California legislators launch new proposal for single-payer healthcare system called CalCare
Assemblyman Ash Kalra, D-San Jose, discusses CalCare, the universal health care bill, during a news conference at the Capitol in Sacramento, Calif., Jan. 6, 2022. El asambleísta Ash Kalra, demócrata de San José, analiza CalCare, el proyecto de ley de atención médica universal, durante una conferencia de prensa en el Capitolio en Sacramento, California, el 6 de enero de 2022 | Rich Pedroncelli / AP

As the California legislature reconvened earlier this month to launch its 2022 session, some 20 California legislators led by Assemblymember Ash Kalra, D-San Jose, launched a new campaign to win comprehensive, universal single-payer healthcare coverage for all Californians.

On Jan. 6, Kalra and Democratic joint- and co-authors introduced Assembly Constitutional Amendment 11, Taxation to Fund Health Care Coverage and Cost Control, which details the funding mechanism for Assembly Bill 1400, the California Guaranteed Health Care for All Act, or CalCare, the comprehensive universal single-payer system Kalra and co-authors first introduced in the 2021 legislative session.

Under CalCare’s provisions, all Californians would have access to comprehensive healthcare coverage, including all primary and preventive care, hospital and outpatient services, prescription drugs, dental, vision, audiology, mental health treatment, long-term care services, and more, and would be free to choose their providers without considering network affiliations. Patients would not pay premiums, deductibles, co-pays, or other out-of-pocket costs.

Passage of AB 1400 would make it possible to seek waivers from the U.S. Department of Health and Human Services to use federal funds to care for residents traditionally covered by federal healthcare programs including Medicare.

CalCare would be an independent public entity, governed by a nine-member executive board with expertise in health care policy and delivery. The new system would work to bring payments to providers more in line with actual costs of care and would negotiate for lower prescription drug prices.

ACA 11 proposes to fund CalCare through an annual excise tax on businesses of 2.3% of gross income above $2 million, payroll taxes of 1.25% on employers with 50 or more employees, and 1% on employees for wages above $49,900/year. Taxpayers with high taxable incomes would pay an additional income tax. As an amendment to the state constitution, the measure would have to pass with a two-thirds supermajority in both houses of the legislature. Following passage, ACA would go before voters in either a June or November statewide election, probably in 2024.

The two measures together give Californians “a clear understanding of what they can expect from a truly publicly financed, single-payer health care system and allows them to decide for themselves if they are better off paying for the most expensive healthcare in the world with the worst outcomes of any wealthy nation, or guaranteed healthcare for all with CalCare while reducing overall healthcare costs,” Kalra said in introducing ACA 11.

“Those that profit off the immoral status quo may not like it,” he added, “but I am confident that the vast majority of working and retired Californians will see the benefit of significant cost savings as we remove debilitating insurance costs, out-of-reach prescription drugs, and arbitrarily high hospital fees.”

Said Assemblymember Alex Lee, D-San Jose, a joint-author of both measures, “Despite being the richest country in the world, the United States is still the only country in the developed world without a system of universal healthcare … Now is the time to realize healthcare as a human right – and California will lead the way with CalCare.”

Stephanie Roberson, government relations director with the California Nurses Association, which is sponsoring both measures, referred to a long history of efforts to achieve single-payer healthcare in California, as she declared, “For decades we’ve had commissions, studies and experts explaining single payer would end this crisis of health insecurity. We don’t need more commissions or studies; we need AB 1400!”

Because it was initially introduced in last year’s legislative session, AB 1400 is now what’s known as a two-year bill. To stay alive, it must pass the Assembly and be sent to the state Senate by the end of this month. The bill passed its first committee test Jan. 11, when the Assembly’s Health Committee approved it on a party-line 11 to 3 vote. It goes next to the Appropriations Committee.

CNA cheered the news. “We are proud of those who took this monumental step,” said CNA President Cathy Kennedy, R.N. “Moving forward on legislation that can finally build health security for millions is a day to remember. It offers hope for California families who have long endured the pain and suffering of a broken healthcare system that shuts out so many in need of care or buries them under thousands of dollars—or more—of medical debt and the nightmare of choosing which other family basics to cut.”

Predictably, organizations representing physicians and health insurers oppose the new single payer legislation, as they have opposed past efforts.

The Associated Press reported earlier this month that Protect California Health Care, a coalition that includes the California Medical Association and California Hospital Association among other providers, is warning that CalCare would remove “any choice for anyone who might want to select private coverage or opt out,” and says the cost would be “unfathomable.” The California Chamber of Commerce charges that CalCare “will increase taxes and disrupt the health care upon which millions of Californians rely at the worst possible time.”

Besides Kalra and Lee, principal coauthors and coauthors of AB 1400—all Democrats—are Assemblymembers Miguel Santiago, Los Angeles; Phil Ting, San Francisco; Isaac Bryan, Baldwin Hills; Wendy Carrillo, Los Angeles; Laura Friedman, Glendale; Kevin McCarty, Sacramento; Adrin Nazarian, Van Nuys; Luz Rivas, Arleta; Mia Bonta, Alameda; Buffy Wicks, Oakland; and state Senators Lena Gonzalez, Long Beach; Mike McGuire, Healdsburg, Scott Weiner, San Francisco; Josh Becker, Peninsula; Dave Cortese, Silicon Valley; John Laird, Santa Cruz; Sydney Kamlager, Los Angeles; and Bob Wieckowski, Fremont.

Bonta, Carrillo, Friedman, Nazarian, Gonzalez, Kamlager, McGuire, Santiago, Wiener, and Cortese are also coauthors of ACA 11.


Marilyn Bechtel
Marilyn Bechtel

Marilyn Bechtel writes from the San Francisco Bay Area. She joined the PW staff in 1986 and currently participates as a volunteer. Marilyn Bechtel escribe desde el Área de la Bahía de San Francisco. Se unió al personal de PW en 1986 y actualmente participa como voluntaria.