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

Published in Politics

California’s Democratic legislators want to extend health benefits to undocumented young adults, the continuation of an effort that ushered children without legal status into the state’s publicly funded health care system last year.

It is unclear when the program would start or how much the state would spend if the proposal, which could cost up to $85 million a year, is approved by Gov. Jerry Brown. Lawmakers are working out details ahead of their June 15 deadline for passing a new budget.

The plan would provide full-scope coverage for 19-to-26-year-olds who qualify for Medi-Cal, the state’s name for Medicaid. Currently, the federally funded program covers only emergency visits and prenatal care for undocumented residents. Under the proposal, revenue from taxes on tobacco products would absorb expenses for all other coverage.

Democratic Sen. Ricardo Lara of Bell Gardens has been one of the strongest voices for expanded care. In 2015, he pushed for coverage for all adults. That proposal was changed to admit only undocumented children; it took effect last year. This year, he said in a recent video message to supporters, “We are going to make the final push to ensure we capture our young adults.”

Supporters’ ultimate goal is to include all undocumented adults, said Anthony Wright, executive director of Health Access California, a health care consumer group backing the proposal.

“We believe without coverage, people are sicker, die younger and are one emergency away from financial ruin. It has consequences for their families and their communities—both health and financial consequences,” he said.

The plan would mean that undocumented children currently in the program would not age out at 19, putting low-income undocumented immigrants on par with those allowed to stay on their parents’ insurance under the Affordable Care Act (often called Obamacare) until they are 26.

Republican Sen. John Moorlach of Costa Mesa opposes an extension of benefits. One reason is financial: California doesn’t have “a balance sheet we can brag about,” he said, citing the state’s debt load, among other reasons.

Secondly, he disapproves of illegal immigration. Moorlach migrated to the U.S. legally as a child with his family from the Netherlands.

“I’m kind of offended that we feel an obligation to pay for expenses for those who did not come through the front door,” he said. “I certainly have compassion and want to help people in need, but I’m having difficulty, as a legal immigrant, because we are already in such bad fiscal shape.”

Advocates argue that undocumented immigrants help propel California’s economy with their labor and the taxes they pay, and that they cost the state money when they don’t work because of illness or when they end up in the emergency room.

“Health care is a right,” said Ronald Coleman, director of government affairs for the California Immigrant Policy Center, an advocacy organization and supporter of the proposal. “These are folks we are investing in through the California Dream Act and through other programs our state offers, and it makes sense to invest in our future, which our young adults will be.”

Estimates vary for how many people this expansion of Medi-Cal would serve and what the costs would be. Each house of the Legislature has passed its own version of the proposal, with differing figures attached.

The Assembly allocated $54 million a year to cover an unspecified number of additional enrollees, with a July 2017 start date. The Senate proposed $63.1 million in the first year, beginning in 2018, and $85 million annually thereafter, also without specific population numbers.

Coleman’s center, which is working closely with lawmakers on the issue, estimates about 80,000 new people would be eligible, and the cost would be around $54 million a year. That assumes the federal Deferred Action for Childhood Arrivals program continues, because it provides access to Medi-Cal. If DACA were eliminated, the figures would increase to about 100,000 eligible people and about $84 million in annual costs, Coleman said.

The governor’s proposed budget does not include the proposed expansion or any money for it.

Kevin, a 19-year-old Angeleno who asked that only his first name be used, because he lives in California illegally, wants the proposal to succeed. He has been working for more than a year to distribute information about Medi-Cal children’s coverage to immigrant families.

He meets all but one of the requirements for DACA: He was not in the country before June 15, 2007. He arrived in the U.S. in 2011 at age 14 from Guatemala, on a visa that later expired. He graduated high school, has no criminal record and is now majoring in business administration at California State University, Los Angeles.

“There’s this misunderstanding that young people are healthy,” said Kevin, who suffers from eczema. He worries about the chronic condition flaring up. “When it gets worse, it doesn’t let me do anything with my hands.”

He is enrolled in a county health insurance program for low-income residents, but he can’t afford a dermatologist. He can barely pay for the prescription lotion he uses for the eczema, and sometimes goes without it.

