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Last updateWed, 27 Sep 2017 1pm

By many measures, the rambunctious campaign for a single-payer health-care system in California appears to be struggling.

A bill that would replace the existing health-care system with a new one run by a single payer—specifically, the state government—paid for with taxpayer money remains parked in the Assembly, with no sign of moving ahead. An effort by activists to recall Assembly Speaker Anthony Rendon for shelving the bill has gone dormant. And an initiative that would lay the financial groundwork for a future single-payer system has little funding, undercutting its chances to qualify for the ballot. 

But even if single-payer is a lost cause in the short term, advocates are playing a long game. For now, it may well be less a realistic policy blueprint than an organizing tool.

And by that metric, advocates are making gains.

Riding a wave of enthusiasm from progressive Democrats, supporters of single-payer have effectively made it a front-and-center issue in California’s 2018 elections. It’s been discussed in virtually every forum with the candidates running for governor, emerged as a point of contention in some legislative races, and will likely be a rallying cry at the upcoming California Democratic Party convention.

“This issue is not going away,” said Garry South, a Democratic political consultant who has worked with the California Nurses Association, which sponsored the stalled single-payer bill. “The progressive elements who are supportive of the single-payer concept know that it’s not going to happen now; it’s not going to happen tomorrow. It’s a long-term process, and Jerry Brown is gone as of January 2019.”

The governor has not needed to stake a position on the bill, because it skidded to a stop in the Assembly last summer without reaching his desk. But state Sen. Toni Atkins, a San Diego Democrat who co-authored Senate Bill 562, said Brown was not receptive. Analyses peg the cost of a statewide single-payer system at between $330 billion and $400 billion—far exceeding the state’s entire budget. That made it an anathema to Brown’s record of prioritizing fiscal stability for state government.

“When the governor saw that we introduced that bill… all he could look at me and do is shake his head and say, ‘$400 billion dollars.’ And I kept trying to say, ‘Can we back up and talk about what you've got to do to get (there)?’" Atkins said in an interview.

“He wasn’t letting it go.”

Atkins, who will take over as Senate leader next month, said she’s not giving up on the goal of single-payer, but does not expect it to happen this year. “People are polarized on this issue in a way that’s not good for coming together to get it done,” she said.

Led by the nurses association—a labor union that embraces firebrand activism—supporters of single-payer have targeted Rendon after he shelved the bill last summer, saying it lacked critical information on how to pay for a massive overhaul of the healthcare system. They peppered social media with images that not only portrayed the bill fight as a boxing match between Rendon and the nurses, but also depicted a knife labeled “Rendon” back-stabbing the bear symbol of California.

The nurses were not involved in the campaign to recall Rendon, said recall organizer Stephen Elzie, who has since dropped the effort and is now helping Democrat Maria Estrada challenge Rendon’s re-election bid. But the nurses union leapt into the governor’s race as one of the first labor unions to endorse Lt. Gov. Gavin Newsom. Single-payer has emerged as one of few issues on which the Democratic candidates disagree.

Newsom and Delaine Eastin, the former state superintendent of schools, have both said they support the nurses’ single-payer bill. Fellow Democrats Antonio Villaraigosa, former mayor of Los Angeles, and John Chiang, the state treasurer, say they want to expand health care so that everyone is covered, but not necessarily with the single-payer model that would abolish private health insurers and replace them with a government-run system.

A coalition of medical groups is lobbying against the single-payer bill, arguing that it makes more sense to protect and expand the federal Affordable Care Act, which has increased the number of Californians who have health insurance. Some members of the coalition have a history of spending big money to sway California elections. One of them, the doctors’ association, donated to Newsom before he voiced support for single-payer; it’s not yet clear if they will shift support to another candidate. 

Almost two-thirds of Californians like the idea of a statewide single-payer health-care system, although enthusiasm drops significantly if it would require raising taxes, according to polling last year by the Public Policy Institute of California. Still, Californians didn’t cite health care as a top priority when asked last month what the Legislature and governor should focus on in 2018.

