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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

The legalization of cannabis for medicinal and now recreational use is crashing across the country like a bong-water tsunami. That means herb is in the news lately—a lot.

Here in California, some of that news is not good.

Assembly Bill 243—part of the Medical Marijuana Regulation and Safety Act (MMRSA), which was signed by Gov. Jerry Brown in October—is causing many cities to clamp down on cannabis businesses. While the bill contains a lot of good, it has a problem: The MMRSA requires local governments to develop regulations for the cultivation and delivery of medical cannabis by March 1. Otherwise, the authority is relinquished to the state. Not wanting to give up that authority, dozens of cities around the state have been enacting all-out bans, denying their patients convenient access to prescribed medications.

This is unfortunate, especially since the provision was never meant to be included in the final legislation.

“It was never our intention to place such a short timeline on local lawmakers,” said Democratic Assemblyman Jim Wood, one of the bill’s proponents, in a news release. “The current deadline gives jurisdictions just 65 more days to consult stakeholders, learn about the industry, and write good policy; that is not nearly enough time.”

Wood is now one of the sponsors of Assembly Bill 21, which is currently in committee but is expected to pass and be signed into law without issue. AB 21 strikes the March 1 deadline, allowing local jurisdictions to regulate and enact their own laws at their own pace. “We have widespread support for this fix, including bi-partisan support from both houses, stakeholders and the governor’s office. I am hoping that AB 21 will be on the governor’s desk before the end of the month, and local lawmakers will give this complicated issue the time it deserves,” said Wood.

Despite the impending fix, the League of California Cities is recommending mass hysteria. Because, you know, caution.

“In an abundance of caution, we have been advising our member cities to enact cultivation ordinances—in this case, a ban—to make sure they preserve their regulatory authority whether the cleanup bill goes through or not,” said Tim Cromartie, the legislative representative for the League of California Cities, to the Los Angeles Times. “A ban is the quickest and cleanest way.”

Great.

So how has that affected the Coachella Valley? While some of our valley cities have been working toward their own marijuana regulations diligently for years, others believed the hype and have reacted with fear and rejection.

Palm Springs, being one of the more progressive areas in the valley, has historically been at the forefront of the cannabis movement. The city recently approved a sixth dispensary permit, and council members have said they’d be open to increasing this number in the future as public need and opinion dictate. Recent City Council meetings have also included the discussion of permitting for commercial grows, edible production and extract production. The council members made it clear they want to be prepared to reap the financial rewards of legalization of recreational use statewide—which most people believe is inevitable, perhaps as soon as this year’s election.

Cathedral City is following the example set by Palm Springs, and has issued several permits in recent months. Indicative of the hurdles involved with this emerging industry, the first dispensary in Cathedral City opened its doors in October, more than a year after the council approved the permit allowing them to operate in the city.

If Palm Springs is the tortoise in this race—carefully planning next steps and moving along at an organic pace—cash-strapped Desert Hot Springs is surely the hare: DHS wants to be a mecca of marijuana production and cultivation. It is the first city in the state to approve massive industrial-grow operations, including a recently approved 380,000-square-foot facility that will generate an estimated $3.8 million in annual tax revenues for the city. Grows of this magnitude are expected to be a rarity in the wake of AB 243’s canopy limit of 10,000 square feet for most facilities.

While Palm Springs, Cathedral City and Desert Hot Springs are working in anticipation of recreational legalization and the revenue streams that will represent, Rancho Mirage has dug its heels in like a child being dragged to the dentist. However, the city’s resistance to the green rush predates the panic caused by AB 243. The city even has a program to reimburse cannabis patients $25 per month for transportation to buy their cannabis elsewhere. It bears noting that no one has taken them up on the offer since the program’s inception. It’s doubtful any cannabis businesses of any kind will be operating in Rancho Mirage anytime soon, regardless of any state legislation.

In January, Palm Desert looked like it would pass an all-out ban on cannabis cultivation and distribution. Then, after hearing from several residents at the Jan. 14 meeting, the council changed the language to allow delivery services to operate in the city. This is great news for Palm Desert cannabis patients who are unable to travel easily.

Indian Wells doubled down on its rejection of cannabis in January, adding delivery and cultivation to its existing ban on dispensaries in the city.

La Quinta has a similar ban in place, but formed an ad hoc committee in December to examine allowing delivery services to operate in the city.

Indio has had a ban on dispensaries in place since 2007, and recently expanded that ban to cultivation. Because, you know, Indio has a reputation to uphold. The City Council is, however, considering regulations for delivery services to operate there.

Coachella recently broke from its long-time ban on all marijuana businesses by approving cultivation in areas of the city that are zoned for auto-wrecking. The approval is seen as a fairly cynical way for the city to reap the tax benefits of the cash crop, and nothing more, because the ban on delivery and storefront dispensaries remains.

AB 243 was meant to stabilize the cannabis industry in California, yet it ended up severely handicapping the cannabis movement with its errant March 1 deadline. Hopefully cities will be as willing to enact meaningful, well-planned regulation once the threat of that deadline has been removed by AB 21.

Published in Cannabis in the CV