By Anna Gorman, California Healthline

Legislation to be introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.

The bill, which is a preliminary step, says that that it would establish a comprehensive, single-payer health care program for the benefit of everyone in the state.

The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.

A single-payer system would replace private insurance with a government plan that pays for coverage for everyone.

Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.

Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.

Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.

“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law.

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Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured.

He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 undocumented immigrant children.

He recently withdrew a request to the federal government, based on a bill he had introduced, that would have allowed adult undocumented immigrants to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.

According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.

In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.

It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”

The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”

The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento this week in support of a single-payer system.

Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.

“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said.

“They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”

Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.

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