The Assembly just wrapped up a series of hearings on what it would take to create a health-care system that covers all Californians. It exposed many obstacles—in both federal and state law—to swiftly enacting single-payer. For one, the state would need permission from the federal government—and perhaps an act of Congress—to shift billions of dollars from Medi-Cal and Medicare into a state-run single-payer plan. For another, if lawmakers raised taxes to fund single-payer, voters would likely need to approve changes to the California Constitution to allow the money to go to health care instead of schools. (That’s the only single-payer initiative that someone is trying to get qualified for the ballot; while a Silicon Valley tech consultant is gathering signatures for it, he doesn’t have support from the nurses’ union or any other well-financed group.)

Assemblyman Jim Wood, a Healdsburg Democrat who chaired the panel, called the single-payer bill “aspirational” and said he’s instead considering legislation that could help more Californians get health care without requiring permission from the federal government. One idea: extending subsidized health plans to adults who are undocumented immigrants.

“I believe we can actually get to single-payer, once we go through a lot of study and a lot of work,” Wood said. “But this feels, at times, more like a litmus test.”

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Politics

You’ve heard the term, “All politics is local”? California Republicans had better hope so.

The pre-vote polls told us that this week’s gubernatorial matchup in Virginia would be a nailbiter. Instead, it was an electoral thrashing. Voters handed the governor’s mansion to Democrat Ralph Northam with a decisive 9 point margin while stripping the state GOP of its firm grip on the legislature’s lower chamber, reducing a supermajority to a virtual tie.

By all accounts, this blue wave—which also swept up statehouse races in New Jersey and New Hampshire, municipal contests in Pennsylvania, a special election in Washington state, and a Medicaid expansion vote in Maine—was as much a referendum on what’s happening in Washington, D.C., as it was a rebuke of local lawmakers. Or as Republican political consultant Mike Murphy told the Washington Post, Virginia was a test of whether the GOP’s electoral fates are tied to the president’s approval numbers. “The canary in the coal mine didn’t just pass out,” he said. “Its head exploded.”

Though political analysts are still analyzing the numbers, it sure looks that way. Virginia saw its highest increase in voter turnout in two decades, with the bulk of the bump coming from Clinton-winning districts in the suburbs. Young voters and voters with college educations flocked to the Democratic side. According to exit polls, a third of all voters said they cast their ballot in part to “express opposition to Donald Trump.”

“There may have been some local issues involved, but the main driver of what happened was the energy among base Democratic constituents who finally woke up,” said Mike Madrid, a Republican political consultant who advises the campaign of Democratic gubernatorial candidate Antonio Villaraigosa.

California Democrats are hoping for a similar awakening in the elections of 2018. On the line: their lock on power in Sacramento, where the party holds a commanding two-thirds supermajority of legislative seats, along with all statewide constitutional offices. At the same time, the GOP’s control of the House of Representatives in Washington, D.C., could also be decided here. Of the 14 California districts that last sent Republicans to Congress, seven voted for Hillary Clinton over Donald Trump.

Hours before Tuesday’s election returns rolled in, GOP Rep. Darrell Issa of Vista became the first of those 14 to withdraw support for the current House GOP tax plan, saying it would strip away tax deductions disproportionately used by Californians. Democrats had identified Issa as a top target for 2018.

So how nervous should California Republican candidates be? Very, said Jason Cabel Roe, a Republican political consultant in San Diego.

“They’ve got to assert their willingness to step up to the president when they feel he’s wrong,” he said, but do so without alienating the party’s base. Though only 27 percent of California likely voters approve of the president, 7 in 10 Republicans still stand by their elected man.

“A majority of Republican voters don’t seem to really care about winning as much as they care about voting for someone who they believe will be a shot to the system,” Roe said.

Indeed, some Trump loyalists are arguing the election results merely prove that Republican candidates fell short because they failed to embrace President Trump even more enthusiastically.

