The vision of a state-run single-payer health system in California remains elusive as leading advocates struggle to find common ground. While some Democratic leaders and advocacy groups support an incremental approach towards unified financing, others oppose it, causing division within the movement.

A coalition consisting of health, labor, and civil rights advocacy groups stands behind Senate Bill 770, which would create a statewide program that would cover healthcare costs for all residents, whether through a single-payer model or a similar approach. The bill proposes the formation of a workgroup comprising experts and consumers to develop a roadmap and submit a report to the Legislature by June of next year. 

Additionally, SB 770 calls for the Newsom administration to engage the federal government in discussions, as federal approval would be required for such a system to be implemented in California. 

The bill, authored by Senator Scott Wiener of San Francisco, is currently progressing through the Legislature after receiving approval from the Assembly Health Committee and heading to a fiscal committee next.

The California nurses union, a longstanding driving force behind the single-payer movement, opposes Wiener's bill. They argue that it could hinder their own legislation, Assembly Bill 1690, which seeks to establish a single-payer system called CalCare. Although introduced earlier this year, AB 1690 will not be heard until the next legislative session. While the details of CalCare are currently unavailable, the union leaders indicate that Assembly Bill 1400, their previous attempt at single-payer, serves as a starting point. AB 1400 failed to advance last year due to insufficient votes.

Assemblyman Ash Kalra, the author of AB 1690, joined the nurses union in publicly opposing Wiener's bill, viewing it as a distraction from their ongoing efforts. The challenge of implementing single payer in California stems from resistance by the health industry, including insurers and certain physician groups, as well as influential business interests like the Chamber of Commerce. These opponents raise concerns about the required tax increases to fund such a system. However, experts and health advocates argue that the current system is costly and leaves many individuals without adequate coverage.

Carmen Comsti, the lead regulatory policy specialist with the California Nurses Association, highlights the conflicting nature of the two bills. She believes that the Legislature may use Wiener's bill as an excuse to postpone voting on the nurses union-backed bill next year. 

“We do not believe the Legislature would pick up and pass single payer if they just authorized another work group to consider the program,” Comsti said, according to CalMatters. Instead, it opens the door for legislators to say: “It’s too soon to talk about CalCare and single payer because we’re studying it,” she said.

Some Democrats on the Assembly Health Committee view Wiener's bill as a means to initiate progress on single payer while waiting for broader support from their colleagues. Assemblyman Kevin McCarty of Sacramento emphasizes that the nurses' single-payer bill from the previous year lacked sufficient votes. He believes that SB 770 offers an opportunity to achieve more rather than adhering to a purist approach. 

Michael Lighty, president of the coalition supporting Wiener's bill, aims to build on the findings of the Healthy California for All Commission, a group established by Governor Gavin Newsom. However, despite the coalition's involvement, the California Nurses Association disagrees on this specific legislation, highlighting concerns about the language used in the commission's report and Wiener's bill. They argue that any unified financing program should exclude middlemen who profit from the system, contradicting their single-payer vision.

Lighty suggests that the disagreement revolves around semantics and asserts that both sides ultimately seek the same outcome. He proposes exploring alternative avenues after multiple failed attempts to implement single payer, acknowledging the political challenges. According to the Healthy California for All Commission report, implementing a unified finance system by 2031 could slow down the projected increase in healthcare spending by $158 billion in California. Additionally, extending coverage to all residents could potentially save approximately 4,000 lives each year.

Despite the current disagreements, Senator Wiener remains optimistic, emphasizing that proponents of both bills have a history of working together to expand healthcare access. He hopes that the current rift can be healed, as the shared goal is to ensure universal access to healthcare for everyone in California.