeglasses, hearing aids and their repair, technical support, and customization needed for individual use

– Necessary transportation for health care services for persons with disabilities or who may qualify as low income

– Hospice care

– Care in a skilled nursing facility

– Home health care, including health care provided in an assisted living facility

– Adult and child dental and vision care

– Podiatric care

– Chiropractic care

– Acupuncture

– Certain complementary and integrative therapies

– Adult day care

– Ancillary health care or social services previously covered by county-integrated health and human services programs or by a regional center for persons with developmental disabilities

– Case management and care coordination

The bill still faces in an uphill climb, as much of the meat of the legislation would have to be added in the Assembly.

The California Nurses Association commissioned the University of Massachusetts Amherst to study the bill and they estimated that it would cost $331 billion to pay for the plan.

The nurses say the Legislature can count on $225 billion in existing federal and state funding used for health coverage for low-income Californians, as well as other tax subsides, to help pay the tab.

The study suggests lawmakers also create two new taxes in the state: a 2.3% gross tax on businesses with revenue above $2 million, and a 2.3% general sales tax on everything except housing, utilities, groceries and other necessities.