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Young: Revisiting Single Payer

  • State: California

In 2017 there was quite a flap in the California Legislature over a single-payer health care bill. That bill, SB 562, known as “The Healthy California Act,” passed the California Senate in June by an essentially party-line (23-17) vote.

Julius Young

Julius Young

Sponsored by the California Nurses Union, a panoply of labor organizations and liberal activist groups joined forces in support of the bill.

SB 562 did not advance further in 2017, as Assembly Speaker Anthony Rendon refused to move forward on the on the Assembly side. It is unclear what will happen with SB 562 in 2018.

This bill has potential consequences for California workers’ comp, as it would institute universal comprehensive health coverage for all California residents. However, SB 562 was short on specifics as to how it would affect workers’ comp, leaving it to the Healthy California board to sort out the details.

Likewise, SB 562 made many assumptions as to the cost and funding of universal comprehensive coverage.

The issue is not likely to go away, however. Many are concerned that the Affordable Care Act and Covered California are vulnerable under an unsupportive Trump administration. And generally, most political observers see the California Democratic Party as moving further left, with activists continuing to push a single-payer goal.

Many of the 2018 statewide Democratic candidates are publicly supportive of universal coverage single payer even if some of them may be privately wary. Sen. Ricardo Lara, a sponsor of the bill, is a high profile 2018 candidate for California Insurance Commissioner.

So it is interesting to see that the California Workers’ Compensation Institute has now issued a report on single payer and workers’ comp. The March 2018 CWCI study is titled “Revisiting 24-Hour Health Care Coverage and Its Integration With the California Workers’ Compensation System."

The authors, Alex Swedlow and Rena David of CWCI, and consultant Mark Webb, are some of the brightest minds in the workers’ comp arena.

SB 562 could have significant consequences for CWCI’s insurer members.

The study analyzes the history of efforts to create 24-hour care in California and two models, single payer and “pay or play” mandates. In an appendix the study reviews efforts to institute 24-hour care going back to AB 3757, a 1992 24-hour pilot program signed into law under Gov. Pete Wilson. And it notes several studies undertaken for Commission on Health and Safety and Workers' Compensation, including a 2004 Rand study.

As the 2018 CWCI study notes, “the California workers’ compensation system makes up approximately 2% of the overall health care economy”.

Workers’ comp is important, but with such a small share of the overall health care spend, it is not the tail that is going to wag the dog, so to speak. It is apparent that workers’ comp is an afterthought for the drafters of SB 562.

The CWCI study does an excellent job at cataloging the many issues that would arise in meshing workers’ comp with a 24-hour care system. The study does not provide in-depth analysis of potential solutions to these problems, however, so the CWCI study is, in my mind, really a “phase-one” effort.

Offhand, some of the issues in integrating 24-hour coverage with the comp system appear to be solvable with some creativity, while others may be more vexing.

Legislators and policy-makers would do well to read the CWCI study to get a handle on the issues that will need to be addressed, including potential unintended consequences for other state programs.

Julius Young is a claimants' attorney for the Boxer & Gerson law firm in Oakland. This column was reprinted with his permission from his blog, www.workerscompzone.com.

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