“We are trying to have a better economic standard, and we are like the building blocks of this society,” he said. “Having health insurance will allow us to focus more on school and do our regular day-to-day activities. A healthier society works better for everyone.”

If lawmakers can now agree on details, a consensus proposal will go to the full Legislature for approval. The deadline for that is June 12. is a nonprofit journalism venture dedicated to exploring state policies and politics.

Published in Local Issues

With a small brown paper bag in her hand, Julie walked out of a Planned Parenthood clinic in Roseville with a new supply of birth control. It didn’t matter that she didn’t have health insurance.

“It’s awesome to have Planned Parenthood,” said Julie, who did not wish to give her last name. “To go to a regular health clinic like this would have cost $100, which would make you think twice about having to go.”

It’s the kind of clinic that President Donald Trump and conservative Republicans in Congress hope to cut off from receiving any federal funds. The federal government already prohibits any federal dollars from paying for abortions, except in cases of rape, incest or to save the mother’s life. But this effort seeks to block federal funds from paying for any other kind of health care by providers who also perform abortions.

If the effort succeeds, the impact would be particularly strong in California—a state where legislators over the years have interpreted federal laws and rules in ways that have allowed more federal dollars to flow to Planned Parenthood clinics. Roughly half of the federal funding that Planned Parenthood receives nationwide currently goes, mostly via Medicaid reimbursements, to cover health care and family planning services for Californians, mostly in the lower-income brackets.

Ironically, Planned Parenthood officials say if they were to lose all their federal funding, their California abortion clinics would remain open; those already are funded by private sources and by state reimbursements for poorer patients. Instead, what would be at risk are all the nonsurgical sites that provide other medical and contraception services.

The state’s progressive state policies, put in place 30 years ago under Republican Gov. Pete Wilson, created a friendly environment for Planned Parenthood to expand and offer family-planning services to low-income men and women above the federal poverty level. That’s in stark contrast to states such as Texas and Mississippi, which unsuccessfully sought to ban their state Medicaid healthcare programs for the poor from channeling any money to health care providers that perform abortions.

As a result, Planned Parenthood today is one of California’s major health care providers, operating 115 clinics that serve 850,000 mostly low-income patients a year who rely on Medicaid (in California, Medi-Cal) for health care. That’s nearly a third of the 2.5 million patients who visit Planned Parenthood clinics nationwide for basic health-care and family-planning services.

“Planned Parenthood is a major safety-net provider at a time of increased health care demand,” said Sara Rosenbaum, a professor of health law and policy at George Washington University. “In a state like California, with more Planned Parenthoods, the reliance would be that much greater.”

The Republican-controlled Congress, bolstered by President Trump’s election, is eyeing several strategies to stop the flow of federal funding to Planned Parenthood. That money—roughly $500 million a year nationwide, through Medicaid reimbursements, Title X family planning money and grants—pays for services such as cancer screenings, breast exams, birth control, prenatal care and the treatment of sexually transmitted diseases.

Although Trump has frequently acknowledged that Planned Parenthood helps millions of women, he also has said he would support congressional efforts to ban funding.

“I would defund it because of the abortion factor,” he said at a February 2016 GOP presidential debate. “I would defund it, because I’m pro-life.”

A draft House GOP bill obtained by Politico would eliminate all federal funding to Planned Parenthood as part of a repeal of the Affordable Care Act. While that provision is likely to clear the House, its fate is uncertain in the Senate, where several moderate Republicans could side with pro-choice Democrats.

If the effort were to prevail, California Planned Parenthood would lose $260 million a year in federal funds—approximately 80 percent of its operating budget. Unless it found a way to replenish that money, the organization warns that it could have to close its 82 California sites that furnish basic health care and family-planning services to mostly low-income patients.

Meanwhile, its remaining 33 surgical abortion sites—which don’t get federal funding—would remain open, said Kathy Kneer, president and CEO of California Planned Parenthood.

“The irony here is that they are going to put in place more barriers for women to gain contraception, and that will lead to more abortions—and by the way, all the abortion sites will stay open,” Kneer said.