While many other Republicans are wringing their hands, Democrats are imagining 2010 in reverse: Recall the historic shellacking the party took that year when conservatives—driven by Tea Party fervor, equal parts anti-Obamacare and anti-Obama—turned statehouses red across the country and flipped the House.

“Trump is clearly the giant orange blob blotting out the sun for Republicans,” said Dan Newman, a political consultant and spokesperson for Lt. Gov. Gavin Newsom, the early Democratic frontrunner to be governor. “He's depressing moderate Republicans, alienating swing voters, and motivating Democrats—who are fired up like they haven't been in years.”

That’s the inversion California Democrats hope for heading into the 2018 midterms: depressed Republican numbers (as the base fails to turn out and moderates cross over to vote blue) and jacked-up Democratic turnout among so-called “low propensity” voters—non-white and younger voters who typically lean Democratic but who are usually less likely to turnout during off-year elections.

In the small number of elections we’ve seen in California this year—a special Congressional election, an assembly primary matchup, a handful of municipal races like the one in Palm Springs—we have haven’t seen that kind of turnout.

This week, in Virginia and elsewhere across the country, those stars finally seem to have aligned. But then again, 2018 is still a year away. And California is not Virginia.

According to Paul Mitchell, vice president of Political Data, Inc., the Golden State has been shielded in the recent past from the political waves that buffet the rest of the country.

As statehouses went red en masse in 2010, for example, Democrats in California actually picked up a legislative seat. “There some evidence to suggest that the waves stop at Reno,” he said.

Plus, the Democratic party’s current political dominance could serve to buffer the effect of an anti-Trump wave. Typically, the voters most animated during midterm elections are those hoping to rebuke the party in power. This week, voters in Virginia, New Jersey and Maine found ready targets for their frustration with the status quo among the Republicans occupying their statehouses and governor’s mansions. But in California, powerful Republicans are hard to come by.

And then there’s the simple fact of geographical distance: While national politics may weigh heavily on the mind of a D.C. suburbanite, said Mitchell, national politics might seem more abstract to a California voter, whereas the quality of local education, the housing crunch or the price of gas might feel more pressing.

California Republicans are certainly banking on that anyway—although the list of Republicans who didn’t respond to requests for comment on this story includes Republican National Committee member Harmeet Dhillon, Assembly Minority Leader Brian Dahle, and Assemblyman/gubernatorial candidate Travis Allen.

“In a low-turnout midterm election, at least some California Republican incumbents will find other issues to help them achieve re-election. Those who do survive, however, will do so in spite of their party’s leaders,” wrote Dan Schnur, a former GOP consultant who was a key aide to the state’s last Republican governor, and now a professor at the University of Southern California.

As far as Schnur is concerned, national Republicans have sized up California’s changing ideology and demographics and concluded “it’s not even worth fighting to retain a foothold in the nation’s largest state.”

So on the campaign trail, state Democrats will do everything in their power to remind voters that every last Republican dog catcher shares a party label with a wildly unpopular president.

“Here in California, the reason they want to talk about Donald Trump is because they don’t want to talk about the record they’ve created here,” Jim Brulte, the state GOP chairman told a gathering of Republicans at the party’s convention last month. After rattling off a list of economic and social ills facing the state (presumably all the fault of the party in power), he then tried out a phrase that is sure to resurface in campaign ads and talking points in the months to come: “They broke it; they own it.”

With that, the California Republicans have crafted themselves a midterm strategy. Keep it local. Talk about the gas tax. Talk about the state’s first-in-the-nation poverty rate. Donald Trump’s latest Twitter spat with Kim Jong Un? No, I’m afraid I haven’t seen that.

Or as Brulte put it while speaking at the Sacramento Press Club last week: “I don’t get the vapors over what’s going on in Washington D.C.”

Nor, presumably, in Virginia, New Jersey, or Maine.

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in Politics