The House recently voted to reverse an Obama administration regulation that requires states and local governments to distribute family-planning funds to health centers, even if they perform abortions. President Barack Obama issued the rule in his final days in office after more than a dozen conservative states directed those funds only to community health-care centers.

Such an 11th-hour move by an outgoing president, Republicans argued during the floor debate, was an affront to states’ rights.

“I know that vulnerable women seeking true comprehensive care deserve better than abortion-centric facilities like Planned Parenthood,” said Rep. Diane Black, R-Tenn.

The resolution is now awaiting a vote in the Senate, where California Democratic Sen. Dianne Feinstein is working to defeat it. It would have no effect on California, given that it is not among the states that have tried to limit those Title X dollars. Nonetheless, she noted that Planned Parenthood provides the only Title X family planning services in 13 California counties, and that any effort to strip federal funding would take a toll in other states and leave “huge numbers of women across the country (with) no place to go for essential health services.”

Trump on the campaign trail vowed to defund Planned Parenthood, and then he appointed Health and Human Services Secretary Tom Price, a former Republican congressman from Georgia who has supported cutting off taxpayer money to Planned Parenthood. Both men have suggested the federal government could reallocate taxpayer dollars to community health centers. But many experts and health care advocates say those health centers cannot absorb the significant number of patients who now rely on Planned Parenthood.

That concern was echoed in January when the Democratic-controlled California Legislature approved resolutions opposing any congressional efforts to defund Planned Parenthood. They did so after Planned Parenthood President Cecile Richards met with Democratic senators at their annual policy retreat in Sacramento.

Assembly Speaker Anthony Rendon, D-Lakewood, proclaimed: “California stands with Planned Parenthood, because Planned Parenthood stands with California.”

But his sentiment was not unanimous. Several Republicans spoke out against the resolutions, with state Sen. Mike Morrell, R-Rancho Cucamonga, saying he could not support an organization that provides abortions. 

“I have no war against women,” he said. “But I also do not have a war against babies created in the image of God.”

With a Democrat-controlled state Legislature, California Planned Parenthood is hopeful it could ask lawmakers to backfill any federal shortfall. However, Medicaid funding is already strapped in the state, where a record one in three Californians are receiving Medi-Cal benefits. Given the potential for other federal cuts in health funding, it’s unclear whether the state would be able to make up the difference.

Meanwhile, Planned Parenthood is drafting contingency plans.

“We are looking at scenario planning. These are all very difficult decisions,” Kneer said. “Closing any location is the last thing we want to do.”

One option is to more aggressively raise funds, but Kneer said private donations can’t possibly make up what they would lose. She also raised the question of whether private funds should be required to pay for a government reimbursement that other organizations receive.

Even if President Trump receives and signs legislation to strip Planned Parenthood of all its federal funding, Planned Parenthood could still challenge in court whether such a restriction is constitutional.

In the last few years, federal courts across the country have denied other states’ efforts to block Planned Parenthood as an eligible provider of taxpayer-funded health, ruling that such moves violated the First Amendment right of free speech and free association to choose a medical provider, and the right of a clinic to provide abortion services under the equal protection clause of the Fourteenth Amendment, said Julie Cantor, an adjunct professor at UCLA who teaches a law class on reproductive medical ethics.

“The government’s behavior has to comport with the Constitution,” Cantor said.

Samantha Young is a contributor to, a nonprofit, nonpartisan media venture explaining California policies and politics.

Published in National/International

As with a lot of other families living in the eastern Coachella Valley, when one of our family members fell sick, it meant driving about 100 miles across the border into Mexico, to the city of Mexicali, to get taken care of by a doctor.

The only other option, it seemed, was not being taken care of at all.

Now, because of health-care reform efforts in the United States, young people growing up today in the eastern Coachella Valley—the unincorporated rural communities of southern Riverside County—don’t need to go without health insurance the way I did. The scenario is finally beginning to change. At least it can change—if people here are made aware of the health services now available to them through federal health-care reform, right in their own community.

“We owe it to our country to inform the citizens to take advantage of all these resources that are available,” said Ronnie Cho, associate director of public engagement for the White House, during a speech about health care reform that I attended in Washington, D.C., as a reporter in April.

Cho is right. For the Affordable Care Act (ACA) to make a difference, people need to first be aware that health care is an option for them. People need to know that they can afford to visit a doctor, without having to stray more than a few miles away from their home.

When my family would go visit relatives across the border in Mexicali, we always took advantage of the opportunity to stop by the Mexican pharmacy to buy medicine for ourselves, as well as for our friends and neighbors who always requested some. As a child, I thought those trips to Mexicali to visit the doctor were the only way—it was just what people did—until later on in my youth, when my father got a job with a new trucking business that gave him medical benefits that included family coverage. Because my dad worked for a lot of different trucking companies during the years, and because there were lengths of time when he was unemployed, our health-care situation was never stable. for those few years, my family and I received the best health care we’d ever had.

“Young people are relatively healthy, so they think, ‘I don’t need health care,’ until something happens, and they actually need it,” said Cho.

Again, Cho got it right. I can remember my worried mother, back in 2008, telling my little sister and me that we once again did not have health insurance and would have to resume our trips to Mexicali.

In retrospect, I never minded the long trips to the doctor or dentist’s office. In fact, I never worried about my health. My parents always had medicine from Mexicali available in our cabinets for emergencies. For my siblings and me, it was not something that got in the way; it was something that we believed had to be done, because there was no cheaper option.

The irony is that even though being uninsured felt normal to me and my siblings growing up, it is families like ours who need that insurance the most. Families like mine who live in the unincorporated communities of the eastern Coachella Valley—most of us are Latino; many (like my parents) are immigrants; and many make a living as farm workers or do some other type of physical labor—are especially in need of the protections provided by health insurance, because of occupational hazards and other health risks associated with living in an area where people lack money and resources.

The Affordable Care Act, the bulk of which will be implemented on Jan. 1, 2014, is helping families like mine take control of our medical insurance, by providing options and a sense of security. It’s an idea—health-care security—that at one time, at least for my family, seemed impossible to imagine. The health insurance that for so long seemed like such a special privilege will now become available to more people than ever before.

The ACA was put into place in part to make sure insurance companies cannot end your coverage plan when you need it the most, cannot bill you into debt, and cannot discriminate due to pre-existing medical conditions.

Among other provisions, the ACA will secure medical insurance for American citizens after getting laid off or changing jobs. It will require insurance companies to cover the cost of mammograms and cancer screenings. And for the first time, young adults will remain eligible to be covered under their parent’s or guardian’s health-insurance plan through the age of 26, even if they are married.

As a result, 3.1 million young adults are now covered along with their families, and more than 107,000 Americans with pre-existing conditions who didn’t previously have insurance are now receiving health coverage, according to federal data.

If you know where to look, it is free and simple to apply for affordable or no-cost medical insurance programs such as Medicaid and the Childrens’ Health Insurance Program (CHIP), which cover medical services that include doctor check-ups, emergency care, hospital care, vaccinations, prescription drugs, vision, hearing and dental.

There was a time for a lot of us living here in the eastern Coachella Valley when driving across the border seemed like the easiest and most-affordable way to access health care. Fortunately, for many of us, that no longer needs to be the case. Our communities can have the security of health insurance that for so long seemed just beyond our reach, if we just know where to find it.

To see if you qualify for Medicaid or CHIP, or to apply online, visit To find out what is your best insurance option for your specific demographics and needs go to

Alejandra Alarcon is a reporter for Coachella Unincorporated, a youth media startup in the east Coachella Valley, funded by the Building Healthy Communities Initiative of the California Endowment and operated by New America Media in San Francisco. The purpose is to report on issues in the community that can bring about change. “Coachella Unincorporated” refers to the region youth journalists cover, but also to the unincorporated communities of the Eastern Valley with the idea to “incorporate” the East Valley into the mainstream Coachella Valley mindset. For more information, visit

Published in Community Voices